2/2-Treatment of Suicidal and Self-Injurious Adolescents with Emotional Dysregula

2/2-情绪失调的自杀和自残青少年的治疗

基本信息

批准号：
8435464
负责人：
Joan Rosenbaum Asarnow
金额：
$ 62.89万
依托单位：
LUNDQUIST INSTITUTE FOR BIOMEDICAL INNOVATION AT HARBOR-UCLA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-04-01 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8435464
关键词：
17 year old Address Adolescent Adult Adverse event Area Behavioral Borderline Personality Disorder California Cause of Death Characteristics Clinical Clinical Trials Collaborations Conflict (Psychology)Coping Skills Data Dialectical behavior therapy Dropout Effectiveness Emotional Emotions Event Family Family Relationship Foundations Frequencies Health Insurance Portability and Accountability Act Hospitalization Hour Incidence Individual Informed Consent Inpatients Intervention Leadership Legal Life Los Angeles Maintenance Mediating Mediator of activation protein Medical Medication Management Monitor Online Systems Outcome Outpatients Parents Participant Personality Traits Privacy Quality of life Research Resources Risk Risk Factors Safety Schools Self-Injurious Behavior Severities Site Stressful Event Suicide Suicide attempt Supervision Supportive care Teenagers Telephone Testing Theoretical model Time Training Universities Visit Washington Work alternative treatment base clinical care cost cost effective cost effectiveness effective therapy emotion regulation follow-up functional outcomes high risk improved improved functioning meetings non-suicidal self injury peer programs psychosocial public health relevance quality assurance randomized trial reducing suicide skills suicidal suicidal adolescent suicidal behavior suicidal risk symposium teacher trait

项目摘要

DESCRIPTION (provided by applicant): The long term aim of our research is to develop and evaluate effective treatments for adolescents at high risk for suicide that will reduce suicidal and self-injurious behaviors as well as improve functioning and the quality of life of teens and their families. The primary aim of the research proposed here is to evaluate the efficacy of dialectical behavior therapy (DBT) for adolescents by comparing it to a combined individual and group supportive therapy control condition (I/GST) chosen specifically to maximize internal validity. Subjects will be 170 teens 13-17 years old with borderline personality traits referred to treatment due to high risk for suicide. Outcome targets include reduced frequency and severity of suicidal behaviors, especially suicide attempts, inpatient or ER treatment for suicidality, increased maintenance in and compliance with treatment, and enhanced functioning across multiple domains. DBT has an empirical track record with adults of reducing the incidence, frequency and medical risk of suicide attempts and non-suicidal self-injuries among individuals meeting criteria for borderline personality disorder (BPD). However, although DBT is widely used with suicidal adolescents, particularly those with difficulties characteristic of BPD such as poor emotion regulation and impulse control, no randomized trial of DBT with adolescents has been conducted. Thus, although non- randomized trials suggest effectiveness, without a randomized trial we simply do not know whether DBT for adolescents is efficacious or not. Given the severity of the problem and the lack of alternative treatments for high risk adolescents, addressing this question is important. The second aim of this research is to analyze mediators of reduced suicidal and self-injurious behaviors in adolescents. DBT is based on a theoretical model that suicidal behavior is a combined outcome of high stressful events and emotion dysregulation together with inadequate behavioral skills for coping with negative emotions and life events. Risk factors for adolescent suicide and intentional self-injury include most importantly family conflict but also conflict with peers, teachers, losses, legal or disciplinary problems (stressful events) combined with high negative emotions and inadequate abilities in emotion regulation. We will analyze the potential mediating effects on suicidal behaviors of decreases in family conflict, increases in parent DBT behavioral skills, reductions in emotion dysregulation and increases in DBT behavioral skills. Preliminary data on cost-effectiveness will also be collected.

描述（由申请人提供）：我们研究的长期目标是开发和评估针对自杀高风险青少年的有效治疗方法，以减少自杀和自残行为，并改善青少年和青少年的功能和生活质量。他们的家人。本文提出的研究的主要目的是通过将辩证行为疗法 (DBT) 与专门为最大化内部有效性而选择的个人和团体支持治疗控制条件 (I/GST) 相结合来进行比较，以评估辩证行为疗法 (DBT) 对青少年的疗效。受试者将是 170 名 13-17 岁的青少年，他们具有边缘人格特征，由于自杀风险高而需要接受治疗。结果目标包括减少自杀行为的频率和严重程度，特别是自杀企图、针对自杀的住院或急诊治疗、增加治疗的维持和依从性，以及增强多个领域的功能。 DBT 在成年人中拥有丰富的经验记录，可降低符合边缘型人格障碍 (BPD) 标准的个体自杀未遂和非自杀性自残的发生率、频率和医疗风险。然而，尽管 DBT 广泛用于有自杀倾向的青少年，特别是那些有 BPD 特征的困难（例如情绪调节和冲动控制不良）的青少年，但尚未对青少年进行 DBT 的随机试验。因此，尽管非随机试验表明有效，但如果没有随机试验，我们根本不知道 DBT 对青少年是否有效。鉴于该问题的严重性以及高危青少年缺乏替代治疗方法，解决这个问题非常重要。这项研究的第二个目的是分析青少年自杀和自残行为减少的中介因素。 DBT 基于这样一个理论模型：自杀行为是高压力事件和情绪失调以及应对负面情绪和生活事件的行为技能不足的综合结果。青少年自杀和故意自伤的危险因素最重要的是家庭冲突，还包括与同龄人、老师的冲突、损失、法律或纪律问题（压力事件）以及高度负面情绪和情绪调节能力不足。我们将分析家庭冲突减少、父母 DBT 行为技能增加、情绪失调减少和 DBT 行为技能增加对自杀行为的潜在中介作用。还将收集有关成本效益的初步数据。