Computerized Intervention for Anxiety Sensitivity Cognitive Concerns

描述(申请人提供)：美国目前的自杀死亡率是15年来最高的。新的证据表明，焦虑敏感性(AS)的一个组成部分，特别是认知担忧(ASCC)是自杀倾向上升的危险因素。ASCC指的是对唤醒的恐惧导致精神上的丧失能力。ASCC与自杀意念(SI)有关 各种各样的人群，包括创伤后应激障碍患者、空军学员和吸烟者。另一项单独的研究表明，通过认知行为干预，AS是可塑性的。此外，这些效果可以通过简短的计算机化干预来实现，而且这些好处似乎在几年内保持不变。然而，目前的AS减少方案几乎完全集中在AS的物理方面(即，唤醒导致物理灾难)。ASCC可能代表与物理AS不同的结构，因此需要进行特定的干预，这有几个原因。首先，ASCC与抑郁症的关系最密切，而由于身体上的担忧更多地与焦虑状况有关，如恐慌症。第二，ASCC升高的个体表现为SI升高，而ASCC升高的个体表现为降低的SI。因此，先前AS干预的效果可能与降低SI无关，需要有针对性的ASCC干预。这项拟议的研究旨在为PI提供心理生理学评估[特别是脑电/事件相关电位(EEG/ERP)]、自杀和设计/执行临床试验的增量培训。学习EEG将允许根据NIMH的研究领域标准(RDoC)倡议进行多级别评估，自杀是一个紧迫的主要公共卫生负担。在这项拟议的研究中，大约60名ASCC和SI升高的个体将随机接受最近开发的单次主动ASCC干预或健康生活控制干预。该项目的第一个具体目标是确定是否可以通过这种短暂的ASCC干预来降低SI升高的样本中的ASCC。下一个具体目标是通过脑电测量，检查高ASCC个体和低ASCC个体在以ASCC威胁性短语为特征的情绪闪现任务中是否表现出不同的恐惧特定事件相关电位(ERP)。为了实现这一具体目标，我们还将招募15名ASCC缺失者/最低限度ASCC患者。一个相关的目的是评估计算机化干预是否导致干预后AN380和P1ERP的减少(在以前的工作中，这两个因素显示出区分个体的高和低)。第三个目标是确定这种干预是否会随着时间的推移导致SI的减少(一个月和四个月的随访)。最终目的是确定ASCC的减少是否会导致SI的减少。通过研究SI升高的样本中对ASCC的简单治疗，这项研究将提供关于如何快速有效地降低ASCC并潜在地预防/改善SI的关键知识。

DESCRIPTION (provided by applicant): Death by suicide in the US is currently at its highest rate in 15 years. Emerging evidence indicates that one component of anxiety sensitivity (AS), specifically cognitive concerns (ASCC) is a risk factor for elevated suicidality. ASCC refers to fear of arousal leading to mental incapacitation. ASCC is associated with suicidal ideation (SI) in a wide variety of populations including patients with post-traumatic stress disorder, air force cadets, and cigarette smokers. A separate line of study has revealed that AS is malleable through cognitive-behavioral interventions. Moreover, these effects can be achieved through brief computerized interventions and the benefits appear to be maintained over several years. However, current AS reduction protocols focus almost exclusively on the physical concerns facet of AS (i.e., arousal leading to physical catastrophe). There are several reasons why ASCC may represent a distinct construct from physical AS and thus warrant a specific intervention. First, ASCC are most closely associated with depression, whereas, AS physical concerns are more associated with anxiety conditions such as panic disorder. Second, individuals with elevated ASCC show elevated SI, whereas individuals with elevated AS physical concerns show reduced SI. Therefore, the effects of previous AS interventions may not be relevant to reducing SI and a targeted ASCC intervention is needed. The proposed study was designed to provide incremental training to the PI in psychophysiological assessment [specifically electroencephalogram/event related potential (EEG/ERP)], suicidology, and designing/executing a clinical trial. Learning EEG will allow for multilevel assessment in line with NIMH's Research Domain Criteria (RDoC) initiative and suicide is an urgent major public health burden. In the proposed study, approximately 60 individuals with elevated ASCC and SI will be randomized to receive either a recently developed one-session active ASCC intervention or a healthy living control intervention. The first specific aim of the project is to determine if ASCC can be reduced among a sample with elevated SI via this brief ASCC intervention. The next specific aim is to examine if high and low ASCC individuals show differential fear-specific event related potentials (ERP) to an emotional stroop task featuring ASCC threatening phrases using EEG measurement. To address this specific aim we will also recruit 15 individuals with absent/minimal ASCC. A related aim is to assess if the computerized intervention leads to reduced AN380 and P1 ERPs post-intervention (which have shown to differentiate high versus low AS individuals in previous work). The third aim is to determine whether this intervention leads to reduction in SI over time (one and four month follow ups). The final aim is to determine if reductions in ASCC mediate reductions in SI. By examining a brief treatment for ASCC in a sample with elevated SI, this study will provide critical knowledge regarding how to quickly and effectively reduce ASCC and potentially prevent/ameliorate SI.