Psychobehavioral intervention with focus either on teaching emotional regulation skills or regularizing daily sleep and activity levels.

Participants will take part in 12 therapy sessions, at a rate of about 1 session every one to two weeks. Sessions are anticipated to last about 1 hour each. Sessions may be focused on teaching skills to regulate emotions or regularize sleep and activity. These therapy sessions may be videotaped and audiotaped (only with the expressed written consent of the participant, and when appropriate, the participant's parent or guardian). Participants will be asked to complete worksheets and practice the skills learned from these sessions and will be asked questions about feelings. There will be an interview, assessments and scanning performed prior to treatment and at the midpoint and end to assess progress. The intervening 9 sessions may be by video telecommunication. Participants may be given devices to track actigraphy and ecological momentary assessments.

FMRI was performed during an emotional face processing task. Signal differences (BOLD changes) were compared between baseline and endpoint, separately for BE-SMART-DR or BE-SMART-ER, at a voxel-level threshold of p<0.001 uncorrected using statistical parametric mapping (SPM) software. If voxels above this threshold survived in a hypothesized region of interest (amygdala and ventral prefrontal cortex, VPFC) then the signal differences in those voxels were extracted and mean values within the region for each subject were used in the analyses below. The only voxel-based finding meeting criteria was left amygdala activation decreases to fearful faces in participants receiving BE-SMART-DR. The results of the mixed model analysis of those values are below.

Signal differences (BOLD changes) between baseline and midpoint in regions of interest that survived the voxel-based threshold in participants who received either BE-SMART variation and had fMRI data of sufficient quality for fMRI activation analyses. The results of the mixed model analyses of those values are below.

Pearson's correlations between the mean timecourse of the seed and the timecourse of each voxel between baseline and endpoint were compared at a voxel-level threshold of p<0.001 uncorrected using statistical parametric mapping (SPM) software. If there were voxels above this threshold in the hypothesized region of interest (ventral prefrontal cortex), then the correlation values from those voxels in that region were extracted and Fisher transformed and averaged, where higher scores indicted greater connectivity. Functional connectivity differences between baseline and endpoint in regions of interest that survived the voxel-based threshold in participants who received either BE-SMART variation and had fMRI data of sufficient quality for fMRI functional connectivity analyses. The results of the mixed model analysis of those values are below.

Adolescents and young adults with BD who received baseline scan and Brain Emotion Circuitry Targeted Self- Monitoring Regulation Therapy Emotion Regulation (BE-SMART ER)

FMRI was performed during an emotional face processing task. Signal differences (BOLD changes) were compared between baseline and endpoint, separately for BE-SMART-DR or BE-SMART-ER, at a voxel-level threshold of p<0.001 uncorrected using statistical parametric mapping (SPM) software. If voxels above this threshold survived in a hypothesized region of interest (amygdala and ventral prefrontal cortex, VPFC) then the signal differences in those voxels were extracted and mean values within the region for each subject were used in the analyses below. The only voxel-based finding meeting criteria was left amygdala activation decreases to fearful faces in participants receiving BE-SMART-DR. The results of the mixed model analysis of those values are below.

Adolescents and young adults with bipolar disorder (BD) who received intervention and had both baseline and endpoint fMRI data of sufficient quality were analyzed. Voxel-level threshold for BE-SMART-ER did not reach p<0.001 uncorrected threshold and therefore there were no extracted values for further analyses.

The group received Brain Emotion Circuitry-Targeted Self-Monitoring and Regulation Therapy (BE-SMART), an intervention designed to provide improvements to the functioning of emotion brain circuitry with variations that focus on either providing skills to improve explicit emotion regulation (BE- SMART-ER) or to regularize sleep and other daily rhythms (BE-SMART-DR).

Participants took part in BE-SMART, designed to be comprised of 12 therapy sessions, at a rate of about 1 session every one to two weeks. Participants were asked to complete worksheets and practice the skills learned from the sessions and asked questions about their symptoms and behaviors. There were interview assessments and scanning performed prior to providing the intervention and at the midpoint and endpoint. The intervening 9 sessions were performed by video telecommunication. Each subject received one of two BE-SMART variations both designed to target the functioning of emotion regulation brain circuitry: one with main focus on providing skills to improve explicit emotion regulation (BE- SMART-ER) and one with main focus to regularize sleep and other daily rhythms (BE-SMART-DR).