Dialectical Behavior Therapy for Bipolar Adolescents

描述（由申请人提供）：尽管青少年双相情感障碍的发病率和死亡率很高，但迄今为止还没有经验验证的心理社会干预措施。这个指导以患者为导向的研究职业发展奖的目的是使候选人能够开发一个研究计划，将临床，发展和神经生物学方法整合到双相情感障碍青少年的情感失调评估和治疗中。拟议的研究计划的重点是治疗开发和初步调查，以家庭为基础的心理社会干预，针对青少年双相情感障碍。干预将包括年龄-和 辩证行为疗法（Dialectical Behavior Therapy，DBT）是一种针对成年人的循证治疗，专注于提高情绪调节技能。以家庭为基础的DBT的可行性和有效性将在拟议的开放试验中进行研究。本研究将在西部精神病研究所和诊所的儿童和青少年双相情感服务诊所进行。60名患有双相情感障碍的青少年（12-18岁）将接受以家庭为基础的DBT。据推测，DBT将是可行的，提供和接受这一人群，并将与改善情绪调节，情绪 随访1年以上的精神病学和心理社会功能。探索性分析将检查治疗应答的预测因素。将寻求以下方面的培训：1）青少年发育，2）情感调节的神经生物学，3）儿童双相情感障碍的药物管理，4）纵向治疗结果数据分析的统计方法。这种培训活动将支持研究计划，通过提高候选人的能力，开发，交付和评估结果的干预，包括多学科的方法来调节情绪。培训和研究计划共同支持候选人的长期目标，即建立一个针对双相情感障碍青少年的多学科创新治疗研究计划。在这一领域的进一步研究具有重要的公共卫生意义，因为它有可能减少与早发性双相情感障碍相关的不良结局，包括进入成年期的恶化过程，慢性心理障碍，治疗抵抗和自杀倾向。

DESCRIPTION (provided by applicant): Despite the substantial morbidity and mortality associated with bipolar disorder in adolescence, there are no empirically validated psychosocial interventions for this population to date. The purpose of this Mentored Patient-Oriented Research Career Development Award is to enable the candidate to develop a program of research that integrates clinical, developmental, and neurobiological approaches to the assessment and treatment of affective dysregulation for adolescents with bipolar disorder. The proposed research plan focuses on treatment development and preliminary investigation of a family-based psychosocial intervention targeting affective dysregulation for adolescents with bipolar disorder. The intervention will include age- and illness-related modifications to Dialectical Behavior Therapy (DBT), an evidence-based treatment for adults focused on enhancing emotion regulation skills. Feasibility and efficacy of Family-Based DBT will be examined in the proposed open pilot trial. The study will be conducted at the Child and Adolescent Bipolar Services clinic at Western Psychiatric Institute and Clinic. Sixty adolescents (age 12-18) with bipolar disorder will receive Family-Based DBT. It is hypothesized that DBT will be feasible to deliver and acceptable to this population, and will be associated with improvements in affect regulation, mood symptomatology, and psychosocial functioning over one-year follow-up. Exploratory analyses will examine predictors of treatment response. Training will be sought in: 1) adolescent development, 2) the neurobiology of affect regulation, 3) pharmacological management of pediatric bipolar disorder, and 4) statistical methods for analyzing longitudinal treatment-outcome data. Such training activities will support the research plan by enhancing the candidate's ability to develop, deliver, and assess outcomes for the intervention that incorporate a multidisciplinary approach to emotion regulation. Together, the training and research plans support the candidate's long-term goal of establishing a multidisciplinary program of innovative treatment research targeting affective dysregulation among adolescents with bipolar disorder. Further research in this area is of significant public health importance, as it has the potential to decrease poor outcomes associated with early-onset bipolar disorder, including a deteriorative course into adulthood, chronic psychosocial impairment, treatment resistance, and suicidality.