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

项目概要/摘要 成年后期的自杀率很高，女性在中年时达到顶峰，男性在晚年时达到顶峰。社会 断开连接也在晚年达到高峰，并增加自杀的风险，持续的自杀倾向，以及对 心理社会干预。我们的提案响应RFA-MH-22-135，概述了识别 调节社会脱节和晚年自杀之间关系的机制， 针对这些机制采取有效的干预措施。 拟议的研究利用了我们团队开发的方法和概念创新， 探讨一种新的社会奖励心理治疗中的正效价系统（PVS）的目标参与 中年和晚年的自杀倾向我们设计了Engage & Connect，一种远程提供的心理治疗， 通过增加对有回报的社会活动的参与来解决社会脱节问题。Engage & Connect旨在 改变可能导致晚年自杀倾向的PVS紊乱。在这项研究中，128名50-80岁的成年人， 重度抑郁症和自杀意念将被随机分配到为期9周的参与和连接或症状 复习和心理教育（SRP）主动控制条件。我们将测量PVS在大脑中的功能， 行为水平，通过PVS的静息状态功能连接和社会行为变化， 奖励反应性使用我们的新验证的星星任务（社会任务评估奖励）。我们将 采用尖端的“精确成像”方法来估计每个人的大脑功能图， 跟踪治疗对PVS电路的纵向影响。我们严谨的方法论将使我们 在个体水平上测试对心理治疗反应的大脑和行为机制 针对社会脱节的问题识别个体患者的生物和行为特征， 治疗反应，可以指导未来的心理治疗个性化，提高其疗效， 易受伤害的老年人有自杀的危险。

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.