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Nineteen BE-SMART-DR and 16 BE-SMART-ER participants completed the intervention, with 11 and 13, respectively, having pre-intervention and post-intervention functional MRI data.\n <\/jats:p>\n <\/jats:sec>\n \n Findings<\/jats:title>\n \n In addition to demonstrating feasibility, only BE-SMART-DR showed pre-treatment to post-treatment improvements in DR regularity (Cohen\u2019s\n d<\/jats:italic>\n =0.55; 95%\u2009CI [0.06, 1.03]), associated with reductions in left amygdala responses to emotional face stimuli (\n p<\/jats:italic>\n FWE (family-wise error)-SVC (small volume correction)<\/jats:sub>\n <0.05), difficulties in emotion regulation (\n d<\/jats:italic>\n =0.75; 95%\u2009CI [0.23, 1.25]) and suicide risk (\n d<\/jats:italic>\n =0.65; 95%\u2009CI [0.15, 1.14]). Significant correlations were observed among these changes (\n p<\/jats:italic>\n <0.05). Both interventions showed high acceptability and improvements in depression and mania symptoms. No intervention-related adverse events were observed.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Regularising DRs may enhance emotion regulation brain circuitry functioning, emotion regulation, and reduce suicide risk in BD\n AYA<\/jats:sub>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Clinical implications<\/jats:title>\n \n Chronotherapeutic interventions regularising DRs, such as SRT, should be studied further as potential treatment strategies for BD\n AYA<\/jats:sub>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT03183388<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjment-2024-301338","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T20:05:55Z","timestamp":1739995555000},"page":"e301338","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Chronotherapeutic intervention targeting emotion regulation brain circuitry, symptoms, and suicide risk in adolescents and young adults with bipolar disorder: a pilot randomised trial"],"prefix":"10.1136","volume":"28","clinical-trial-number":[{"clinical-trial-number":"nct03183388","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03183388","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2573-4866","authenticated-orcid":false,"given":"Jihoon A","family":"Kim","sequence":"first","affiliation":[{"name":"Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA"},{"name":"Psychiatry, Columbia University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjali","family":"Sankar","sequence":"additional","affiliation":[{"name":"Neurobiology Research Unit, Copenhagen University Hospital, Kobenhavn, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Marks","sequence":"additional","affiliation":[{"name":"Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Carrubba","sequence":"additional","affiliation":[{"name":"Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernadette","family":"Lecza","sequence":"additional","affiliation":[{"name":"Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Quatrano","sequence":"additional","affiliation":[{"name":"Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Spencer","sequence":"additional","affiliation":[{"name":"Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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