Target Engagement During Social Reward Psychotherapy for Mid- and Late-Life Suicidality: A Precision Imaging Trial

项目摘要/摘要 自杀率在成年后期很高，女性在中年达到顶峰，男性在晚年达到顶峰。社交 断线也会在晚年达到顶峰，并增加自杀、持续性自杀和对 心理社会干预。我们的提案响应了RFA-MH-22-135，概述了确定 社会脱节与晚年自杀关系的调节机制及其发展 针对这些机制的有效干预措施。 拟议的研究利用了我们团队开发的方法和概念创新，以 一种新的社会奖励心理治疗中正向配价系统(PVS)靶向参与的研究 对中老年自杀的指控。我们设计了Engage&Connect，一种远程提供的心理治疗 通过增加对奖励社交活动的参与度来解决社交脱节的问题。Engage&Connect的目标是 改变可能导致晚年自杀的PVS干扰。在这项研究中，128名年龄在50-80岁之间的成年人 严重抑郁障碍和自杀意念将被随机分配到9周的Engage&Connect或症状 回顾和心理教育(SRP)的积极控制条件。我们将测量PVS的大脑功能和 行为水平，通过静息状态下PVS的功能连接和社会中的行为变化 使用我们新颖的验证STAR任务(用于评估奖励的社交任务)的奖励响应性。我们会 使用尖端的“精确成像”方法来估计每个个体的功能脑图 跟踪治疗对PVS电路的纵向影响。我们严格的方法论方法将使我们 在个体层面上测试心理治疗潜在的基于大脑和行为的机制 这是针对社交脱节的。识别个别患者的生物和行为特征，链接 通过治疗反应，可以指导未来的心理治疗个体化，提高其疗效，达到 易受伤害的老年人有自杀风险。

PROJECT SUMMARY / ABSTRACT Suicide rates are high in late adulthood, peaking in midlife among women and late life among men. Social disconnection also peaks in late life and increases risks of suicide, persistent suicidality, and poor response to psychosocial interventions. Our proposal responds to RFA-MH-22-135, outlining the critical need to identify the mechanisms mediating the relationship between social disconnection and late-life suicidality and develop efficacious interventions to target these mechanisms. The proposed study leverages methodological and conceptual innovations, developed by our team, to investigate target engagement of the Positive Valence System (PVS) during a novel social reward psychotherapy for mid- and late-life suicidality. We designed Engage & Connect, a remotely delivered psychotherapy that targets social disconnection by increasing engagement in rewarding social activities. Engage & Connect aims to alter disturbances of the PVS that may underlie late-life suicidality. In this study, 128 adults aged 50-80 with major depressive disorder and suicidal ideation will be randomized to 9 weeks of Engage & Connect or Symptom Review and Psychoeducation (SRP) active control condition. We will measure PVS functions on brain and behavioral levels, through resting state functional connectivity of the PVS and behavioral changes in social reward responsivity using our novel validated STAR task (Social Task for Assessment of Reward). We will employ a cutting-edge “precision imaging” approach to estimate the functional brain map of each individual and track the longitudinal effects of treatment on PVS circuitry. Our rigorous methodological approach will allow us to test, at the individual level, the brain-based and behavioral mechanisms underlying response to psychotherapy that targets social disconnection. Identification of individual patients’ biological and behavioral profiles, linked with treatment response, can guide future psychotherapy personalization and increase its efficacy and reach to vulnerable older adults at risk of suicide.