Improvements in Mentalizing as a Mechanism of Change in Psychotherapy for Depressed and Suicidal Adolescents

作为美国青少年死亡的第二大原因，青少年自杀是一个重要的 公共卫生问题。最近的一些研究表明，心智上的缺陷，或能力 对…的思想、情感、行为和意图作出大致准确的推断 其他的，与青少年自杀风险有关。一项研究还表明，心灵化-- 基础治疗降低了青少年非自杀性自伤(NSSI)的发生率。然而，没有一个 这些研究使用成人依恋访谈(AAI)，这是得出估计的黄金标准 没有治疗研究检查青少年的改善 减少自杀风险症状(例如，减少自杀风险症状的频率和强度 想法、意图、尝试次数)。拟议研究的目标是确定 青春期精神化的改善可预测在整个过程中自杀风险症状的减少 进行了16周的心理治疗。这项研究有两个具体目的：1)确定青少年是否 在青少年自杀风险的心理治疗过程中，心理治疗有所改善；2) 确定意念化的改善是否可以预测和调节自杀的改善 风险症状。这项研究将利用最近完成的随机对照试验的次要数据 研究青少年自杀风险的两种治疗方法(基于依恋的家庭治疗和 家庭强化非指导性支持疗法)(N=129)。两种治疗方法相似 有效减少自杀风险症状。所有青少年完成治疗前和治疗后 人工智能，它将被编码用于心智。数据集包括处理前和处理后的数据 (第0周和第16周)、中点数据(第4周、第8周、第12周)和为期一年的随访数据(周 20、32、40、52)。这一丰富的数据集将允许进行测试前和测试后的分析、纵向增长曲线 建模和调解分析。 思维化是社会理解的核心组成部分，是能力的同义词 为了了解精神状态，“确定了NIMH研究域子结构的一个关键部分， 更广泛的“感知和理解他人”的概念。实现新世纪的目标 拟议的研究将显著影响对治疗目标的了解，该治疗目标可能是 对于有自杀风险的青少年来说尤其重要，这将是迈向未来的第一步 R01提交意见书的目的是：1)构建对提供商友好的工具，以评估将指导化作为 青少年自杀的治疗进展；以及2)完善青少年自杀干预措施，以针对性和 衡量意念化方面的改进。

As the second leading cause of death for U.S. teens, adolescent suicide is a significant public health concern. A number of recent studies show that deficits in “mentalizing,” or the ability to make generally accurate inferences about the thoughts, emotions, behaviors, and intentions of others, are linked to adolescent suicide risk. One study also demonstrated that mentalization- based treatment reduced rates of adolescent non-suicidal self-injury (NSSI). However, none of these studies used the Adult Attachment Interview (AAI), the gold standard for deriving estimates of mentalizing, and no treatment studies have examined whether improvements in adolescent mentalizing reductions in suicide risk symptoms (e.g. decreases in frequency and intensity of ideation, intent, number of attempts). The objective of the proposed study is to determine whether improvements in adolescent mentalizing predict suicide risk symptom reduction over the course of 16 weeks of psychotherapy. The study has two specific aims: 1) Determine whether adolescent mentalizing improves over the course of psychotherapy for adolescent suicide risk; and 2) Determine whether improvements in mentalizing predict and mediate improvements in suicide risk symptoms. The study will capitalize on secondary data from a recently completed RCT examining two treatments for adolescent suicide risk (Attachment Based Family Therapy and Family-Enhanced Non-Directive Supportive Therapy) (N = 129). Both treatments were similarly efficacious in reducing suicide risk symptoms. All adolescents completed pre and post-treatment AAIs, which will be coded for mentalizing. The data set includes pre- and post-treatment data (weeks 0 and 16), mid-point data (weeks 4, 8,12), and data through 1-year of follow-up (weeks 20, 32, 40, 52). This rich data set will allow for pre-post-test analyses, longitudinal growth curve modeling, and mediation analyses. Mentalizing is a core component of social understanding and synonymous with the “ability to understand mental states,” identified a key NIMH research domain sub-construct, under the broader construct of “perception and understanding of others. Accomplishing the aims of the proposed study will significantly impact knowledge about a treatment target that may be particularly important for adolescents at risk for suicide and will be a first step towards a future R01 submission aimed at: 1) building provider-friendly tools to assess mentalizing as a marker of treatment progress for youth suicide; and 2) refining youth suicide interventions to target and measure improvements in mentalizing.