JMIR Publications

ABSTRACT

Background:

Inhibitory deficits are common in psychopathology. Emotion-related impulsivity (ERI) and rumination are general risk factors for psychiatric distress that are similarly associated with dysfunctional inhibition – particularly in affective contexts. A number of cognitive remediation procedures have been developed to improve inhibitory control; however, most programs focus on “cold” cognition independent of affective processing. This pilot trial will gather preliminary evidence for a new cognitive training intervention targeting “hot” affective control (i.e., inhibitory functions during elevated emotional arousal) in a transdiagnostic sample of adults who report heightened emotion dysregulation.

Objective:

This manuscript describes a protocol for a pilot randomized waitlist-controlled trial to assess changes in ERI and rumination after Neurobehavioral Affective Control Training (N-ACT), an eight-week cognitive training intervention designed to improve emotional response inhibition and emotional working memory. Our primary aim is to evaluate the efficacy, feasibility, and acceptability of N-ACT in reducing rumination and emotion-related impulsivity, which we respectively conceptualize as complementary cognitive and behavioral consequences of emotion dysregulation. Secondarily, we will examine whether N-ACT produces accompanying inhibitory control improvement and more distally, psychopathology symptom reduction.

Methods:

The final sample will comprise 80 adults who report high levels of ERI and/or rumination. Participants will be randomized to (1) begin the N-ACT program without delay or (2) join a waitlist condition and then complete N-ACT. Exclusion criteria (confirmed via clinical interview) include active alcohol/substance use disorders, psychosis, and suicide risk. At baseline and post-intervention, participants will complete online measures of emotion dysregulation and psychiatric symptoms, as well as in-person neuropsychological assessment of inhibitory control. Individuals assigned to the control group will undergo an identical assessment before joining the waitlist, followed by parallel assessments before and after N-ACT.

Results:

This trial is funded by support from the University of California Board of Regents and the Peder Sather foundation (10/22–9/25). Recruitment is scheduled to begin in fall 2024. We will begin data analysis once data collection is complete, which is planned to occur in fall 2025.

Conclusions:

This randomized waitlist-controlled pilot trial aims to determine the initial efficacy, feasibility, and acceptability of N-ACT, a novel cognitive remediation approach developed to address two key contributors to psychopathology: ERI and rumination. The N-ACT program specifically uses computerized adaptive behavioral tasks to strengthen affective inhibitory control processes theoretically and empirically linked to these characteristics. We hope this work will help inform future studies with sufficient statistical power to ascertain whether enhancing affective control through cognitive training (N-ACT) produces downstream reductions in psychiatric symptoms via diminished emotion dysregulation. Clinical Trial: ClinicalTrials.gov Identifier: NCT06226467. Registered via Open Science Framework (OSF) on 11/02/2023: https://osf.io/wpsxf.