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。

基本信息

批准号：
10703354
负责人：
Kelly Zuromski
金额：
$ 26.16万
依托单位：
FRANCISCAN HOSPITAL FOR CHILDREN, INC.
依托单位国家：
美国
项目类别：
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

项目摘要

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.

项目摘要/摘要自杀是美国青少年的第二大死亡原因和非致命的自我自杀原因有害的思想和行为（Sitb;例如自杀思想和企图以及非杀害自我伤害（NSSI））各自与未来自杀的风险有关。许多青少年高自杀的风险需要精神病患者住院治疗。不幸的是，这些青少年经常继续考虑自杀并在住院期间从事NSSI。最多令人震惊的是，住院后的一个月是自杀的最高风险时间，自杀率比一般青少年率高10倍。研究表明人们参与SITB的人表现出对情绪相关刺激的隐式厌恶降低。这减少了厌恶可能会促进静电局，因为这意味着这种自然的障碍阻止人们伤害自己是较低的。参与SITB的人也表现出更多的隐含自我厌恶，这也可能通过支持人们应受到惩罚的信念来促进静坐。逆转这些潜在的SITB的干预措施可能有助于防止这种想法和行为。当前项目的目的是测试一种这样的干预措施：治疗评估条件（TEC），旨在通过增加隐式厌恶来减少SITB 仰卧并减少对自己的隐性厌恶。 TEC使用评估条件，帕夫洛维亚调节的形式，例如，与情感曲线相关的刺激与之配对自然厌恶的刺激（例如，蛇）会增加对SITB的隐式厌恶。在研究中在成年人中，TEC在一个月内降低了21-77％的SITB。电流项目旨在测试TEC是否可以减少在自杀的最高风险时期，精神病患者住院和（2）；后一个月医院出院。首先，一项试点研究将测试TEC是否可行且可以接受为在住院期间和住院后，青少年的干预。第二，a 随机对照试验将将TEC的主动形式与不活动的控制形式进行比较 tec。 TEC有可能使自杀产生广泛的影响，因为它是可扩展的，简短的（> 5分钟即可完成），低负担且易于通过智能手机的移动应用程序管理。此外，在分期后期，TEC可以提供连续的治疗覆盖范围，填补出院与患者的首次门诊治疗之间的差距。也可以用于在精神卫生保健资源较少的地方扩展覆盖范围（例如粗糙区域）。该提议解决了减少青少年自杀的迫切需要，其中之一在美国和世界各地，最具破坏性和宽度的公共卫生问题。