The Influence of Childhood Adversity on Psychotherapy Skill Acquisition in Adolescent Depression

项目总结/摘要 在美国，近60%的年轻人在童年时经历过逆境，包括暴力暴露、虐待、 忽视、失去照顾者和生活贫困。全球和国家数据表明，逆境造成了 30-50%的风险抑郁症发作从童年到青春期，并回应循证医学 一线干预（例如，认知行为疗法（CBT）和抗抑郁药）在 暴露在逆境中的年轻人研究表明，暴露在逆境中会破坏一般的学习 过程，包括高阶认知过程（即，认知控制）。学习障碍可能会阻碍 循证心理治疗中最常见和最关键的中间治疗过程之一： 获得治疗技巧。这项建议采用了一种创新的方法来调查童年的逆境 暴露作为抑郁青年最常见的CBT技能获得的预测因子， 认知重构为了完善干预措施并优化效果，关键是要确定现有的 治疗失败。本研究将采用重复测量、多层次分析的方法来评估 获得和保留的实验者介绍的认知重建技能，抑郁症 青少年与人口水平的变化，在一生的逆境暴露（n=90）。候选人提议 调查逆境暴露和学习相关的认知控制过程之间的关联， 青少年抑郁症（Aim 1）逆境暴露和认知控制将被视为直接的 CBT技能获得和技能保留的预测因子超过6个月;从逆境到技能的间接途径 通过认知控制的习得也将被检查（目标2）。候选人将进一步探索关键 逆境的特点，即类型（伤害的威胁与剥夺资源）和发展 暴露的时间，作为技能获得的不同预测因素（探索性目标3）。拟议的K23建立在 候选人在精神病理学的环境和生物行为风险方面的先前培训，以及 治疗有效性，在1）实验疗法; 2）发展概念化方面进行新的培训 3）认知和情感学习过程的行为评估。的 匹兹堡大学精神病学系是一个理想的科学环境，以实现拟议的 职业发展目标，候选人将接受导师团队的培训（Goldstein博士，吕比， 和谢里丹）和顾问（福布斯博士、林德希姆博士和华莱士博士），他们在目标集中的干预方面具有专长 研究，儿童逆境和风险，为不良的临床过程中，青年抑郁症，发展认知和 情感科学该奖项的近期目标是确定抑郁症干预的敏感标志物 面对逆境的年轻人的反应。这将提供一个重要的工具，以促进候选人的 总体职业目标：开发利用基础科学进步的转化研究计划 为个性化和优化高危青少年抑郁症治疗的实验疗法提供信息。

PROJECT SUMMARY/ABSTRACT Nearly 60% of youths in the U.S. are exposed to childhood adversity, including violence exposure, abuse, neglect, loss of caregivers, and living in poverty. Global and national data indicate that adversity accounts for 30-50% of the risk for depression onset from childhood through adolescence, and response to evidence-based front-line interventions (e.g., cognitive behavioral therapy [CBT] and antidepressants) is notably poor among adversity-exposed youths. Research demonstrates that exposure to adversity disrupts general learning processes, including higher-order cognitive processes (i.e., cognitive control). Learning impairments may impede one of the most common and critical intermediary treatment processes across evidence-based psychotherapies: the acquisition of therapy skills. This proposal uses an innovative approach to investigate childhood adversity exposure as a predictor of skill acquisition for the most commonly implemented CBT skill with depressed youths, cognitive restructuring. To refine interventions and optimize effectiveness, it is critical to identify how existing treatments break down. This study will use a repeated-measures, multiple levels of analysis approach to assess acquisition and retention of an experimenter-introduced cognitive restructuring skill, among depressed adolescents with population-level variability in lifetime adversity exposure (n=90). The candidate proposes to investigate associations between adversity exposure and learning-related cognitive control processes in the context of adolescent depression (Aim 1). Adversity exposure and cognitive control will be examined as direct predictors of CBT skill acquisition and skill retention over six-months; an indirect pathway from adversity to skill acquisition through cognitive control will also be examined (Aim 2). The candidate will further explore key characteristics of adversity, namely the type (threat of harm versus deprivation of resources) and developmental timing of exposure, as distinct predictors of skill acquisition (exploratory Aim 3). The proposed K23 builds on the candidate’s prior training in environmental and biobehavioral risk for psychopathology, and evaluation of treatment effectiveness, with new training in 1) experimental therapeutics; 2) developmental conceptualizations of childhood adversity, and 3) behavioral assessments of cognitive and affective learning processes. The Department of Psychiatry at the University of Pittsburgh is an ideal scientific setting to achieve the proposed career development goals, and the candidate will receive training from a team of mentors (Drs. Goldstein, Luby, and Sheridan) and consultants (Drs. Forbes, Lindhiem, and Wallace) with expertise in target-focused intervention research, child adversity and risk for poor clinical course in youth depression, and developmental cognitive and affective science. The near-term goal of this award is to identify sensitive markers of depression intervention response among adversity-exposed youths. This will provide a crucial vehicle to advance the candidate’s overarching career objective: to develop a translational research program leveraging advances in basic science to inform experimental therapeutics for personalizing and optimizing depression treatment in high-risk youths.