Skills to Enhance Positivity in Suicidal Adolescents

描述(由申请人提供)：青少年自杀行为的流行率仍然高得令人无法接受。对已发表的青少年自杀随机对照试验(RCT)的回顾得出结论，到目前为止，治疗效果最低。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，我们的试点工作和其他最近的数据表明，独立于其他危险因素考虑低积极情感对自杀风险贡献的重要性，可能是导致自杀行为的另一种机制。我们的模型基于Fredrickson的经验支持的扩展和构建模型，该模型认为积极情感(PA)的功能包括通过改善社会支持、解决问题和个人韧性来帮助个人茁壮成长。以上每一个领域都有助于减少自杀行为。我们认为，PA通过减少自杀意念直接提高存活率，通过增加社会支持和解决问题间接提高存活率。在这项R34治疗发展赠款中，我们寻求开发一种新颖的、基于个人技能的PA干预措施，作为常规治疗(TAU)的辅助手段，针对高危青少年--那些因自杀风险而住院的青少年。我们专注于三种策略，这三种策略已经被证明可以在社区和抑郁症成年人中增加可持续的(相对于短暂的)PA：冥想、感激和品味。有几种方法来实践每种策略；我们以个性化的方法考虑患者的喜好，让患者选择最适合他们需求和情况的实践(S)。我们建议使用多种干预传递手段，包括他们选择的新技术媒介，以加强体内实践。我们的干预，技能增强积极计划(STEPP)包括两个阶段：a)面对面阶段，包括3个单独的面对面会议和1个住院期间的联合家长会议，以教授PA技能和开发个性化干预；b)远程交付阶段，包括出院后4周内每周的电话助推电话和每天的短信或电子邮件。这些电话将用于审查或调整个性化干预组件，并加强技能的使用。短信/电子邮件将包括练习技能的自我脚本提醒和指向在线资源的链接。文本与电子邮件的传递将基于可访问性和首选项。STEPP将在有20名参与者的开放试验中进行测试，在进一步修订后，在试点RCT中进行测试，并在50名青少年样本中与TAU进行比较。这种干预的主要目标是让患者通过将技能和实践融入到他们正常的家庭生活中来增加积极的情绪，我们相信这将导致解决问题和社会支持的增加，以及自杀意念的减少。我们的建议符合NIMH战略目标3。这是一种通过不同的机制(即PA)对高危急性人群进行的新型干预，在概念上有别于其他经验证的理论方法。

DESCRIPTION (provided by applicant): The prevalence of suicidal behaviors in adolescents remains unacceptably high. Reviews of published randomized controlled trials (RCTs) for adolescent suicidality conclude that treatments to date have been minimally efficacious. The preponderance of interventions focus on crisis intervention, underlying psychiatric disorders, regulating negative affect and reducing cognitive distortions. However, our pilot work and other recent data suggest the importance of considering how low positive affectivity contributes to suicide risk independent of other risk factors and may be another mechanism that leads to suicidal behaviors. Our model is based on Fredrickson's empirically-supported Broaden and Build model which asserts that the function of positive affect (PA) includes helping individuals thrive by improving social supports, problem-solving, and personal resilience. Each of these areas is instrumental in decreasing suicidal behavior. We propose that PA increases survival directly by decreasing suicidal ideation and indirectly by increasing social support and problem-solving. In this R34 treatment development grant we seek to develop a novel, individual skills-based, PA intervention, delivered adjunctively to treatment as usual (TAU), targeting the highest risk adolescents - those hospitalized due to suicide risk. We focus on three strategies that have been demonstrated to increase sustainable (vs. transient) PA in community and depressed adults: meditation, gratitude, and savoring. There are several ways to practice each strategy; we take into account patient preferences in a personalized approach in which patients select the practice(s) that fits best with their needs and circumstances. We propose using multiple means of intervention delivery that includes a new technology medium of their choosing, to reinforce in-vivo practice. Our intervention, Skills To Enhance Positivity Program (STEPP) includes two phases: a) in-person phase consisting of 3 individual in-person sessions and 1 joint parent session during the inpatient hospital stay to teach PA skills and develop a personalized intervention; b) remote delivery phase which consists of weekly telephone booster calls and daily text or email messages over 4 weeks post-discharge. The phone calls will be used to review or adjust personalized intervention components and reinforce use of skills. The text/email messages will include self-scripted reminders to practice skills and links to online resources. Text vs. email delivery will be based on accessibility and preference. STEPP will be tested in an open trial with 20 participants, and after further revision, in a pilot RCT, compared to TAU in a sample of 50 adolescents. The primary goal of this intervention is for patients to increase positive affect by incorporating skills and practices into their normal home-based routines, which we believe will lead to increases in problem-solving and social support and decreases in suicidal ideation. Our proposal meets NIMH Strategic Objective #3. This is a novel intervention for a high-risk acute population via a different mechanism (i.e. PA), and conceptually distinct from other empirically examined theoretical approaches.