Adapting Dialectical Behavior Therapy for Children with Suicidality and/or Self-H

对有自杀倾向和/或自我 H 的儿童采用辩证行为疗法

基本信息

批准号：
7989472
负责人：
Francheska Perepletchikova
金额：
$ 9万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-07-01 至 2012-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7989472
关键词：
11 year old 14 year old Accident and Emergency department Adaptive Behaviors Address Adolescence Adolescent Adult Affect Age Aggressive behavior Algorithms American Behavior Behavior Therapy Behavioral Biometry Bite Caregivers Caring Case Management Categories Cause of Death Child Child Abuse and Neglect Childhood Classification Client Clinical Clinical Psychology Clinical Trials Competence Consultations Coping Skills Death Rate Development Dialectical behavior therapy Doctor of Philosophy Drops Economic Burden Educational Materials Emotional Epidemic Etiology Evaluation Evidence based treatment Family Feeling Feeling suicidal Fostering Future Genetic Goals Health Personnel Home environment Hospitalization Individual Inpatients Intervention Interview Knowledge Life Cycle Stages Manuals Measures Medical Mental Depression Mentors Modeling Moods Neurobiology Patients Pharmaceutical Preparations Phase Pilot Projects Post-Traumatic Stress Disorders Procedures Property Psychometrics Psychopathology Psychotherapy Questionnaires Rage Randomized Clinical Trials Reading Recording of previous events Reporting Research Research Personnel Research Project Grants Research Support Risk Risk Factors Selection Criteria Self-Injurious Behavior Self-control as a personality trait Services Societies Subjects Selections Suicide Suicide attempt Supervision Symptoms System Target Populations Techniques Training Training Activity Trauma Treatment Efficacy Universities Validation Validity and Reliability Videotape Violence Visit Work Youth accomplished suicide aged caregiver education child protective service coping cost cost effective depressive symptoms early onset emotion regulation experience foster care ideation improved maltreated children maltreatment meetings mortality prognostic psychosocial public health relevance research and development satisfaction skills skills training social skills suicidal suicidal adolescent suicidal behavior treatment adherence treatment as usual trial comparing

项目摘要

DESCRIPTION (provided by applicant): Suicide and suicidal behaviors in youth are occurring at an epidemic rate. In the past 20 years death rates for suicide for youth 5 to 14 years of age have doubled. In 2005, suicide was the sixth leading cause of death in the USA for 5- to 14-year-olds and the third leading cause of death for 10- to 14-year-olds. The medical cost of suicide for Americans aged 0 to 20 approaches $1 billion a year. Although completed suicides are less frequent in childhood than in adolescence, the rate of 14.4 suicide attempts for every suicide in 10- to 11-year- olds indicates that suicide attempts are quite frequent in childhood. Further, suicidality is strongly associated with non-suicidal self-harm behaviors (e.g., cutting) as up to 40% of those who engage in self-harm report having suicidal ideations and up to 85% have attempted suicide at least once. Despite the urgent need, there are no empirically supported treatments, including psychosocial and pharmacological interventions, to address suicidality and self-harm behaviors in at risk children. The proposed research project will involve adapting Dialectical Behavior Therapy (DBT) for maltreated children (ages 7 to 12) with suicidality (ideations and attempts) and/or self-harm behaviors. DBT is an empirically supported intervention for adults with suicidality and self-harm behaviors, and is currently the only empirically supported intervention for suicidal adolescents. DBT engages patients in treatment and is cost effective, as clients receiving this treatment require fewer psychiatric hospitalizations and emergency room visits. Candidate: Dr. Perepletchikova received her Ph.D. in Clinical Psychology from Yale University. She has extensive clinical experience working with children and their families, expertise in treatment integrity of psychotherapy research, received intensive training in DBT, and has worked clinically with adults and adolescents using DBT model. Further, her preliminary studies support feasibility, acceptability and initial efficacy of DBT skills training for children. Training goals: 1) work closely with experts in the field of psychotherapy development research; 2) acquire knowledge in childhood maltreatment research and interventions, suicidality and self-harm behaviors, and interfacing with the child protective services system; 3) acquire expertise in conducting randomized clinical trials; 4) take courses in biostatistics and fundamentals of clinical trials; and 5) acquire knowledge on the neurobiological effects of trauma, and genetic and environmental predictors of risk and resiliency, to better understand the etiology of these symptoms in children. Research goals: 1) adapt established adult/adolescent DBT treatment manuals and treatment integrity measures for DBT for children; and 2) conduct a pilot randomized clinical trial comparing DBT for children with Treatment-As-Usual with maltreated children in state custody with suicidality and/or self- harm behaviors. The proposed training activities and research project will allow Dr. Perepletchikova to transition into an independent investigator with a specific focus on addressing the needs of maltreated children, including suicidality and self-harm behaviors. PUBLIC HEALTH RELEVANCE: Although suicidality and self-harm behaviors in children are currently on a rise, and are associated with increase in mortality and significant cost to society, there are no empirically supported interventions to address this problem. This research project will evaluate the efficacy of an intervention geared towards stabilization of children's self-control, reduction in suicidality, self-harm behaviors and other emotional and behavioral difficulties, helping caregivers manage severely affected children in the home environment, and reducing the need for higher level services (e.g., psychiatric hospitalizations) and, thus, associated economic burden. Given the impact of early onset psychopathology on development, the main objective of this intervention is to improve the life course trajectory of these vulnerable children.

描述（由申请人提供）：年轻人的自杀和自杀行为正在以流行病的速度发生。在过去的20年中，5至14岁的青年自杀率翻了一番。 2005年，自杀是美国第六次死亡原因5至14岁，也是10至14岁的第三大死亡原因。每年为0至20岁的美国人的自杀费用10亿美元。尽管在童年时期的自杀率不及青春期的频率少，但每次自杀的率为14.4自杀企图，这表明自杀企业在童年时期很频繁。此外，自杀性与非杀害自我伤害行为（例如，削减）密切相关，因为从事自杀念头的自我伤害报告中，多达40％的人至少尝试过一次自杀。尽管需要迫切需要，但仍未有经验支持的治疗方法，包括社会心理和药理学干预措施，无法应对风险儿童的自杀和自我伤害行为。拟议的研究项目将涉及对虐待儿童（7至12岁）的辩证行为疗法（DBT），具有自杀性（构想和尝试）和/或自我伤害行为。 DBT是对具有自杀性和自我伤害行为的成年人的经验支持的干预，目前是自杀青少年的唯一经验支持的干预措施。 DBT参与患者进行治疗，并且具有成本效益，因为接受此治疗的客户需要更少的精神病住院和急诊就诊。候选人：Perepletchikova博士获得博士学位。耶鲁大学临床心理学博士学位。她拥有与儿童及其家人合作的丰富临床经验，在心理治疗研究的治疗完整性方面的专业知识，接受了DBT的深入培训，并使用DBT模型与成年人和青少年合作。此外，她的初步研究支持DBT技能培训对儿童的可行性，可接受性和最初功效。培训目标：1）与心理治疗发展研究领域的专家紧密合作； 2）获得儿童虐待研究和干预，自杀性和自我伤害行为以及与儿童保护服务系统的接触知识； 3）获得进行随机临床试验的专业知识； 4）参加临床试验的生物统计学和基础知识的课程； 5）获取有关创伤的神经生物学影响以及风险和弹性的遗传和环境预测因素，以更好地了解儿童这些症状的病因。研究目标：1）适应儿童DBT的成人/青少年DBT治疗手册和治疗完整性指标；和2）进行一项试验随机临床试验，比较了与虐待儿童的DBT与受虐待的儿童进行自杀和/或自我伤害行为的虐待儿童。拟议的培训活动和研究项目将使Perepletchikova博士过渡到独立的研究者，特别着眼于满足虐待儿童的需求，包括自杀和自我伤害行为。公共卫生相关性：尽管儿童的自杀和自我伤害行为目前正在上升，并且与死亡率的增加和对社会的巨大成本有关，但没有经验支持的干预措施来解决这一问题。该研究项目将评估针对儿童自我控制稳定，自杀式降低，自我伤害行为以及其他情绪和行为困难的干预措施的功效，帮助护理人员在家庭环境中管理严重影响的儿童，以及减少对更高层次服务的需求（例如，精神病医院住院）以及相关的经济效果。鉴于早期发作心理病理学对发展的影响，这种干预的主要目的是改善这些脆弱儿童的生活轨迹。