Implementation intentions, cognitive abilities and self-harm

实施意图、认知能力和自残

• 批准号: 2112816
• 金额: --
• 依托单位: University of Strathclyde
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2112816
• 关键词: Implementation; intentions; cognitive; abilities; self

OverviewSuicide is the second leading cause of death among 15-29-year-olds and nearly 800K people die from suicide each year (World Health Organisation, 2017). A history of self-harm is the best predictor of eventual suicide. As is the case for many behaviours (e.g., Elliott et al., 2015), self-harm is a multifaceted problem (e.g., Rasmussen et al., 2012). However, it is well-established that critical situations (e.g., feeling hopelessness) act as triggers for this behaviour (O'Connor et al., 2013). Interventions that provide coping strategies for dealing with these critical situations are therefore required. Implementation intentions (IMPs) have recently shown promise in this regard. ContextIMPs (Gollwitzer, 1999) are 'IF-THEN' plans that require people to specify critical situations that trigger unwanted behaviours (e.g., self-harm) and mentally link them with coping strategies (e.g., IF I am tempted to self-harm when I feel hopeless, THEN I will think about how my self-harming would upset my loved ones). The specification of the critical situation (IF) serves to encode a representation of that situation to memory. That mental representation is activated when the specified critical situation is encountered. The mental association between the specified critical situation (IF) and the coping strategy (THEN) serves to initiate a suitable response for ensuring that the unwanted behaviour is not performed when the mental representation of the critical situation has been activated. Essentially, the situations that typically prompt unwanted behaviours become triggers, instead, for desirable courses of action (e.g., avoidance of self-harm).Aims1. To test the extent to which IMPs reduce self-harm in the longer-term (6-months post-intervention) using objective outcomes (hospital readmission rates) in addition to self-reported outcomes (e.g., suicidal thoughts) and therefore extend the findings of Armitage et al. (2016). It is hypothesised that suicide-outcomes will be less prevalent in patients who have been asked to form IMPs than in patients who have not.2. To explore the profiles of cognitive abilities within self-harm patients that are likely to help explain why IMPs reduce suicide outcomes for some patients but not others. It is expected that there will be variation in key cognitive abilities that govern attention and memory encoding, as well as long-term storage and retrieval.3. To identify which cognitive abilities distinguish between patients for whom IMPs reduce suicide-outcomes and those for whom they do not. It is hypothesised that deficiencies in key cognitive abilities will distinguish between these two groups. 4. To develop ways of delivering IMP interventions that can help overcome the cognitive deficits that interfere with their effectiveness.MethodologyA series of randomised controlled experiments will be conducted. All consecutive adult patients (aged 16 years or over) admitted to the medical wards of Glasgow Royal and Queen Elizabeth Infirmaries following a self-harm episode (intentional self-injury or poisoning; Hawton et al., 2003) will be eligible for participation in the research. The Consultant Psychiatrist at Glasgow Liaison Psychiatry Service has confirmed that access will be provided to the N > 1000 self-harm patients per year in these two hospitals, meaning that the sample sizes specified below can be achieved within the time-scale (power analyses confirm that the target Ns provide sufficient power).

自杀是15-29岁人群的第二大死因，每年有近80万人死于自杀（世界卫生组织，2017年）。自残史是最终自杀的最佳预测因素。与许多行为的情况一样（例如，Elliott等人，2015），自我伤害是一个多方面的问题（例如，Rasmussen等人，2012年）。然而，众所周知，关键情况（例如，感到绝望）作为这种行为的触发因素（奥康纳等人，2013年）。因此，需要采取干预措施，为处理这些危急局势提供应对战略。执行意向最近在这方面显示出希望。情境IMP（Gollwitzer，1999）是一种“如果-那么”计划，要求人们指定触发不想要的行为的关键情况（例如，自我伤害），并在心理上将其与应对策略联系起来（例如，如果我在感到绝望的时候想自残，那么我会想我的自残会让我所爱的人多么难过。关键情况（IF）的说明用于将该情况的表示编码到记忆中。当遇到特定的危急情况时，这种心理表征就会被激活。特定的危急情况（IF）和应对策略（THEN）之间的心理联系有助于启动适当的反应，以确保当危急情况的心理表征被激活时，不需要的行为不会被执行。从本质上讲，通常会引发不想要的行为的情况反而会触发人们采取可取的行动（例如，避免自我伤害）。使用客观结局（再入院率）以及自我报告结局（例如，自杀想法），因此扩展了Armitage et al.（2016）的发现。据推测，自杀结局在被要求形成IMP的患者中的发生率低于未被要求形成IMP的患者。探索自我伤害患者的认知能力概况，这可能有助于解释为什么IMP减少了一些患者的自杀结局，而不是其他患者。预计控制注意力和记忆编码以及长期存储和检索的关键认知能力将会发生变化。3.确定哪些认知能力可以区分使用IMP减少自杀结局的患者和不使用IMP减少自杀结局的患者。据推测，关键认知能力的缺陷将区分这两个群体。 4.为了开发提供IMP干预措施，可以帮助克服认知缺陷，干扰其effectiveness.MethodologyA系列随机对照实验将进行的方式。所有连续成人患者（16岁或以上）在自我伤害事件（故意自我伤害或中毒; Hawton等人，2003年）将有资格参加这项研究。格拉斯哥联络精神病学服务中心的顾问精神病学家已确认，这两家医院每年将向N > 1000名自残患者提供访问权限，这意味着可以在时间范围内实现以下指定的样本量（功效分析证实目标N提供了足够的功效）。