Therapeutic evaluative conditioning to reduce adolescents' self-injurious thoughts and behaviors during and after psychiatric inpatient hospitalization.

项目摘要/摘要 自杀是美国青少年的第二大死因，非致命性自杀 伤害性想法和行为(SITB；例如，自杀想法和企图以及非自杀 自伤(NSSI)都与未来自杀的风险有关。许多青少年处于高位 自杀的风险需要精神科住院治疗。不幸的是，这些青少年 在住院期间，他们经常继续考虑自杀和进行NSSI。多数 令人担忧的是，住院后的一个月是自杀风险最高的时间， 自杀率是一般青少年自杀率的10倍。研究表明，人们 参与SITB的人对SITB相关刺激的内隐厌恶程度降低。这减少了 厌恶可能会促进SITB，因为它意味着这种天然的屏障阻止人们 伤害自己的程度更低。参与SITB的人也表现出更多的内隐自我 厌恶，这也可能通过支持一个人应该受到惩罚的信念来促进SITB。 逆转SITB这些潜在促进者的干预可能有助于防止这种想法 和行为。当前项目的目标是测试一种这样的干预：治疗性干预 评估性条件反射(TEC)，旨在通过增加内隐厌恶来减少SITB 面对SITB，减少对自己的内隐厌恶。TEC使用评估条件，a 巴甫洛夫条件反射的一种形式，例如，与SITB相关的刺激与 自然厌恶的刺激(如蛇)，以增加对SITB的隐性厌恶。在研究中 在成年人中，TEC与一个月内SITB减少21%-77%有关。海流 该项目旨在测试TEC是否可以减少自伤青少年的SITB(1) 精神科住院及(2)自杀高危期间；次月 出院。首先，一项初步研究将测试TEC是否可行和可接受为 对住院期间和住院后的青少年进行干预。第二，一个 随机对照试验将比较活性形式的TEC和非活性的对照形式的TEC Tec.TEC有潜力产生广泛的影响，减少自杀，因为它是可扩展的，简短的 (&gt；5分钟即可完成)，负担轻，通过智能手机上的移动应用程序即可轻松管理。 此外，在出院后阶段，TEC可以提供持续的治疗覆盖， 填补出院和患者第一次门诊治疗之间的空白。它也可以是 用于在用于精神健康护理的资源较少的地方扩展覆盖范围(例如， 农村地区)。这项提案解决了减少青少年自杀的迫切需要，青少年自杀是 美国和世界上最具破坏性和最广泛的公共卫生问题。

Project Summary/Abstract Suicide is the 2nd leading cause of death for adolescents in the U.S. and non-lethal self- injurious thoughts and behaviors (SITB; e.g., suicide thoughts and attempts and non-suicidal self-injury (NSSI)) are each associated with the risk of future suicide. Many adolescents at high risk of suicide require psychiatric inpatient hospitalization. Unfortunately, these adolescents often continue to think about suicide and engage in NSSI while they are hospitalized. Most alarmingly, the month following hospitalization is the highest risk time for suicide, with the suicide rate 10 times higher than the general adolescent rate. Research suggests that people who engage in SITB show reduced implicit aversion toward SITB-related stimuli. This reduced aversion may facilitate SITB because it means this natural barrier preventing people from harming themselves is lower. People who engage in SITB also show increased implicit self- aversion, which may also facilitate SITB by supporting beliefs that one deserves to be punished. An intervention that reverses these potential facilitators of SITB may help prevent such thoughts and behaviors. The goal of the current project is to test one such intervention: Therapeutic Evaluative Conditioning (TEC), which aims to reduce SITB by increasing implicit aversion toward SITB and reducing implicit aversion toward oneself. TEC uses evaluative condition, a form of Pavlovian conditioning, in which, for example, SITB-related stimuli are paired with naturally aversive stimuli (e.g., snakes) to increase implicit aversion towards SITB. In studies among adults, TEC was associated with a 21-77% reduction in SITB over a month. The current project aims to test whether TEC can reduce SITB among self-injurious adolescents (1) during psychiatric inpatient hospitalization and (2) in the highest-risk period for suicide; the month after hospital discharge. First, a pilot study will test whether TEC is feasible and acceptable as an intervention for adolescents, both during and after inpatient hospitalization. Second, a randomized controlled trial will compare an active form of TEC with an inactive, control form of TEC. TEC has the potential to make broad impact reducing suicide because it is scalable, brief (> 5 min to complete), low-burden, and easy to administer via mobile app on a smartphone. Furthermore, in the post-discharge period, TEC can provide continuous therapeutic coverage, filling the gap between discharge and patients’ first outpatient therapy session. It can also be used to extend coverage in places where there are fewer resources for mental health care (e.g., rural areas). This proposal addresses the urgent need to reduce adolescent suicide, one of the most devastating and widespread public health problems in the U.S. and around the world.