Causal Mechanisms Underlying Social Pain and Suicidal Behaviors: Examining the Role of Altered Decision-making and Psychophysiological Reactivity

项目概要/摘要 这个F32奖学金项目和培训计划的目标是准备候选人独立 开展创新研究，旨在提高我们对自杀风险的认识， 高风险人群的行为（SB）。尽管有几十年的自杀风险研究，我们预测和 预防自杀是不够的，24自杀率继续上升。37在18-35岁的年轻人中， 自杀是第二大死亡原因。37拟议的研究对于理解和减少自杀是至关重要的。 在青年期的高风险发展期自杀。社会痛苦和社会排斥是 理论上和经验上与自杀意念和SB相关，但社会机制， 疼痛导致SB在很大程度上未经测试。核心假设是对社会痛苦的适应不良反应 （由感知的长期社会排斥引起）导致决策受损（价值赤字 比较）和钝化的生理反应（钝化的交感神经唤醒和钝化的 为了验证这一假设，虚拟现实（VR） 模拟，SB的有效和安全的实验室代理，39，50将与高灵敏度的 认知和生理唤醒的客观测量。这些机制将在一个 125名最近有自杀意念和/或SB的年轻人（18-35岁）的跨诊断样本。 多方法研究是一个人内交叉设计，其中社会排斥的序列 在参与者之间随机进行操作（排除与中性对照）。参与者完成 决策任务和VR自杀场景与生理评估，以及采访和 自杀风险和社会排斥的自我报告措施，在前，后，和4个月的后续行动。本研究 有两个具体的目标：1）识别认知和生理机制连接社会痛苦， 参与VR SB场景; 2）确定实验室衍生认知和 未来真实世界SB的生理机制和潜在的调节剂（例如，拒绝 敏感性，拒绝的看法）这些协会。我的研究将为2提供因果证据 SB的可改变机制：决策障碍和生理唤醒。这对于 改善我们对SB的评估、预测和治疗。这是实现我的目标的基本步骤。 隔离现实世界中的关键机制并制定有效干预措施的长期目标（例如， 注意力或认知偏差修正，84，85实时生物反馈86）关键时刻的靶向机制 时间点，以减少SB。与拟议的培训和研究计划，候选人将发展 在生理，认知和VR方法学方面的专业知识，以及实践，临床和统计 对高危人群进行自杀风险前沿研究所需的技能。

Project Summary/Abstract The goal of this F32 fellowship project and training plan is to prepare the candidate to independently conduct innovative research aimed at improving our understanding of suicide risk and preventing suicidal behaviors (SB) in high-risk populations. Despite decades of suicide risk research, our ability to predict and prevent suicide is inadequate,24 and suicide rates continue to rise.37 Among young adults ages 18-35, suicide is the 2nd leading cause of death.37 The proposed research is critical to understanding and reducing suicide during the high-risk developmental period of young adulthood. Social pain and social exclusion are theoretically and empirically associated with suicide ideation and SB, but the mechanisms by which social pain leads to SB are largely untested. The central hypothesis is that a maladaptive response to social pain (elicited by perceived chronic social exclusion) leads to impaired decision-making (deficits in value comparisons) and blunted physiological reactivity (blunted sympathetic arousal and blunted parasympathetic withdrawal), which is associated with SB. To test this hypothesis, virtual reality (VR) simulation, a valid and safe laboratory proxy for SB, 39,50 will be used in combination with highly sensitive objective measures of cognition and physiological arousal. These mechanisms will be examined in a transdiagnostic sample of 125 young adults (ages 18-35) with recent suicide ideation and/or SB. This multi-method study is a within-person crossover design, in which the sequence of the social exclusion manipulation (exclusion vs. neutral control) is randomized across participants. Participants complete decision-making tasks and VR suicide scenarios with physiological assessment, as well as interview and self-report measures of suicide risk and social exclusion at pre-, post-, and 4-month follow-up. This study has two specific aims: 1) Identify cognitive and physiological mechanisms linking social pain and engagement in VR SB scenarios; 2) Determine the predictive value of laboratory-derived cognitive and physiological mechanisms for future real-world SB and the potential moderators (e.g., rejection sensitivity, perceptions of rejection) of these associations. My study will provide causal evidence for 2 modifiable mechanisms for SB: impaired decision-making and physiological arousal. This is critical to improving our assessment, prediction, and treatment of SB. This is the fundamental step towards my long-term goal of isolating key mechanisms in the real-world and developing effective interventions (e.g., attentional or cognitive bias modification,84,85 real-time biofeedback86) targeting mechanisms at critical time points to reduce SB. With the proposed training and research plan, the candidate will develop expertise in physiological, cognitive, and VR methodology, as well as the practical, clinical, and statistical skills necessary to conduct cutting-edge research on suicide risk with high-risk populations.