A Novel Cognitive Reappraisal Intervention for Suicide Prevention

摘要 本项目的目标是改进和测试一种新的基于情绪调节的心理社会干预。 旨在降低已出院的中老年人(50-90岁)的自杀风险 在与自杀有关的住院治疗(即自杀意念或自杀未遂)之后。这一群体的自杀率 高得令人震惊，降低高危人群的自杀率是NIMH的主要优先事项。 我们开发了一种新的心理社会干预方法，称为自杀的认知重估干预 预防(CRISP)，旨在改善认知重新评估(即将对情况的评估修改为 改变其情感意义)(目标)，并降低自杀风险(结果)。我们的概念框架视图 自杀意念和行为是调节负面情绪和改善认知的失败尝试 重新评估，这是一种有效的情绪调节策略，我们预计可以降低自杀风险。我们的理论得到了支持 研究表明，不成功的控制负面情绪的尝试会降低认知能力 重新评估与自杀念头和行为的增加有关。 R61阶段是原则验证阶段，其目标是优化CRISP并测试其参与度 进行认知重新评估。注册社会工作者将管理6到12周的CRISP到30 中老年人(50-90岁)因自杀住院后。研究助理， 在不知道研究目的的情况下，将在研究开始(入院)、出院、6和12岁时进行评估 出院后数周。将使用皮层测量(即晚期阳性)来评估目标参与度 潜在)和自我报告的情绪在一个新的认知重新评估范式。 R33阶段旨在提供优化CRISP在更大范围内目标交战的进一步证据 样本，评估认知再评价与哥伦比亚自杀测量的自杀风险之间的关系 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。一个 75名中老年人的不同样本(使用与R61相同的纳入/排除标准 阶段)将随机(4比1)到CRISP(N=60)或支持疗法(ST，对照治疗不是 旨在改善情绪调节)(N=15)。评估将在入院、出院时进行， 出院后6周、12周、24周。主要目标是：1)干净利落的参与者将在 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 与超过24周的自杀风险有关。

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.