Therapeutic evaluative conditioning to reduce adolescents' self-injurious thoughts and behaviors during and after psychiatric inpatient hospitalization.

治疗性评估性调节，以减少青少年在精神科住院期间和住院后的自残想法和行为。

• 批准号: 10353109
• 负责人: Alexander Millner
• 金额: $ 16.5万
• 依托单位: FRANCISCAN HOSPITAL FOR CHILDREN, INC.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-09 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10353109
• 关键词: 3-Dimensional; Address; Adherence; Adolescent; Adult; Attitude; Aversive Stimulus; Behavior; Belief; Cause of Death; Cellular Phone; Child; Clinical; Cognition; Effectiveness; Ensure; Feedback; Feeling suicidal; First Name; Forms Controls; Future; Goals; Hospitalization; Hospitals; Image; Inpatients; Intervention; Massachusetts; Mental Health Services; Methods; Outcome; Outpatients; Patient Monitoring; Patients; Persons; Pilot Projects; Placebos; Procedures; Protocols documentation; Public Health; Randomized; Randomized Controlled Trials; Research; Resources; Risk; Self-Injurious Behavior; Skin; Snakes; Stimulus; Suicide; Suicide attempt; Testing; Therapeutic; Therapeutic Intervention; Thinking; Time; Treatment Efficacy; acceptability and feasibility; adolescent suicide; classical conditioning; conditioning; efficacy testing; experience; high risk; mobile application; non-suicidal self injury; novel strategies; operation; paired stimuli; post intervention; prevent; programs; public health relevance; reducing suicide; rural area; suicidal; suicidal adolescent; suicidal behavior; suicidal morbidity; suicidal risk; suicide rate; therapeutic evaluation; treatment response

Project Summary/Abstract Suicide is the 2nd leading cause of death for adolescents in the U.S. and non-lethal self- injurious thoughts and behaviors (SITB; e.g., suicide thoughts and attempts and non-suicidal self-injury (NSSI)) are each associated with the risk of future suicide. Many adolescents at high risk of suicide require psychiatric inpatient hospitalization. Unfortunately, these adolescents often continue to think about suicide and engage in NSSI while they are hospitalized. Most alarmingly, the month following hospitalization is the highest risk time for suicide, with the suicide rate 10 times higher than the general adolescent rate. Research suggests that people who engage in SITB show reduced implicit aversion toward SITB-related stimuli. This reduced aversion may facilitate SITB because it means this natural barrier preventing people from harming themselves is lower. People who engage in SITB also show increased implicit self- aversion, which may also facilitate SITB by supporting beliefs that one deserves to be punished. An intervention that reverses these potential facilitators of SITB may help prevent such thoughts and behaviors. The goal of the current project is to test one such intervention: Therapeutic Evaluative Conditioning (TEC), which aims to reduce SITB by increasing implicit aversion toward SITB and reducing implicit aversion toward oneself. TEC uses evaluative condition, a form of Pavlovian conditioning, in which, for example, SITB-related stimuli are paired with naturally aversive stimuli (e.g., snakes) to increase implicit aversion towards SITB. In studies among adults, TEC was associated with a 21-77% reduction in SITB over a month. The current project aims to test whether TEC can reduce SITB among self-injurious adolescents (1) during psychiatric inpatient hospitalization and (2) in the highest-risk period for suicide; the month after hospital discharge. First, a pilot study will test whether TEC is feasible and acceptable as an intervention for adolescents, both during and after inpatient hospitalization. Second, a randomized controlled trial will compare an active form of TEC with an inactive, control form of TEC. TEC has the potential to make broad impact reducing suicide because it is scalable, brief (> 5 min to complete), low-burden, and easy to administer via mobile app on a smartphone. Furthermore, in the post-discharge period, TEC can provide continuous therapeutic coverage, filling the gap between discharge and patients’ first outpatient therapy session. It can also be used to extend coverage in places where there are fewer resources for mental health care (e.g., rural areas). This proposal addresses the urgent need to reduce adolescent suicide, one of the most devastating and widespread public health problems in the U.S. and around the world.

项目概要/摘要 自杀是美国青少年的第二大死因，非致命性的自我 伤害性想法和行为（SITB；例如，自杀想法和尝试以及非自杀性想法和行为） 自残（NSSI））都与许多青少年未来自杀的风险有关。 不幸的是，这些青少年有自杀的风险需要住院治疗。 住院期间经常继续考虑自杀并参与 NSSI。 令人担忧的是，住院后的一个月是自杀风险最高的时​​间， 研究表明，人们的自杀率比一般青少年高出10倍。 参与 SITB 的人对 SITB 相关刺激的内隐厌恶程度有所降低。 厌恶可能会促进 SITB，因为这意味着这种自然屏障阻止人们 参与 SITB 的人也表现出更多的内隐自我伤害。 厌恶，这也可能通过支持人们应该受到惩罚的信念来促进 SITB。 逆转 SITB 这些潜在促进因素的干预措施可能有助于防止此类想法 当前项目的目标是测试这样一种干预措施：治疗。 评价性条件反射 (TEC)，旨在通过增加隐性厌恶来减少 SITB TEC 使用评价条件，即 SITB 并减少对自己的内隐厌恶。 巴甫洛夫条件反射的形式，其中，例如，SITB 相关刺激与 在研究中，自然厌恶的刺激（例如蛇）会增加对 SITB 的内隐厌恶。 在成年人中，TEC 与一个月内 SITB 减少 21-77% 相关。 该项目旨在测试 TEC 是否可以减少自残青少年 (1) 期间的 SITB 精神科住院治疗以及 (2) 在自杀风险最高的时​​期之后的一个月； 首先，一项试点研究将测试 TEC 作为一种方法是否可行且可接受。 其次，在住院期间和住院之后对青少年进行干预。 随机对照试验将比较 TEC 的活性形式与 TEC 的非活性对照形式 TEC 具有对减少自杀产生广泛影响的潜力，因为它具有可扩展性、简短性。 （> 5 分钟即可完成）、低负担且易于通过智能手机上的移动应用程序进行管理。 此外，在出院后期间，TEC可以提供持续的治疗覆盖， 也可以填补患者出院和第一次门诊治疗之间的空白。 用于扩大精神卫生保健资源较少地区的覆盖范围（例如， 该提案解决了减少青少年自杀的迫切需要，这是减少青少年自杀的一个因素。 美国和世界各地最具破坏性和最广泛的公共卫生问题。