Skills to Enhance Positivity in adolescents at risk for suicide: Protocol for a randomized controlled trial.
Skills to Enhance Positivity in adolescents at risk for suicide: Protocol for a randomized controlled trial.
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DOI：
10.1371/journal.pone.0287285
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
Spirito, Anthony
中科院分区：
文献类型：
--
作者：
Yen, Shirley;Suazo, Nazaret;Doerr, Jackson;Macrynikola, Natalia;Villarreal, Leanna S.;Sodano, Sophia;O'Brien, Kimberly H. M.;Wolff, Jennifer C.;Breault, Christopher;Gibb, Brandon E.;Elwy, Rani;Kahler, Christopher W.;Ranney, Megan;Jones, Richard;Spirito, Anthony
在过去的二十年里，青春期的自杀和自杀行为一直在稳步增加。干预的优势集中在危机干预、潜在的精神障碍、调节负面情绪和减少认知扭曲。然而，低积极情感可能是导致青少年自杀念头和行为独立于其他危险因素的一种机制。增强积极性技能(STEP)是一种以接受为基础的干预措施，旨在提高人们对积极情绪和积极经历的关注和认识。一项试验性随机对照试验的结果显示，目标参与(积极影响)和临床结果的减少(自杀事件；即自杀未遂或急性自杀危机的紧急干预)，为在临床工作人员实施干预的更大临床试验中测试STEP的临床有效性提供了支持。为了测试STEP与常规强化治疗(Etau)相比，在减少因自杀风险而住院接受精神护理的青少年自杀事件和意念方面的有效性。我们假设，与Etau相比，那些随机接受STEP的患者在6个月的随访期内自杀事件、积极自杀意念(SI)和抑郁情绪的发生率将较低。我们假设，与Etau相比，那些被随机分配到STEP的人，将在对积极情感刺激的注意以及对生活的感激和满意的假设机制上表现出更大的改善。参与者将被随机分配到STEP或Etau。Step由四个面对面的会议组成，重点是关于积极和消极情绪、正念冥想、感恩和品味的心理教育。情绪监测提示和技能提醒将在出院后第一个月每天通过短信发送，在接下来的两个月每隔一天发送一次。Etau病情患者将收到短信提醒，要求他们使用出院时提供的安全计划和与Step小组频率相匹配的健康习惯信息。该试验于2021年8月6日注册(ClinicalTrials.gov NCT04994873)。STEP协议于2022年3月4日获得国家精神卫生研究所(NIMH)数据和安全监测委员会的批准。区域合作研究目前正在进行中。STEP方案是一种创新的辅助治疗，有可能对青少年的自杀意念和企图产生积极影响，而不仅仅是标准治疗。
Suicide and suicidal behavior during adolescence have been steadily increasing over the past two decades. The preponderance of interventions focuses on crisis intervention, underlying psychiatric disorders, regulating negative affect, and reducing cognitive distortions. However, low positive affectivity may be a mechanism that contributes to adolescent suicidal ideation and behaviors independent of other risk factors. Skills to Enhance Positivity (STEP) is an acceptance-based intervention, designed to increase attention to, and awareness of, positive affect and positive experiences. Results from a pilot RCT demonstrated engagement of the target (positive affect) and a decrease in clinical outcomes (suicidal events; i.e., either a suicide attempt or an emergency intervention for an acute suicidal crisis), providing support to test the clinical effectiveness of STEP in a larger clinical trial with clinical staff implementing the intervention. To test the effectiveness of STEP, compared to Enhanced Treatment as Usual (ETAU), in reducing suicidal events and ideation in adolescents admitted to inpatient psychiatric care due to suicide risk. We hypothesize that those randomized to STEP, compared to ETAU, will have lower rates of suicide events, active suicidal ideation (SI), and depressed mood over the 6-month follow-up period. We hypothesize that those randomized to STEP, compared to ETAU, will demonstrate greater improvement in the hypothesized mechanisms of attention to positive affect stimuli and gratitude and satisfaction with life. Participants will be randomized to either STEP or ETAU. STEP consists of four in-person sessions focused on psychoeducation regarding positive and negative affect, mindfulness meditation, gratitude, and savoring. Mood monitoring prompts and skill reminders will be sent via text messaging daily for the first month post-discharge and every other day for the following two months. The ETAU condition will receive text-delivered reminders to use a safety plan provided at discharge from the hospital and healthy habits messages, matched in frequency to the STEP group. This trial was registered on 6 August 2021 (ClinicalTrials.gov NCT04994873). The STEP protocol was approved by the National Institute of Mental Health (NIMH) Data and Safety Monitoring Board on March 4, 2022. The RCT is currently in progress. The STEP protocol is an innovative, adjunctive treatment that has the potential to have positive effects on adolescent suicidal ideation and attempts beyond that found for standard treatment alone.
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作者：
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