Document Type : Original Article
Authors
- Farzaneh Habashi Varnosfaderani 1
- Parisa Rahimi Niyar 2
- Azam Nasirpour 3
- Farzin Bagheri Sheykhangafshe 4
- Hojjatollah Farahani 4
1 Department of General Psychology, Payame Noor University, Nowshahr Branch, Nowshahr, Iran
2 Department of Health Psychology, Faculty of Medical Sciences, Islamic Azad University, Gorgan Branch, Golestan, Iran
3 Department of Clinical Psychology, Islamic Azad University, Ardabil Branch, Ardabil, Iran
4 Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
Abstract
Introduction: Disruptive mood dysregulation disorder (DMDD) is one of the common psychiatric disorders in children, significantly impacting their behavior, anxiety levels, and social interactions. This study aimed to examine the effectiveness of group dialectical behavior therapy (DBT) in reducing anxiety and aggression and enhancing social competence in children diagnosed with DMDD.
Methods: The present research employed a quasi-experimental pretest-posttest design with a control group. The statistical population consisted of male children diagnosed with DMDD in the year 2024. A total of 36 boys were randomly assigned to either an experimental group (n=18) or a control group (n=18). Data collection instruments included the disruptive mood dysregulation disorder scale (DMDDS), the children’s anxiety scale (CAS), the Buss-Perry aggression questionnaire (BPAQ), and the social competence questionnaire (SCQ). The experimental group received eight 90-minute sessions of group DBT, while the control group received no intervention. Data were analyzed using multivariate analysis of covariance (MANCOVA) via SPSS software (version 27).
Results: The findings indicated that group DBT significantly reduced anxiety symptoms—including separation anxiety, social phobia, generalized anxiety, agoraphobia, obsessive-compulsive symptoms, and fear of physical injury—as well as aggression—physical aggression, verbal aggression, hostility, and anger—while significantly improving social competence among children with DMDD (P<0.01).
Conclusion: The results demonstrated that group DBT was an evidence-based, effective intervention for reducing anxiety and aggression and for enhancing social competence in children with DMDD. It is recommended that this approach be incorporated into specialized therapeutic programs, and further research is suggested to explore its broader applications.
Keywords
- Wiggins JL, Briggs-Gowan MJ, Brotman MA, Leibenluft E, Wakschlag LS. Toward a developmental nosology for disruptive mood dysregulation disorder in early childhood. J Am Acad Child Adolesc Psychiatry. 2021;60(3):388-97.
- Lin YJ, Tseng WL, Gau SS. Psychiatric comorbidity and social adjustment difficulties in children with disruptive mood dysregulation disorder: a national epidemiological study. J Affect Disord. 2021;281:485-92.
- Uran P, Kilic BG. Family functioning, comorbidities, and behavioral profiles of children with ADHD and disruptive mood dysregulation disorder. J Atten Disord. 2020;24(9):1285-94.
- Benarous X, Lahaye H, Consoli A, Cohen D, Labelle R, Guile JM. Prevalence and comorbidity rates of disruptive mood dysregulation disorder in epidemiological and clinical samples: systematic review and meta-analysis. Eur Psychiatry. 2025;68(1):e11.
- Tugen LE, Goksu M, Burcu Ayaz A. Disruptive mood dysregulation disorder in a primary school sample. Asian J Psychiatr. 2020;48:101858.
- Freeman AJ, Youngstrom EA, Youngstrom JK, Findling RL. Disruptive mood dysregulation disorder in a community mental health clinic: prevalence, comorbidity and correlates. J Child Adolesc Psychopharmacol. 2016;26(2):123-30.
- Bruno A, Celebre L, Torre G, Pandolfo G, Mento C, Cedro C, et al. Focus on disruptive mood dysregulation disorder: a review of the literature. Psychiatry Res. 2019;279:323-30.
- Linke J, Kircanski K, Brooks J, Perhamus G, Gold AL, Brotman MA. Exposure-based cognitive-behavioral therapy for disruptive mood dysregulation disorder: an evidence-based case study. Behav Ther. 2020;51(2):320-33.
- Benarous X, Renaud J, Breton JJ, Cohen D, Labelle R, Guile JM. Are youths with disruptive mood dysregulation disorder different from youths with major depressive disorder or persistent depressive disorder? J Affect Disord. 2020;265:207-15.
- Apicella M, Pisa MC, Averna R, Labonia M, Pontillo M, Vicari S. Neurocognitive and adaptive phenotypes in adolescent inpatients with mood disorders: an exploratory study on disruptive mood dysregulation disorder in the framework of depressive disorders. Front Psychiatry. 2023;14:1253589.
- Bhatara VS, Bernstein B, Fazili S. Complementary and integrative treatments of aggressiveness/emotion dysregulation associated with disruptive disorders and disruptive mood dysregulation disorder. Child Adolesc Psychiatr Clin N Am. 2023;32(2):297-315.
- Hendrickson B, Girma M, Miller L. Review of the clinical approach to the treatment of disruptive mood dysregulation disorder. Int Rev Psychiatry. 2020;32(3):202-11.
- Braenden A, Coldevin M, Zeiner P, Stubberud J, Melinder A. Executive function in children with disruptive mood dysregulation disorder compared to attention-deficit/hyperactivity disorder and oppositional defiant disorder, and in children with different irritability levels. Eur Child Adolesc Psychiatry. 2024;33(1):115-25.
- Laporte PP, Matijasevich A, Munhoz TN, Santos IS, Barros AJD, Pine DS, et al. Disruptive mood dysregulation disorder: symptomatic and syndromic thresholds and diagnostic operationalization. J Am Acad Child Adolesc Psychiatry. 2021;60(2):286-95.
- Hosie J, Dunne AL, Meyer D, Daffern M. Aggressive script rehearsal in adult offenders: relationships with emotion regulation difficulties and aggressive behavior. Aggress Behav. 2022;48(1):5-16.
- Braenden A, Coldevin M, Zeiner P, Oyen AS, Melinder A, Stubberud J. Neuropsychological mechanisms of social difficulties in disruptive mood dysregulation disorder versus oppositional defiant disorder. Child Neuropsychol. 2024;30(3):402-24.
- Westby CE. Disruptive behavior disorders and social communication disorder. In: Social communication development and disorders. London: Routledge; 2022. p. 304-43.
- Benarous X, Iancu C, Guile JM, Consoli A, Cohen D. Missing the forest for the trees? A high rate of motor and language impairments in disruptive mood dysregulation disorder in a chart review of inpatient adolescents. Eur Child Adolesc Psychiatry. 2021;30(10):1579-90.
- Coldevin M, Braenden A, Zeiner P, Oyen AS, Melinder A, Stubberud J. Disruptive mood dysregulation disorder in a Norwegian clinical child population. Clin Child Psychol Psychiatry. 2024;29(2):393-406.
- Meyers E, DeSerisy M, Roy AK. Disruptive mood dysregulation disorder (DMDD): an RDoC perspective. J Affect Disord. 2017;216:117-22.
- Perepletchikova F, Nathanson D, Axelrod SR, Merrill C, Walker A, Grossman M, et al. Randomized clinical trial of dialectical behavior therapy for preadolescent children with disruptive mood dysregulation disorder: feasibility and outcomes. J Am Acad Child Adolesc Psychiatry. 2017;56(10):832-40.
- Zhang Y, Zhang W, Yu E. Systematic review and meta-analysis: pharmacological and nonpharmacological interventions for disruptive mood dysregulation disorder. J Child Adolesc Psychopharmacol. 2024;34(5):217-25.
- Martin CG, Roos LE, Zalewski M, Cummins N. A dialectical behavior therapy skills group case study on mothers with severe emotion dysregulation. Cogn Behav Pract. 2017;24(4):405-15.
- Waxmonsky JG, Baweja R, Bansal PS, Waschbusch DA. A review of the evidence base for psychosocial interventions for the treatment of emotion dysregulation in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2021;30(3):573-94.
- Huang C, editor. Review of treatment of disruptive mood dysregulation disorder. In: 4th International Conference on Humanities Education and Social Sciences (ICHESS 2021). Paris: Atlantis Press; 2021. p. 40-7.
- Khan YS, Mathew S, Jasem AlMeraisi M, Alabdulla M. Group dialectical behaviour therapy for adolescents with emotional dysregulation and maladaptive coping: pilot implementation in Qatar. BJPsych Int. 2024;21(4):83-7.
- Pardo ES, Rivas AF, Barnier PO, Mirabent MB, Lizeaga IK, Cosgaya AD, et al. A qualitative research of adolescents with behavioral problems about their experience in a dialectical behavior therapy skills training group. BMC Psychiatry. 2020;20(1):245.
- Nasri B, Castenfors M, Fredlund P, Ginsberg Y, Lindefors N, Kaldo V. Group treatment for adults with ADHD based on a novel combination of cognitive and dialectical behavior interventions: a feasibility study. J Atten Disord. 2020;24(6):904-17.
- Shahmohammadi GA, Abedi A, Khayatan F, Aghaei A. Construction and validation of the Disruptive Mood Dysregulation Disorder Scale (DMDDS)—Parent Form. J Child Ment Health. 2021;19(2):263-75. Persian.
- Bagheri Sheykhangafshe F, Savabi Niri V, Baryaji S, Saeedi Z, Kiani A, Fathi-Ashtiani A. The effectiveness of acceptance and commitment therapy on sexual function, coping strategies and distress tolerance of employees with rheumatoid arthritis. Sadra Med J. 2023;11(4):360-73. Persian.
- Spence SH. Structure of anxiety symptoms among children: a confirmatory factor-analytic study. J Abnorm Psychol. 1997;106(2):280-97.
- Buss AH, Perry M. The aggression questionnaire. J Pers Soc Psychol. 1992;63(3):452-9.
- Felner R, Lease A, Phillips R. Social competence and the language of adequacy as a subject matter for psychology: a quadripartite tri-level framework. In: The development of social competence in adolescence. Beverly Hills: Sage Publications; 1990. p. 254-64.
- Linehan MM. Skills training manual for treating borderline personality disorder. New York: Guilford Press; 1993.
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