A Novel Cognitive Reappraisal Intervention for Suicide Prevention

摘要 这个项目的目标是完善和测试一种新的情绪调节为基础的心理社会干预 旨在降低已出院的中老年（50-90岁）自杀风险 自杀相关住院后（即自杀意念或自杀企图）。该组的自杀率 自杀率高得惊人，降低高危人群的自杀率是NIMH的一个主要优先事项。 我们开发了一种新的心理社会干预，称为“自杀认知重新评估干预 预防（CRISP）”，旨在改善认知重新评估（即修改对情况的评估， 改变其情绪意义）（目标），并降低自杀风险（结果）。我们的概念框架观点 自杀意念和行为作为失败的尝试，以调节负面情绪，并通过改善认知 重新评价是一种有效的情绪调节策略，我们希望减少自杀风险。我们的理论得到了 研究表明，不成功的调节负面情绪的尝试和认知能力的下降， 重新评价与自杀意念和行为的增加有关。 R61阶段是原理验证阶段，其目标是优化CRISP并测试其参与度 认知重新评估。注册社会工作者将管理6或12个每周会议的CRISP到30 中年和老年人（50-90岁）在自杀相关住院后。研究助理， 不知道研究目的，将在研究入组（住院）、出院、6和12时进行评估 出院后几周。将使用皮层电测量（即晚期阳性）评估靶点接合 潜在的，LPP）和自我报告的影响在一个新的认知重新评价范式。 R33阶段旨在提供优化的CRISP在更大范围内靶向接合的进一步证据。 样本，评估认知重新评估与自杀风险的关系，以哥伦比亚自杀为衡量标准 严重程度评定量表-C-SSRS和估计大规模临床试验的实施参数。一 75名中年和老年人的不同样本（使用与R61相同的入选/排除标准 阶段）将随机（4比1）接受CRISP（N=60）或支持治疗（ST，一种对照治疗， 改善情绪调节）（N=15）。评估将在入院时、出院时、 以及出院后6、12和24周。主要目标是：1）CRISP参与者将在以下方面有所改善： 从出院到治疗结束的认知重新评估;和2）认知重新评估的改善将是 与24周内的自杀风险相关。

ABSTRACT The goal of this project is to refine and test a novel emotion-regulation based psychosocial intervention designed to reduce suicide risk in middle-aged and older adults (50-90 years old) who have been discharged after a suicide-related hospitalization (i.e. for suicidal ideation or suicide attempt). Suicide rates in this group are alarmingly high, and reducing suicide rates in at-risk populations is a major NIMH priority. We developed a novel psychosocial intervention called “Cognitive Reappraisal Intervention for Suicide Prevention (CRISP),” which aims to improve cognitive reappraisal (i.e. modifying the appraisal of a situation to alter its emotional significance) (target), and reduce suicide risk (outcome). Our conceptual framework views suicidal ideation and behavior as failed attempts to regulate negative emotions and by improving cognitive reappraisal, an effective emotion regulation strategy, we expect to reduce suicide risk. Our theory is supported by studies showing that unsuccessful attempts to regulate negative emotions and decreased cognitive reappraisal are associated with increased suicidal ideation and behavior. The R61 phase is a proof-of-principle phase and its goals are to optimize CRISP and test its engagement with cognitive reappraisal. Certified social workers will administer 6 or 12 weekly sessions of CRISP to 30 middle-aged and older adults (50-90 years old) after a suicide-related hospitalization. Research assistants, unaware of the study aims, will conduct assessments at study entry (hospital admission), discharge, 6 and 12 weeks post-discharge. Target engagement will be assessed with electrocortical measures (i.e. late positive potential, LPP) and self-reported affect during a novel cognitive reappraisal paradigm. The R33 phase aims to provide further evidence of target engagement of the optimized CRISP in a larger sample, evaluate the relationship of cognitive reappraisal with suicide risk as measured with Columbia Suicide Severity Rating Scale-C-SSRS and estimate implementation parameters for a large-scale clinical trial. A different sample of 75 middle-aged and older adults (using the same inclusion/exclusion criteria as for the R61 phase) will be randomized (4 to 1) to CRISP (N=60) or to Supportive Therapy (ST, a control treatment not designed to improve emotion regulation) (N=15). Assessments will be conducted on admission, at discharge, and at 6, 12 and 24 weeks post-discharge. Primary aims are: 1) CRISP participants will show improvement in cognitive reappraisal from discharge to end of treatment; and 2) improvement in cognitive reappraisal will be associated with suicide risk over 24 weeks.