Targeting Emotion Dysregulation to Reduce Suicide in People with Psychosis

针对情绪失调以减少精神病患者的自杀率

• 批准号: 10689011
• 负责人: Peter Lee Phalen
• 金额: $ 18.22万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10689011
• 关键词: Accounting; Address; Aftercare; Area; Behavior; Cause of Death; Clinical Research; Clinical Trials; Complement; Complex; Data; Data Collection; Dialectical behavior therapy; Disease; Ecological momentary assessment; Emotional; Emotions; Environment; Exclusion; Failure; Feeling suicidal; Future; Goals; Health Services Research; Institution; Intervention; Interview; Investigational Therapies; Knowledge; Laboratories; Link; Maryland; Measurement; Measures; Mental Health Services; Mentorship; Methodology; Methods; Modeling; Modification; National Institute of Mental Health; Outcome; Outpatients; Participant; Patient Self-Report; Patients; Persons; Pilot Projects; Population; Population Intervention; Procedures; Psychoses; Psychotic Disorders; Qualitative Methods; Randomized, Controlled Trials; Reproducibility; Research; Research Personnel; Research Project Grants; Research Proposals; Risk Reduction; Sampling; Science; Statistical Methods; Statistical Models; Structure; Suicide; Suicide prevention; Techniques; Testing; Training; Universities; Work; World Health Organization; acceptability and feasibility; clinically relevant; completed suicide; design; emotion dysregulation; emotion regulation; experience; follow-up; health service use; high risk population; improved; intervention effect; medical specialties; multimodality; neglect; patient population; psychosis risk; psychosocial; psychotic; recruit; reducing suicide; response; satisfaction; severe mental illness; showing emotion; skills; skills training; suicidal; suicidal behavior; suicidal risk; temporal measurement; treatment as usual

Project Summary Suicide is an alarmingly common cause of death for people living with psychosis. Conservative estimates suggest that at least 5% of people with psychotic spectrum disorders complete suicide, accounting for approximately 11% of suicides worldwide or nearly 100,000 suicides each year. The absolute risk of suicide remains high even for people who are engaged in specialty psychosis treatment, and interventions that have been designed specifically to prevent suicide in people with psychosis have shown limited impact. One important suicidogenic factor for people with psychosis is emotion dysregulation, which is the failure to regulate emotion resulting in problematic emotional states. Emotion dysregulation is a core feature of psychotic disorders and yet this factor is commonly neglected in treatments provided to this population. Research has shown that emotion dysregulation is closely linked to suicide in people with psychosis and emotion regulation is a primary target of some of the best-established and most effective psychosocial interventions for suicidality in other populations, most notably Dialectical Behavior Therapy (DBT), but relevant clinical trials routinely exclude people with psychosis. The goal of this K23 is to conduct a prepilot and pilot randomized controlled trial of group DBT skills training (DBT-ST), an intervention that targets emotion regulation, in a sample of people with psychosis and heightened suicidality. This pilot study would allow us to determine feasibility, acceptability, and obtain preliminary estimates of the impact of DBT-ST on key outcomes. A critical component of this work is the use of a rigorous methodology for measuring emotion dysregulation. Such measurement has seen advances in recent years in the form of ecological momentary assessment (EMA) which enables the direct statistical modeling of emotion dysregulation without reliance on retrospective self-report. To further increase rigor and reproducibility, we propose to pair such ecological measurements with qualitative assessments of participant experiences of EMA data collection to aid in the construction and interpretation of sophisticated statistical models of emotion dysregulation in psychosis that account for non-random missingness as well as exogenous variables that may confound measurement of the impact of DBT on emotion dysregulation. This mixed methods approach will allow us to better assess how DBT-ST might improve emotion regulation in people with psychosis. The proposed study will pave the way for a larger trial evaluating whether treatment of emotion dysregulation can decrease suicide risk in psychosis. The above research proposal will be carried out within the University of Maryland Division of Psychiatric Services Research—an institution with a strong track record of successful clinical trials research with people with serious mental illness—and will be paired with mentorship and training in the areas of (1) the conduct of experimental clinical trials with serious mental illness, (2) suicide-focused clinical research, and (3) the multimodal measurement and modeling of intervention effects.

项目摘要 自杀是精神病患者死亡的一个惊人的常见原因。保守估计表明， 至少5%的精神病谱系障碍患者完成自杀，约占自杀总数的11%。 全球每年有近10万人自杀。自杀的绝对风险仍然很高，即使是那些 从事专业精神病治疗，以及专门为预防自杀而设计的干预措施， 对精神病患者的影响有限。 对于精神病患者来说，一个重要的自杀因素是情绪失调， 导致有问题的情绪状态的情绪。情绪失调是精神障碍的核心特征， 然而，在向这一群体提供的治疗中，这一因素通常被忽视。研究表明，情绪 在精神病患者中，情绪调节障碍与自杀密切相关，而情绪调节是一些 对其他人群中自杀行为的最佳和最有效的心理社会干预， 辩证行为疗法（DBT），但相关的临床试验通常排除精神病患者。这个目标 K23是进行一项预试验和试点随机对照试验的小组DBT技能培训（DBT-ST），干预 针对情绪调节，在一个有精神病和高度自杀倾向的人的样本中。这项试点研究将 使我们能够确定可行性，可接受性，并获得DBT-ST对关键 结果。 这项工作的一个关键组成部分是使用严格的方法来测量情绪失调。等 近年来，生态瞬时评估（EMA）的形式取得了进展， 能够直接对情绪失调进行统计建模，而不依赖于回顾性自我报告。进一步 为了增加精确性和可重复性，我们建议将这种生态测量与对 EMA数据收集的参与者经验，以帮助构建和解释复杂的统计 解释非随机缺失和外生变量的精神病情绪失调模型 这可能会混淆DBT对情绪失调的影响的测量。这种混合方法将 使我们能够更好地评估DBT-ST如何改善精神病患者的情绪调节。拟定研究 这将为一项更大规模的试验铺平道路，该试验评估情绪失调的治疗是否可以降低自杀风险。 精神病 上述研究计划将在马里兰州大学精神病学服务部内进行 研究-一个具有成功的临床试验研究与严重精神疾病患者的良好记录的机构 疾病，并将与指导和培训领域配对（1）进行实验性临床试验， 严重精神疾病，（2）以自杀为重点的临床研究，（3）多模态测量和建模， 干预效果。