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

项目总结 提高有自杀风险青少年的积极性的技巧 在过去的两年里，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，已发表的青少年自杀随机对照试验(RCT)的综述 得出的结论是，到目前为止，治疗效果都很低，特别是与成人试验相比。 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，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 考虑积极情感可能是导致自杀的一种机制的重要性 不受其他风险因素影响的行为。因此，我们制定了一项干预措施，以提高技能 积极(STEP；MH R34101272)，前提是扩大和建立积极情感理论，以增加 注意并意识到积极的情感和经历。我们的试验性随机对照试验(N=52)的结果 住院自杀青少年发现，与健康习惯相比/照常加强治疗 (Etau)条件下，那些随机到STEP的人报告自杀事件的人数减少了50%，报告自杀事件的人减少了50% 总体来说，自杀事件以及报告积极自杀意念(SI)的参与者比以下参与者减少得更多 上涨(49%的步幅对19.2%的Etau)。步骤似乎也与目标机制接合为步骤 与Etau相比，在注意偏向任务中，参与者对积极探测的反应时间更快 只有那些处于STEP状态的人报告了在上岗前在感恩和生活满意度上的显著差异。 在这些有希望的结果中，我们能够展示目标的参与度(积极的情感)和 临床结果的减少(自杀事件)表明有必要测试Step by 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 提出了一种混合I型效能实施设计。具体地说，我们建议测试 STEP对216例住院青少年减少自杀事件和意念的效果 由于自杀风险而进行的精神护理。参与者将被随机分配到STEP或Etau。步骤涉及4 面对面会议(3个人，1个家庭)侧重于教授正面和负面情绪的心理教育， 正念、冥想、感恩和品味。具有情绪监测提示和数字健康消息 技能提醒在出院后的第一个月每天发送，在接下来的两个月每周发送三次 月份。Etau Condition将每天收到登录安全资源应用程序的提醒。我们假设 那些被随机分为STEP组(与Etau组相比)的患者的自杀事件、意念、抑郁和经历会更少 增加了积极情感和对积极情感的注意，减少了消极情感和对 消极情绪，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，并且几乎没有参与的排除标准。 实施方面包括为战略提供信息的数据，以增加在现实世界实践中的认识。

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.