Implementation intentions, cognitive abilities and self-harm

自杀是15-29岁人群的第二大死因，每年有近80万人死于自杀（世界卫生组织，2017年）。自残史是最终自杀的最佳预测指标。与许多行为一样（例如，Elliott等人，2015），自残是一个多方面的问题（例如，Rasmussen等人，2012）。然而，众所周知，危急情况（例如，感到绝望）是这种行为的触发因素（O’connor et al., 2013）。因此，需要采取干预措施，为处理这些危急情况提供应对策略。实施意图（imp）最近在这方面显示出希望。情境计划（Gollwitzer, 1999）是一种“如果-那么”计划，它要求人们指定引发不想要的行为（例如，自残）的关键情况，并在心理上将它们与应对策略联系起来（例如，如果我在感到绝望时想要自残，那么我会考虑我的自残会如何使我所爱的人感到不安）。关键情况（IF）的说明用于将该情况的表示编码到记忆中。当遇到特定的危急情况时，这种心理表征就会被激活。特定的危急情境（IF）与应对策略（THEN）之间的心理关联是在危急情境的心理表征被激活后，为确保不发生不良行为而启动适当的反应。从本质上讲，那些通常会促使人们做出不想要的行为的情况，反而会引发人们想要的行为（例如，避免自残）。除了自我报告的结果（如自杀念头）外，还使用客观结果（医院再入院率）来测试imp在长期（干预后6个月）减少自我伤害的程度，从而扩展Armitage等人（2016）的研究结果。据推测，被要求形成imp的患者比没有被要求形成imp的患者自杀率更低。探索自残患者的认知能力概况，这可能有助于解释为什么imp减少了一些患者的自杀结果，而不是其他患者。预计在控制注意力和记忆编码以及长期存储和检索的关键认知能力方面会有变化。确定哪些认知能力可以区分imp降低自杀结果的患者和不降低自杀结果的患者。据推测，关键认知能力的缺陷将区分这两组人。4. 开发提供IMP干预措施的方法，帮助克服影响其有效性的认知缺陷。方法进行一系列随机对照实验。所有在自残事件（故意自残或中毒；Hawton et al., 2003）后连续入住格拉斯哥皇家和伊丽莎白女王医院病房的成年患者（16岁或以上）将有资格参加本研究。格拉斯哥精神病学联络服务处的精神科顾问医生证实，这两家医院每年将向1000名自残病人提供服务，这意味着可以在规定的时间尺度内实现以下规定的样本量（功率分析证实，目标N提供了足够的功率）。

OverviewSuicide is the second leading cause of death among 15-29-year-olds and nearly 800K people die from suicide each year (World Health Organisation, 2017). A history of self-harm is the best predictor of eventual suicide. As is the case for many behaviours (e.g., Elliott et al., 2015), self-harm is a multifaceted problem (e.g., Rasmussen et al., 2012). However, it is well-established that critical situations (e.g., feeling hopelessness) act as triggers for this behaviour (O'Connor et al., 2013). Interventions that provide coping strategies for dealing with these critical situations are therefore required. Implementation intentions (IMPs) have recently shown promise in this regard. ContextIMPs (Gollwitzer, 1999) are 'IF-THEN' plans that require people to specify critical situations that trigger unwanted behaviours (e.g., self-harm) and mentally link them with coping strategies (e.g., IF I am tempted to self-harm when I feel hopeless, THEN I will think about how my self-harming would upset my loved ones). The specification of the critical situation (IF) serves to encode a representation of that situation to memory. That mental representation is activated when the specified critical situation is encountered. The mental association between the specified critical situation (IF) and the coping strategy (THEN) serves to initiate a suitable response for ensuring that the unwanted behaviour is not performed when the mental representation of the critical situation has been activated. Essentially, the situations that typically prompt unwanted behaviours become triggers, instead, for desirable courses of action (e.g., avoidance of self-harm).Aims1. To test the extent to which IMPs reduce self-harm in the longer-term (6-months post-intervention) using objective outcomes (hospital readmission rates) in addition to self-reported outcomes (e.g., suicidal thoughts) and therefore extend the findings of Armitage et al. (2016). It is hypothesised that suicide-outcomes will be less prevalent in patients who have been asked to form IMPs than in patients who have not.2. To explore the profiles of cognitive abilities within self-harm patients that are likely to help explain why IMPs reduce suicide outcomes for some patients but not others. It is expected that there will be variation in key cognitive abilities that govern attention and memory encoding, as well as long-term storage and retrieval.3. To identify which cognitive abilities distinguish between patients for whom IMPs reduce suicide-outcomes and those for whom they do not. It is hypothesised that deficiencies in key cognitive abilities will distinguish between these two groups. 4. To develop ways of delivering IMP interventions that can help overcome the cognitive deficits that interfere with their effectiveness.MethodologyA series of randomised controlled experiments will be conducted. All consecutive adult patients (aged 16 years or over) admitted to the medical wards of Glasgow Royal and Queen Elizabeth Infirmaries following a self-harm episode (intentional self-injury or poisoning; Hawton et al., 2003) will be eligible for participation in the research. The Consultant Psychiatrist at Glasgow Liaison Psychiatry Service has confirmed that access will be provided to the N > 1000 self-harm patients per year in these two hospitals, meaning that the sample sizes specified below can be achieved within the time-scale (power analyses confirm that the target Ns provide sufficient power).