Improvements in Mentalizing as a Mechanism of Change in Psychotherapy for Depressed and Suicidal Adolescents

作为美国青少年死亡的第二大原因，青少年自杀是一个重要的原因。 公共卫生问题。最近的一些研究表明，在“心智化”，或能力的缺陷， 对他人的思想、情感、行为和意图做出大致准确的推断， 另一些则与青少年自杀风险有关。一项研究还表明，心理化- 基础治疗降低了青少年非自杀性自伤（NSSI）的发生率。但是没有一 这些研究使用了成人依恋访谈（AAI），这是得出评估结果的金标准 心理化，没有治疗研究已经检查是否改善青少年 心理化降低自杀风险症状（例如， 意念、意图、尝试次数）。拟议研究的目的是确定是否 青少年心理化的改善可以预测整个过程中自杀风险症状的减少 16周的心理治疗本研究有两个具体目标：1）确定青少年是否 心理化在青少年自杀风险的心理治疗过程中得到改善; 2） 确定心理化的改善是否可以预测和介导自杀的改善 风险症状。这项研究将利用最近完成的随机对照试验的二级数据 研究两种治疗青少年自杀风险的方法（基于依恋的家庭治疗和 家庭强化非指导性支持治疗）（N = 129）。两种治疗方法相似 有效降低自杀风险症状。所有青少年完成治疗前和治疗后 AAI，这将被编码为精神化。数据集包括治疗前和治疗后数据 （第0周和第16周）、中点数据（第4、8、12周）和1年随访数据（周 20、32、40、52）。这一丰富的数据集将允许前后测试分析，纵向增长曲线 建模和中介分析。 心理化是社会理解的核心组成部分，与“能力”同义 理解心理状态，”确定了一个关键的NIMH研究领域的子结构，根据 更广泛的概念是“对他人的感知和理解”。实现联合国的目标 拟议的研究将显著影响有关治疗靶点的知识， 这对有自杀风险的青少年尤其重要，并将成为未来的第一步。 R 01提交材料的目的是：1）建立方便提供者的工具，以评估心理化作为 青少年自杀的治疗进展;以及2）完善青少年自杀干预措施， 衡量心理化的改善。

As the second leading cause of death for U.S. teens, adolescent suicide is a significant public health concern. A number of recent studies show that deficits in “mentalizing,” or the ability to make generally accurate inferences about the thoughts, emotions, behaviors, and intentions of others, are linked to adolescent suicide risk. One study also demonstrated that mentalization- based treatment reduced rates of adolescent non-suicidal self-injury (NSSI). However, none of these studies used the Adult Attachment Interview (AAI), the gold standard for deriving estimates of mentalizing, and no treatment studies have examined whether improvements in adolescent mentalizing reductions in suicide risk symptoms (e.g. decreases in frequency and intensity of ideation, intent, number of attempts). The objective of the proposed study is to determine whether improvements in adolescent mentalizing predict suicide risk symptom reduction over the course of 16 weeks of psychotherapy. The study has two specific aims: 1) Determine whether adolescent mentalizing improves over the course of psychotherapy for adolescent suicide risk; and 2) Determine whether improvements in mentalizing predict and mediate improvements in suicide risk symptoms. The study will capitalize on secondary data from a recently completed RCT examining two treatments for adolescent suicide risk (Attachment Based Family Therapy and Family-Enhanced Non-Directive Supportive Therapy) (N = 129). Both treatments were similarly efficacious in reducing suicide risk symptoms. All adolescents completed pre and post-treatment AAIs, which will be coded for mentalizing. The data set includes pre- and post-treatment data (weeks 0 and 16), mid-point data (weeks 4, 8,12), and data through 1-year of follow-up (weeks 20, 32, 40, 52). This rich data set will allow for pre-post-test analyses, longitudinal growth curve modeling, and mediation analyses. Mentalizing is a core component of social understanding and synonymous with the “ability to understand mental states,” identified a key NIMH research domain sub-construct, under the broader construct of “perception and understanding of others. Accomplishing the aims of the proposed study will significantly impact knowledge about a treatment target that may be particularly important for adolescents at risk for suicide and will be a first step towards a future R01 submission aimed at: 1) building provider-friendly tools to assess mentalizing as a marker of treatment progress for youth suicide; and 2) refining youth suicide interventions to target and measure improvements in mentalizing.