Skills to Enhance Positivity (STEP) for Adolescents at Risk for Suicide

项目摘要 提高自杀风险青少年积极性的技巧 过去两年，青少年的自杀率和自杀行为一直在稳步上升 几十年不幸的是，对已发表的关于青少年自杀倾向的随机对照试验（RCT）的综述 得出的结论是，迄今为止的治疗效果最低，特别是与成人试验相比。 干预措施的优势集中在危机干预，潜在的精神疾病，调节 负面影响，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， 重要的是要考虑到低积极情感可能是导致自杀的机制 与其他风险因素无关。因此，我们开发了一种干预措施， 积极性（STEP; MH R34101272），基于积极影响的Broket和Build理论，以增加 注意和意识到积极的影响和经验。来自我们的试点RCT（N = 52）的结果， 住院自杀青少年发现，与健康习惯/加强治疗相比， （ETAU）条件下，随机接受STEP的患者报告自杀事件的人数减少50%， 总体自杀事件，以及报告主动自杀意念（SI）的参与者的降幅大于随访 上升（49% STEP vs. 19.2% ETAU）。STEP似乎也参与了目标机制作为STEP 与ETAU相比，参与者在注意力偏差任务中对阳性探针的反应时间更快， 只有那些在STEP条件下的人在感恩和对生活的满意度上报告了显着的前后差异。 这些有希望的结果，我们能够证明参与的目标（积极影响）和一个 临床结局（自杀事件）的减少表明需要通过以下方式测试STEP的临床有效性： 让临床工作人员实施干预。此外，认识到需要加快翻译速度，我们 提出一种混合I型容错实现设计。具体来说，我们建议测试 STEP在减少216例住院青少年自杀事件和意念方面的有效性 精神病治疗，因为有自杀风险。受试者将被随机分配至STEP或ETAU。STEP涉及4 面对面的课程（3个人，1个家庭），重点是教授积极和消极情感的心理教育， 正念冥想，感恩，品味。带有情绪监测提示的数字健康信息， 在出院后的第一个月，将每天发送技能提醒，在随后的两个月，每周发送三次 个月ETAU条件将收到每日提醒登录到安全资源应用程序。我们假设， 随机分配到STEP组（与ETAU组相比）的患者自杀事件、意念、抑郁和经验 增加积极情感和对积极情感的关注，减少消极情感， 消极影响，通过内隐任务和自我报告测量。设计的有效性方面 包括使用临床工作人员作为干预者，以及参与的排除标准很少。 实施方面包括提供数据，为战略提供信息，以增加在真实的世界实践中的采用。

PROJECT SUMMARY SKILLS TO ENHANCE POSITIVITY IN ADOLESCENTS AT RISK FOR SUICIDE Rates of suicide and suicidal behavior in adolescents have been steadily increasing over the past two decades. Unfortunately, reviews of published randomized controlled trials (RCTs) for adolescent suicidality conclude that treatments to date have been minimally efficacious, particularly when compared to adult trials. The preponderance of interventions focus on crisis intervention, underling 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 may be a mechanism that contributes to suicidal behaviors independent of other risk factors. Therefore, we developed an intervention, Skills to Enhance Positivity (STEP; MH R34101272), premised on the Broaden and Build theory of positive affect, to increase attention to, and awareness of positive affect and experiences. Results from our pilot RCT (N=52) with inpatient suicidal adolescents found that compared to a Healthy Habits / Enhanced Treatment as Usual (ETAU) condition, those randomized to STEP had 50% fewer individuals reporting a suicidal event, 50% fewer suicidal events overall, and a larger decrease in participants reporting active suicidal ideation (SI) over follow up (49% STEP vs. 19.2% ETAU). STEP also appears to have engaged the target mechanism as STEP participants had faster reaction times to positive probes on an attentional bias task compared to ETAU, and only those in the STEP condition reported significant pre-post differences on gratitude and satisfaction with life. These promising results in which we were able to demonstrate engagement of the target (positive affect) and a decrease in clinical outcomes (suicidal events) suggest the need to test the clinical effectiveness of STEP by having clinical staff implement the intervention. Furthermore, recognizing the need to speed translation, we propose a Hybrid Type I Effectiveness-Implementation design. Specifically, we propose to test the effectiveness of STEP in reducing suicidal events and ideation in 216 adolescents, admitted to inpatient psychiatric care due to suicide risk. Participants will be randomized to either STEP or ETAU. STEP involves 4 in-person sessions (3 individual, 1 family) focused on teaching psychoeducation of positive and negative affect, mindfulness meditation, gratitude, and savoring. Digital health messages with mood monitoring prompts and skills reminders will be sent daily for the first month post-discharge and three times a week for the following two months. ETAU condition will receive daily reminders to log into a safety resource app. We hypothesize that those randomized to STEP (vs. ETAU) will have less suicide events, ideation, and depression, and experience increased positive affect and attention to positive affect, and decreased negative affect, and attention to negative affect, as measured by implicit tasks and self-report measures. Effectiveness aspects of the design include using clinical staff as interventionists and having very few exclusion criteria for participation. Implementation aspects include data to inform strategies to increase uptake in real world practice.