A Novel Cognitive Remediation Intervention Targeting Poor Decision-Making and Depression in Veterans at High Risk for Suicide: A Safe,Telehealth Approach During the COVID-19 Pandemic

针对自杀高风险退伍军人的决策失误和抑郁症的新型认知补救干预措施：COVID-19 大流行期间的安全远程医疗方法

• 批准号: 10366431
• 负责人: ERIN A. HAZLETT
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10366431
• 关键词: Address; Aftercare; Behavior; Behavioral; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; Client satisfaction; Clinical; Cognitive; Cognitive Therapy; Cognitive remediation; Data; Decision Making; Elderly; Emotions; Evaluation; Executive Dysfunction; Feeling suicidal; Gambling; Goals; Impairment; Individual; Intervention; Intervention Studies; Iowa; Language; Major Depressive Disorder; Measures; Mental Depression; Mental disorders; Names; Neurocognitive; Neurocognitive Deficit; Neuronal Plasticity; Neuropsychology; Participant; Patients; Pattern; Performance; Pilot Projects; Problem Solving; Public Health; Quality of life; Questionnaires; Recording of previous events; Recovery; Rehabilitation therapy; Reporting; Risk Factors; Sampling; Schizophrenia; Semantics; Services; Severities; Social Adjustment; Social Distance; Suicide; Suicide attempt; Testing; Therapeutic Intervention; Thinking; Time; Veterans; Work; acceptability and feasibility; base; cognitive control; cognitive function; cognitive rehabilitation; cognitive skill; cognitive testing; daily functioning; depressive symptoms; evidence base; executive function; feasibility testing; follow up assessment; follow-up; high risk; implementation intervention; improved; innovation; military veteran; novel; recruit; response; skills; social; stressor; suicidal behavior; suicidal risk; symptomatology; targeted treatment; telehealth; therapy development; tool; treatment as usual; virtual

PROJECT SUMMARY Despite large-scale, nationwide efforts to better address suicidal behavior (defined as thoughts and behavior) in high-risk Veterans with major depressive disorder (MDD), the development of interventions that target some of the key risk factors associated with suicide in Veterans with MDD remains limited. That is, while much intervention research continues to investigate treatments like cognitive behavioral therapy (CBT) that target behavioral patterns, emotion processing problems, and cognitive styles associated with suicide risk in MDD, deficits in the neurocognitive substrates that underlie these CBT targets remain under-addressed. Cognitive remediation (CR) and rehabilitation have long been a primary treatment for patients with other psychiatric illnesses, like schizophrenia, for improving cognitive functioning and facilitating transfer of cognitive skills to every-day functioning. However, scant work has examined CR that addresses the neurocognitive deficits underlying suicidal behavior in individuals with MDD. Empirical work has identified key executive functioning (EF) deficits that may be specific to MDD patients with suicidal behavior, and meta-analytic work indicates that CR has moderate effect sizes on cognitive functioning, depression, and daily functioning in MDD. Thus, the field is in dire need of work that examines CR as a recovery-oriented treatment approach for MDD patients at risk for suicide. The proposed study aims to collect pilot data to test the feasibility and acceptability of adjunctive neuroplasticity-based CR on key treatment targets delivered via telehealth during this time of COVID-19 in a sample of 36 Veterans with MDD and a history of suicide attempt(s). Specifically, it will test the effects of an adjunctive evidence-based cognitive remediation (CR) therapy (adjunctive to treatment as usual) augmented with manualized “Bridging” sessions on transfer and practice of cognitive control and decision-making/problem- solving strategies for real-world situations and problems, including those that trigger suicidal thoughts. We propose to administer the Neuropsychological Educational Approach to Cognitive Remediation (NEAR, termed CR plus “Bridging” session, CR+Bridging) to a total of 36 Veterans with MDD and a history of suicide attempt(s). The intervention will be delivered in 20 90-minute sessions (2x/week for 10 weeks). Pre-treatment assessments of neurocognitive, clinical, social, and real-world functioning will be conducted, including measures that examine the impact of COVID-19 and its accompanying “social-distancing” restrictions. Post- treatment assessments of the same targets will be conducted to determine clinical response to and feasibility of this therapeutic intervention immediately following conclusion of the intervention (Week 10) and at a follow- up assessment (Week 20). This application is novel in that it constitutes the first implementation of this intervention in Veterans with MDD and suicidal behavior. Consistent with RR&D’s SPiRE mechanism, this study is high risk, but it has high potential impact and promise to help improve quality of life for Veterans at high risk for suicide.

项目概要 尽管在全国范围内做出了大规模的努力来更好地解决自杀行为（定义为思想和行为） 患有重度抑郁症（MDD）的高风险退伍军人的行为），制定干预措施 针对患有抑郁症的退伍军人自杀的一些关键风险因素仍然有限。 许多干预研究仍在继续研究诸如认知行为疗法（CBT）之类的治疗方法， 针对与自杀风险相关的行为模式、情绪处理问题和认知方式 MDD，这些 CBT 目标背后的神经认知基质缺陷仍未得到解决。 认知矫正（CR）和康复长期以来一直是其他疾病患者的主要治疗方法 精神疾病，如精神分裂症，用于改善认知功能和促进认知转移 然而，很少有工作研究解决神经认知问题的 CR。 实证工作已经确定了重度抑郁症患者自杀行为背后的缺陷。 具有自杀行为的MDD患者可能特有的功能（EF）缺陷，以及荟萃分析工作 表明 CR 对 MDD 的认知功能、抑郁和日常功能具有中等影响。 因此，该领域迫切需要研究 CR 作为 MDD 以恢复为导向的治疗方法 有自杀风险的患者。 本研究旨在收集试点数据来测试辅助治疗的可行性和可接受性 在 COVID-19 疫情期间，通过远程医疗对关键治疗目标进行基于神经可塑性的 CR 具体来说，它将测试 36 名患有 MDD 且有自杀未遂史的退伍军人的样本。 辅助循证认知矫正（CR）疗法（作为常规治疗的辅助疗法） 通过关于认知控制和决策/问题的转移和实践的手动“桥接”课程 解决现实世界情况和问题的策略，包括那些引发自杀念头的问题。 提议实施认知矫正的神经心理学教育方法（NEAR，称为 CR 加“桥接”课程（CR+Bridging），共 36 名患有 MDD 且有自杀史的退伍军人 干预将在 20 次 90 分钟的疗程中进行（治疗前每周 2 次，持续 10 周）。 将进行神经认知、临床、社会和现实世界功能的评估，包括 检查 COVID-19 及其伴随的“社交距离”限制影响的措施。 将进行相同目标的治疗评估，以确定临床反应和可行性 干预结束后（第 10 周）立即进行该治疗干预，并在随后进行 评估（第 20 周） 该应用程序的新颖之处在于它是该应用程序的首次实现。 对患有 MDD 和自杀行为的退伍军人的干预与 RR&D 的 SPiRE 机制一致。 研究风险很高，但具有很高的潜在影响，并有望帮助改善退伍军人的生活质量 自杀的风险很高。