A Novel Cognitive Remediation Intervention Targeting Poor Decision-Making and Depression in Veterans at High Risk for Suicide: A Safe,Telehealth Approach During the COVID-19 Pandemic

项目摘要 尽管大规模的，全国范围内的努力，以更好地解决自杀行为（定义为思想和 行为）在高风险的退伍军人与重性抑郁症（MDD），干预措施的发展， 针对一些与MDD退伍军人自杀相关的关键风险因素的研究仍然有限。即在 许多干预研究继续调查认知行为疗法（CBT）等治疗方法， 目标行为模式、情绪处理问题和与自杀风险相关的认知方式， MDD，作为这些CBT目标基础的神经认知底物的缺陷仍然没有得到充分解决。 认知补救（CR）和康复长期以来一直是其他疾病患者的主要治疗方法。 精神疾病，如精神分裂症，用于改善认知功能和促进认知转移 日常运作的技能。然而，很少有工作研究CR，解决神经认知 抑郁症患者自杀行为的潜在缺陷。实证工作已确定关键高管 功能（EF）缺陷，可能是特定的MDD患者的自杀行为，和荟萃分析工作 表明CR对MDD患者的认知功能、抑郁和日常功能具有中等效应量。 因此，该领域迫切需要研究CR作为MDD的恢复导向治疗方法 有自杀风险的病人 建议的研究旨在收集试验数据，以测试 在COVID-19期间，通过远程医疗提供基于神经可塑性的CR， 36名患有MDD且有自杀企图史的退伍军人样本。具体来说，它将测试 增强了连续循证认知矫正（CR）治疗（与常规治疗无关） 与手动“桥接”会议的转移和认知控制和决策/问题的实践- 解决现实世界的情况和问题的策略，包括那些引发自杀念头的问题。我们 建议管理认知矫正的神经心理学教育方法（NEAR，称为 CR+“桥接”阶段，CR+桥接），共36名有MDD和自杀史的退伍军人 尝试。干预将在20个90分钟的会议中进行（每周2次，持续10周）。预处理 将进行神经认知、临床、社会和现实世界功能的评估，包括 研究COVID-19及其伴随的“社交距离”限制的影响的措施。后 将对相同靶点进行治疗评估，以确定临床反应和可行性 在干预结束后立即（第10周）和随访时， 评估（第20周）。本申请是新颖的，因为它构成了本发明的第一实施方式。 对患有MDD和自杀行为的退伍军人进行干预。与RR&D的SPiRE机制一致， 研究是高风险，但它具有很高的潜在影响，并有望帮助提高退伍军人的生活质量， 自杀风险高。

PROJECT SUMMARY Despite large-scale, nationwide efforts to better address suicidal behavior (defined as thoughts and behavior) in high-risk Veterans with major depressive disorder (MDD), the development of interventions that target some of the key risk factors associated with suicide in Veterans with MDD remains limited. That is, while much intervention research continues to investigate treatments like cognitive behavioral therapy (CBT) that target behavioral patterns, emotion processing problems, and cognitive styles associated with suicide risk in MDD, deficits in the neurocognitive substrates that underlie these CBT targets remain under-addressed. Cognitive remediation (CR) and rehabilitation have long been a primary treatment for patients with other psychiatric illnesses, like schizophrenia, for improving cognitive functioning and facilitating transfer of cognitive skills to every-day functioning. However, scant work has examined CR that addresses the neurocognitive deficits underlying suicidal behavior in individuals with MDD. Empirical work has identified key executive functioning (EF) deficits that may be specific to MDD patients with suicidal behavior, and meta-analytic work indicates that CR has moderate effect sizes on cognitive functioning, depression, and daily functioning in MDD. Thus, the field is in dire need of work that examines CR as a recovery-oriented treatment approach for MDD patients at risk for suicide. The proposed study aims to collect pilot data to test the feasibility and acceptability of adjunctive neuroplasticity-based CR on key treatment targets delivered via telehealth during this time of COVID-19 in a sample of 36 Veterans with MDD and a history of suicide attempt(s). Specifically, it will test the effects of an adjunctive evidence-based cognitive remediation (CR) therapy (adjunctive to treatment as usual) augmented with manualized “Bridging” sessions on transfer and practice of cognitive control and decision-making/problem- solving strategies for real-world situations and problems, including those that trigger suicidal thoughts. We propose to administer the Neuropsychological Educational Approach to Cognitive Remediation (NEAR, termed CR plus “Bridging” session, CR+Bridging) to a total of 36 Veterans with MDD and a history of suicide attempt(s). The intervention will be delivered in 20 90-minute sessions (2x/week for 10 weeks). Pre-treatment assessments of neurocognitive, clinical, social, and real-world functioning will be conducted, including measures that examine the impact of COVID-19 and its accompanying “social-distancing” restrictions. Post- treatment assessments of the same targets will be conducted to determine clinical response to and feasibility of this therapeutic intervention immediately following conclusion of the intervention (Week 10) and at a follow- up assessment (Week 20). This application is novel in that it constitutes the first implementation of this intervention in Veterans with MDD and suicidal behavior. Consistent with RR&D’s SPiRE mechanism, this study is high risk, but it has high potential impact and promise to help improve quality of life for Veterans at high risk for suicide.