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

治疗性评估性调节，以减少青少年在精神科住院期间和住院后的自残想法和行为。

• 批准号: 10703354
• 负责人: Kelly Zuromski
• 金额: $ 26.16万
• 依托单位: FRANCISCAN HOSPITAL FOR CHILDREN, INC.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-09 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10703354
• 关键词: 3-Dimensional; Address; Adherence; Adolescent; Adult; Association Learning; Attitude; Aversive Stimulus; Behavior; Belief; Cause of Death; Cellular Phone; Child; Clinical; Cognition; Effectiveness; Eligibility Determination; Ensure; Feedback; Feeling suicidal; First Name; Forms Controls; Future; Goals; Hospitalization; Hospitals; Image; Inpatients; Intervention; Massachusetts; Mental Health Services; Methods; Outcome; Outpatients; Patient Monitoring; Patients; Persons; Pilot Projects; Placebos; Procedures; Protocols documentation; Public Health; Punishment; Randomized; Randomized, Controlled Trials; Research; Resources; Risk; Self-Injurious Behavior; Skin; Snakes; Stimulus; Suicide; Suicide attempt; Testing; Therapeutic; Thinking; Time; Treatment Efficacy; acceptability and feasibility; adolescent suicide; conditioning; effective intervention; efficacy testing; experience; high risk; mobile application; non-suicidal self injury; novel strategies; operation; paired stimuli; post intervention; prevent; programs; public health relevance; reducing suicide; rural area; skills; suicidal; suicidal adolescent; suicidal behavior; suicidal morbidity; suicidal risk; suicide rate; therapeutic evaluation; treatment response

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.

项目总结/摘要 自杀是美国青少年死亡的第二大原因，而非致命的自我伤害是 有害的想法和行为（SITB;例如，自杀想法和企图以及非自杀 自我伤害（NSSI）都与未来自杀的风险有关。许多青少年在高中 自杀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并进行NSSI。最 令人担忧的是，住院后的一个月是自杀风险最高的时期， 自杀率比一般青少年高10倍。研究表明， 参与SITB的人对SITB相关刺激的内隐厌恶减少。这种减小的 厌恶可能会促进STB，因为它意味着这种天然屏障阻止人们 伤害自己是最低的。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而促进SITB。 逆转这些潜在的STB促进因素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这样一种干预措施： 评价性条件反射（TEC），旨在通过增加内隐厌恶来减少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，其中，例如，SITB相关刺激与 自然厌恶的刺激（例如，蛇），以增加对SITB的隐性厌恶。研究中 在成年人中，TEC与一个月内SITB减少21-77%有关。当前 一个项目旨在测试TEC是否可以减少自伤青少年的SITB（1） 精神病住院治疗和（2）在自杀的最高风险期;后一个月 出院首先，将进行一项试点研究，以测试TEC作为一种 在住院期间和住院后对青少年进行干预。二是 随机对照试验将比较TEC的活性形式与非活性对照形式， TEC。TEC有可能产生广泛的影响，减少自杀，因为它是可扩展的，简短的， （> 5分钟完成），低负担，易于通过智能手机上的移动的应用程序管理。 此外，在出院后阶段，TEC可以提供持续的治疗覆盖， 填补了出院和患者首次门诊治疗之间的差距。它也可以 用于在精神卫生保健资源较少的地方扩大覆盖范围（例如， 农村地区）。这项建议解决了减少青少年自杀的迫切需要，这是 最具破坏性和广泛的公共卫生问题在美国和世界各地。