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：
8248711
负责人：
Joan Rosenbaum Asarnow
金额：
$ 67.31万
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/8248711
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. PUBLIC HEALTH RELEVANCE: The primary aim of the research proposed here is to evaluate the efficacy of dialectical behavior therapy (DBT) for adolescents by comparing it to individual and group supportive therapy control condition (I/GST) chosen specifically to maximize internal validity. Subjects will be teens 13-17 years old referred to treatment due to high risk for suicide. Outcome targets include reduced frequency and severity of suicidal behaviors, increased maintenance in and compliance with treatment and enhanced functioning across multiple domains.

描述（由申请人提供）：我们的研究的长期目的是开发和评估有效的自杀风险的青少年有效治疗方法，这将减少自杀和自我伤害行为，并改善青少年及其家庭生活质量的功能和生活质量。这里提出的研究的主要目的是通过将辩证法行为疗法（DBT）的功效评估，通过将其与联合的个体和团体支持治疗控制条件（I/GST）进行比较，以最大程度地提高内部有效性。受试者将为13-17岁的青少年，由于自杀的高风险，其边缘性格特征将具有边缘性人格特征。结果目标包括自杀行为的频率和严重程度降低，尤其是自杀企图，住院或ER治疗以自杀，增加了维持和对治疗的依从性以及在多个领域的功能增强。 DBT具有经验记录，成年人降低了自杀未遂的发生率，频率和医疗风险，并且在满足边缘人格障碍标准（BPD）标准的个体中，自杀企图的发生率，频率和医疗风险。然而，尽管DBT与自杀青少年广泛使用，尤其是那些特征BPD的困难的青少年，例如情绪调节差和脉冲控制，但未对DBT进行与青少年的随机试验。因此，尽管非随机试验表明有效性，但如果没有随机试验，我们根本不知道青少年的DBT是否有效。鉴于问题的严重程度以及缺乏高风险青少年的替代治疗方法，解决这个问题很重要。这项研究的第二个目的是分析青少年自杀和自杀行为减少的介体。 DBT基于一个理论模型，即自杀行为是高压力事件和情绪失调的综合结果，以及无法应对负面情绪和生活事件的行为技能不足。青少年自杀和故意自我伤害的危险因素包括家庭冲突，同时与同龄人，教师，损失，法律或纪律问题（压力事件）以及高负面情绪和情绪调节能力不足的冲突。我们将分析家庭冲突减少自杀行为的潜在中介作用，父型DBT行为技能的提高，情绪失调的降低以及DBT行为技能的提高。还将收集有关成本效益的初步数据。公共卫生相关性：这里提出的研究的主要目的是通过将辩证法行为疗法（DBT）的功效评估为青少年的功效，通过将其与个人和小组支持治疗控制条件（I/GST）进行比较，以最大程度地提高内部有效性。由于自杀的高风险，受试者将是13-17岁的青少年。结果目标包括自杀行为的频率和严重程度降低，维持量的增加以及遵守治疗和跨多个领域的功能增强。