EMERGE: Ecological Momentary Evaluation of Responses to Gain/Loss and Emotions

EMERGE：对得失和情绪反应的生态瞬时评估

• 批准号: 10573213
• 负责人: Katherine Lee Dixon-Gordon
• 金额: $ 38.48万
• 依托单位: UNIVERSITY OF MASSACHUSETTS AMHERST
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-15 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10573213
• 关键词: Accident and Emergency department; Accounting; Affective; Age; Arousal; Award; Behavior; Behavior Therapy; Borderline Personality Disorder; Cause of Death; Cessation of life; Clinical; Cognitive; Complex; Computer Models; Data; Decision Making; Distal; Ecological momentary assessment; Emotional; Emotions; Evaluation; Feedback; Feeling suicidal; Functional disorder; Future; Goals; Health; Impairment; Individual; Intervention; Joints; Knowledge; Laws; Learning; Life; Link; Maps; Measures; Medical; Methods; Mission; Modeling; Nature; Outcome; Participant; Patient Self-Report; Patients; Pattern; Persons; Physiological; Populations at Risk; Prevention; Process; Psychiatry; Psychological reinforcement; Psychopathology; Punishment; Research; Rewards; Risk; Risk Factors; Risk Marker; Sampling; Severities; Suicide; Suicide prevention; Testing; Time; United States National Institutes of Health; Work; behavior measurement; biomarker identification; clinical risk; cognitive process; experience; follow-up; high risk; high risk population; improved; indexing; innovation; mindfulness; morphogens; mortality; novel; prospective; recruit; reducing suicide; remediation; response; societal costs; suicidal; suicidal act; suicidal behavior; suicidal individual; suicidal patient; suicidal risk; suicide rate; therapy development

PROJECT SUMMARY/ABSTRACT Suicide is a leading cause of death worldwide, accounting for nearly 800,000 deaths each year.1,2 Suicide rates continue to increase in the U.S.3 Most research on suicide risk factors has identified static, dispositional factors.4 These data inform us about groups at actuarial risk, but do very little to predict with useful precision when people will have suicidal thoughts or act on suicide thoughts. Thus, there is an urgent need to identify proximal risk factors for suicide risk. Two of the leading factors distally associated with increased suicide risk are dysfunctional emotional responses5 and decision-making deficits.6 Suicidal individuals have poorer reinforcement learning,6,7 demonstrating impaired ability to learn and modify behavior in response to reward and punishment. Individuals at high risk for suicide (i.e., borderline personality disorder) also show difficulties learning from punishment and reward,8,9 and the PI’s data show that negative emotions uniquely impair learning in such high-risk populations relative to healthy and clinical controls.10 It is necessary to understand the interactive effects of emotion and reinforcement learning as factors elevating near-term risk for suicidal thoughts and behaviors. Therefore, the proposed study examines both emotional and cognitive processes associated with suicidal thoughts and behaviors among 170 patients with a range of suicidal risk recently treated in an emergency department for a suicidal crisis. Using innovative ecological momentary assessment methods (EMA), the proposed study will examine behavioral measures of reinforcement learning and both physiological and subjective measures of momentary emotions. Aim 1 identifies the main and interactive effects of emotional responses, reinforcement learning, and emotion-related decrements in learning on recent suicidal thoughts and behaviors among suicidal patients recently seen in the emergency department. Aim 2 examines how emotions and learning interact to predict momentary suicidal thoughts and behaviors over four weeks. Aim 3 tests emotion- related decrements in learning as prospective predictors of future suicide risk over a six-month follow-up. The research team (PI: Dixon-Gordon, Co-Is: Ammerman, Boudreaux, Rathlev; Consultants: Hackel; Collaborator: Laws) has access to world-class expertise, with extensive experience recruiting suicidal participants from medical settings, EMA, computational modeling, and experimental psychopathology. The most important challenge facing suicide prevention today is unraveling the complex emotional and cognitive proximal drivers that transform nascent suicide risk into action. Combining state-of-the-art behavioral measures and EMA, we will tease apart the complex longitudinal relations between dysfunctional emotional responses, reduced capacity to learn from reward and punishment, and fluctuations in suicidal thoughts and behaviors. Given the high societal costs of suicide, this work has important health significance. Findings will inform the development of treatments that target emotion dysfunction and learning in samples at-risk for suicide.

项目总结/摘要 自杀是全世界死亡的主要原因，每年造成近80万人死亡。 在美国，自杀率继续上升。3大多数关于自杀风险因素的研究已经确定了静态， 4这些数据告诉我们关于精算风险的群体，但对预测有用的信息很少。 准确的人会有自杀的想法或自杀的想法。因此，迫切需要 确定自杀风险的近端风险因素。 与自杀风险增加相关的两个主要因素是功能失调的情绪， 6自杀者的强化学习能力较差，6，7 表现出对奖励和惩罚的学习和改变行为的能力受损。个人 处于自杀的高风险（即，边缘型人格障碍）也表现出从惩罚中学习的困难， 奖励，8，9和PI的数据表明，负面情绪独特地损害了这些高危人群的学习 相对于健康和临床对照。10有必要了解情绪和 强化学习是提高自杀想法和行为的近期风险的因素。 因此，拟议的研究探讨了与自杀有关的情感和认知过程， 170例近期接受急诊治疗的有自杀风险的患者的想法和行为 自杀危机部门。利用创新的生态瞬时评估方法（EMA）， 拟议的研究将检查强化学习的行为措施，以及生理和 对瞬间情绪的主观测量目标1确定情绪的主要和交互作用 反应，强化学习，和情绪相关的递减学习最近的自杀想法， 最近在急诊科看到的自杀患者的行为。目标2研究情绪如何 和学习互动来预测四周内瞬间的自杀想法和行为。目标3测试情感- 相关的学习减退作为未来自杀风险的前瞻性预测因子超过6个月的随访。 研究团队（PI：Dixon-Gordon，Co-Is：Ammerman，Boudreaux，Rathlev;顾问：Hackel; 合作者：Laws）拥有世界一流的专业知识，拥有招募自杀者的丰富经验， 参与者来自医疗机构，EMA，计算建模和实验精神病理学。 今天预防自杀面临的最重要的挑战是解开复杂的情感和 将新生自杀风险转化为行动的认知近端驱动因素。结合最先进的行为学 措施和EMA，我们将梳理除了复杂的纵向关系，功能失调的情绪 反应，减少从奖励和惩罚中学习的能力，以及自杀想法的波动， 行为。鉴于自杀的社会成本很高，这项工作具有重要的健康意义。发现将 为针对自杀风险样本中情绪功能障碍和学习的治疗方法的开发提供信息。