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.

项目摘要 尽管大规模，全国范围 行为）在患有严重抑郁症（MDD）的高风险退伍军人中，开发干预措施 目标是与MDD的退伍军人相关的一些与自杀相关的关键危险因素仍然有限。那就是 许多干预研究继续研究诸如认知行为疗法（CBT）等疗法， 目标行为模式，情感处理问题以及与自杀风险相关的认知方式 MDD在神经认知底物中定义了这些CBT靶标的基础。 认知补救（CR）和康复长期以来一直是其他患者的主要治疗方法 精神疾病，例如精神分裂症，用于改善认知功能和支持的认知转移 每天运作的技能。但是，很少工作检查了CR，该CR解决了神经认知的问题 MDD患者的自杀行为的缺陷。经验工作已经确定了关键主管 功能（EF）定义可能针对自杀行为的MDD患者和荟萃分析工作 表明CR对MDD的认知功能，抑郁和日常功能具有中等效应。 那是该领域迫切需要工作，以检查CR作为MDD的一种以恢复为导向的治疗方法 有自杀风险的患者。 拟议的研究旨在收集试点数据以测试辅助性的可行性和可接受性 基于神经可塑性的CR对通过远程医疗传递的关键治疗靶标的CR 36名退伍军人的样本和自杀企图的历史。具体来说，它将测试 基于证据的认知补救（CR）疗法（照常治疗的辅助）增强 通过手动的“桥接”会议，关于认知控制和决策/问题的转移和实践 - 解决现实情况和问题的策略，包括触发自杀思想的策略。我们 提出管理神经心理学教育方法来进行认知补救的建议（接近，称为 CR加上“桥接”会议，CR+桥接），总共有36名退伍军人和自杀历史 尝试。干预措施将在20个90分钟（2倍/周持续10周）中进行。预处理 将对神经认知，临床，社会和现实世界功能进行评估，包括 研究Covid-19的影响及其参与的“社会持续”限制的措施。邮政- 将对相同目标进行治疗评估，以确定对临床反应和可行性 干预结束后立即进行治疗干预（第10周），然后 提高评估（第20周）。该应用程序是新颖的，因为它构成了此应用程序的第一个实施 干预具有MDD和自杀行为的退伍军人。与RR＆D的尖刺机制一致 研究是高风险，但具有很高的潜在影响和承诺，可以帮助改善退伍军人的生活质量 自杀的高风险。