A Novel Cognitive Remediation Intervention Targeting Poor Decision-Making and Depression in Veterans at High Risk for Suicide: A Safe,Telehealth Approach During the COVID-19 Pandemic

项目总结 尽管在全国范围内努力更好地解决自杀行为(定义为思想和 行为)，在患有严重抑郁障碍(MDD)的高危退伍军人中，制定 针对患有MDD的退伍军人中与自杀相关的一些关键危险因素仍然有限。也就是说，虽然 许多干预研究继续研究认知行为疗法(CBT)等治疗方法 自杀风险相关的靶向行为模式、情绪处理问题和认知方式 MDD，作为CBT靶点的神经认知底物的缺陷仍然没有得到很好的解决。 认知矫正(CR)和康复治疗长期以来一直是其他疾病患者的主要治疗方法 精神疾病，如精神分裂症，用于改善认知功能和促进认知转移 日常运作的技能。然而，很少有工作研究解决神经认知问题的认知障碍 MDD患者自杀行为的潜在缺陷。经验性工作确定了关键高管 可能是有自杀行为的MDD患者特有的功能(EF)缺陷，以及荟萃分析工作 提示CR对MDD患者的认知功能、抑郁和日常功能有中等程度的影响。 因此，该领域迫切需要研究CR作为MDD的一种面向康复的治疗方法 有自杀危险的病人。 这项拟议的研究旨在收集试点数据，以测试附加语的可行性和可接受性 新冠肺炎治疗期间通过远程医疗提供的关键治疗靶点的神经可塑性CR 36例有自杀未遂病史的退伍军人样本(S)具体地说，它将测试 辅助性循证认知补救(CR)疗法(照常作为治疗的辅助疗法)得到加强 通过关于认知控制和决策/问题的转移和实践的手工“搭桥”会议-- 解决现实世界情况和问题的策略，包括那些引发自杀念头的策略。我们 建议将神经心理学教育方法应用于认知补救(NEAR，简称 CR+桥接课程，CR+桥接)共36名患有MDD并有自杀史的退伍军人 尝试(S)。干预将分20次进行，每次90分钟(每周2次，为期10周)。前处理 将对神经认知、临床、社交和现实世界功能进行评估，包括 考察新冠肺炎及其随之而来的“社交距离”限制影响的措施。邮寄- 将对相同目标进行治疗评估，以确定临床反应和可行性。 在干预结束后立即(第10周)和在以下时间进行的治疗干预- 向上评估(第20周)。该应用程序是新颖的，因为它构成了该应用程序的第一个实现 对患有MDD和自杀行为的退伍军人进行干预。与RR&D的尖顶机制一致，这 学习是高风险的，但它具有很高的潜在影响，并有望帮助改善退伍军人的生活质量 自杀的风险很高。

PROJECT SUMMARY Despite large-scale, nationwide efforts to better address suicidal behavior (defined as thoughts and behavior) in high-risk Veterans with major depressive disorder (MDD), the development of interventions that target some of the key risk factors associated with suicide in Veterans with MDD remains limited. That is, while much intervention research continues to investigate treatments like cognitive behavioral therapy (CBT) that target behavioral patterns, emotion processing problems, and cognitive styles associated with suicide risk in MDD, deficits in the neurocognitive substrates that underlie these CBT targets remain under-addressed. Cognitive remediation (CR) and rehabilitation have long been a primary treatment for patients with other psychiatric illnesses, like schizophrenia, for improving cognitive functioning and facilitating transfer of cognitive skills to every-day functioning. However, scant work has examined CR that addresses the neurocognitive deficits underlying suicidal behavior in individuals with MDD. Empirical work has identified key executive functioning (EF) deficits that may be specific to MDD patients with suicidal behavior, and meta-analytic work indicates that CR has moderate effect sizes on cognitive functioning, depression, and daily functioning in MDD. Thus, the field is in dire need of work that examines CR as a recovery-oriented treatment approach for MDD patients at risk for suicide. The proposed study aims to collect pilot data to test the feasibility and acceptability of adjunctive neuroplasticity-based CR on key treatment targets delivered via telehealth during this time of COVID-19 in a sample of 36 Veterans with MDD and a history of suicide attempt(s). Specifically, it will test the effects of an adjunctive evidence-based cognitive remediation (CR) therapy (adjunctive to treatment as usual) augmented with manualized “Bridging” sessions on transfer and practice of cognitive control and decision-making/problem- solving strategies for real-world situations and problems, including those that trigger suicidal thoughts. We propose to administer the Neuropsychological Educational Approach to Cognitive Remediation (NEAR, termed CR plus “Bridging” session, CR+Bridging) to a total of 36 Veterans with MDD and a history of suicide attempt(s). The intervention will be delivered in 20 90-minute sessions (2x/week for 10 weeks). Pre-treatment assessments of neurocognitive, clinical, social, and real-world functioning will be conducted, including measures that examine the impact of COVID-19 and its accompanying “social-distancing” restrictions. Post- treatment assessments of the same targets will be conducted to determine clinical response to and feasibility of this therapeutic intervention immediately following conclusion of the intervention (Week 10) and at a follow- up assessment (Week 20). This application is novel in that it constitutes the first implementation of this intervention in Veterans with MDD and suicidal behavior. Consistent with RR&D’s SPiRE mechanism, this study is high risk, but it has high potential impact and promise to help improve quality of life for Veterans at high risk for suicide.