Skills to Enhance Positivity in Suicidal Adolescents

描述（由申请人提供）：青少年自杀行为的患病率仍然高得令人无法接受。对已发表的针对青少年自杀倾向的随机对照试验（RCT）的综述得出结论，迄今为止的治疗效果最低。干预措施的优势集中在危机干预，潜在的精神障碍，调节负面影响和减少认知扭曲。然而，我们的试点工作和其他最近的数据表明，考虑低积极情感如何独立于其他风险因素而导致自杀风险的重要性，并且可能是导致自杀行为的另一种机制。我们的模型是基于Fredrickson的实验支持的Brochure和Build模型，该模型声称积极影响（PA）的功能包括通过改善社会支持，解决问题和个人弹性来帮助个人茁壮成长。这些领域中的每一个都有助于减少自杀行为。我们认为，PA增加生存直接通过减少自杀意念和间接通过增加社会支持和解决问题。在这项R34治疗开发补助金中，我们寻求开发一种新型的、基于个人技能的PA干预措施，作为常规治疗（TAU）的辅助治疗，针对风险最高的青少年--那些因自杀风险而住院的青少年。我们专注于三种已被证明可以增加社区和抑郁成年人可持续（与短暂）PA的策略：冥想，感恩和品味。有几种方法来实践每一种策略;我们考虑到患者的喜好，在个性化的方法中，患者选择最适合他们的需求和情况的做法。我们建议使用多种干预手段，包括他们选择的新技术媒介，以加强体内实践。我们的干预措施，提高积极性的技能计划（STEPP）包括两个阶段：a）在住院期间，面对面阶段包括3个单独的面对面会议和1个联合家长会议，以教授PA技能并制定个性化干预措施; B）远程交付阶段，包括出院后4周内每周电话助推器呼叫和每日短信或电子邮件。电话将用于审查或调整个性化干预组件，并加强技能的使用。文本/电子邮件消息将包括自我脚本提醒练习技能和链接到在线资源。文本与电子邮件传递将基于可访问性和偏好。STEPP将在一项有20名参与者的开放试验中进行测试，并在进一步修订后，在一项试点RCT中进行测试，与TAU在50名青少年样本中进行比较。这种干预的主要目标是让患者通过将技能和实践融入他们正常的家庭日常生活中来增加积极的影响，我们相信这将导致解决问题和社会支持的增加，并减少自杀意念。我们的提案符合NIMH战略目标#3。这是一种通过不同机制（即PA）对高风险急性人群进行的新型干预，在概念上与其他经经验检验的理论方法不同。

DESCRIPTION (provided by applicant): The prevalence of suicidal behaviors in adolescents remains unacceptably high. Reviews of published randomized controlled trials (RCTs) for adolescent suicidality conclude that treatments to date have been minimally efficacious. The preponderance of interventions focus on crisis intervention, underlying psychiatric disorders, regulating negative affect and reducing cognitive distortions. However, our pilot work and other recent data suggest the importance of considering how low positive affectivity contributes to suicide risk independent of other risk factors and may be another mechanism that leads to suicidal behaviors. Our model is based on Fredrickson's empirically-supported Broaden and Build model which asserts that the function of positive affect (PA) includes helping individuals thrive by improving social supports, problem-solving, and personal resilience. Each of these areas is instrumental in decreasing suicidal behavior. We propose that PA increases survival directly by decreasing suicidal ideation and indirectly by increasing social support and problem-solving. In this R34 treatment development grant we seek to develop a novel, individual skills-based, PA intervention, delivered adjunctively to treatment as usual (TAU), targeting the highest risk adolescents - those hospitalized due to suicide risk. We focus on three strategies that have been demonstrated to increase sustainable (vs. transient) PA in community and depressed adults: meditation, gratitude, and savoring. There are several ways to practice each strategy; we take into account patient preferences in a personalized approach in which patients select the practice(s) that fits best with their needs and circumstances. We propose using multiple means of intervention delivery that includes a new technology medium of their choosing, to reinforce in-vivo practice. Our intervention, Skills To Enhance Positivity Program (STEPP) includes two phases: a) in-person phase consisting of 3 individual in-person sessions and 1 joint parent session during the inpatient hospital stay to teach PA skills and develop a personalized intervention; b) remote delivery phase which consists of weekly telephone booster calls and daily text or email messages over 4 weeks post-discharge. The phone calls will be used to review or adjust personalized intervention components and reinforce use of skills. The text/email messages will include self-scripted reminders to practice skills and links to online resources. Text vs. email delivery will be based on accessibility and preference. STEPP will be tested in an open trial with 20 participants, and after further revision, in a pilot RCT, compared to TAU in a sample of 50 adolescents. The primary goal of this intervention is for patients to increase positive affect by incorporating skills and practices into their normal home-based routines, which we believe will lead to increases in problem-solving and social support and decreases in suicidal ideation. Our proposal meets NIMH Strategic Objective #3. This is a novel intervention for a high-risk acute population via a different mechanism (i.e. PA), and conceptually distinct from other empirically examined theoretical approaches.