Augmenting hospitalization for SMI by targeting interpretation bias

项目摘要 国家卫生研究所战略目标4指出，“慢性残疾..”严重精神疾病（SMI）需要一个 快速反应”。大约4.1%的美国成年人符合精神疾病SMI的标准 与严重的功能障碍有关。即使有效，药理学和心理学 治疗通常会使患有SMI的个体留下残留症状、损伤，并处于再发的风险中。 住院和自杀。住院后的一个月是特别危险的时期;因此， 治疗可以在短暂的住院期间加速改善，并为门诊患者提供桥梁 迫切需要护理。因此，我们建议发展一种增强精神病医院护理的方法（称为“I- 变化”），出院后可以在家中继续。I-Change目标解释偏差， 倾向于消极地解决模棱两可的情况。口译偏见是一种公认的认知偏见， 易受精神病理学的影响，并与不良的情绪调节、沉思、症状 严重程度和自杀意念例如，在我们的精神病医院样本中， 入院占治疗反应方差的28%，并预测自杀意念， 出院，入院时控制意念。尽管一些现有的治疗针对这种机制， 最著名的是认知行为疗法（CBT），他们要求个人能够认识到他们的 自动解释，并使用复杂的技术来重新评估它们。患有SMI的个人， 出现严重到需要住院治疗的症状通常是难治性的， 在应用这些技术时遇到了特别的困难。因此，至关重要的是， 有效打击这个目标。在过去的14年里，PI开发并验证了一项培训任务， 利用重复和反馈来加强更健康的解释风格。电脑版的 任务对于SMI人群是可接受的，并且在患者中导致比安慰剂任务更好的治疗应答 在基线时表现出解释偏倚的患者。我们试图将这一任务发展成为一个个性化的智能手机 进行干预。我们将利用智能手机技术来提高技能的获得和推广 通过提高用户参与度并提示患者在设定的时间完成会话， 剂量和时间间隔。我们将进行一项开放试验（n = 16）和随机对照试验（n = 64），以确定目标 参与度（改善解释偏差），评估交付I的可行性和可接受性， 从部分医院出院期间和出院后的变化，并检查临床结局（全球 改进、运作）与口译方面的变化有关。我们希望I-Change能够改变对 偏倚，SMI患者可接受，并导致与症状相比更大的总体改善 跟踪控制。结果将支持完全把握度的R 01有效性试验。

Project Summary NIMH Strategic Objective 4 states that the “chronic disability ... of Serious Mental Illnesses (SMI)...demands a rapid response.” Approximately 4.1% of the adult US population meets the criteria for SMI, a mental disorder associated with significant functional impairment. Even when effective, pharmacologic and psychological treatments often leave individuals with SMI with residual symptoms, impairment, and at risk for re- hospitalization and suicide. The month following hospitalization is a particularly risky time; thus, augmentation treatments that can speed up improvement during brief hospital stays, as well as provide a bridge to outpatient care are urgently needed. Thus, we propose to develop an augmentation to psychiatric hospital care (called “I- Change”) that can be continued at home following discharge. I-Change targets interpretation bias, the tendency to resolve ambiguous situations negatively. Interpretation bias is a well-established cognitive vulnerability for psychopathology and is associated with poor emotion regulation, rumination, symptom severity, and suicidal ideation. For example, in our psychiatric hospital sample, interpretation bias upon admission accounted for 28% of the variance in treatment response, and predicted suicidal ideation at discharge, controlling for ideation at admission. Although some existing treatments target this mechanism, most notably Cognitive Behavioral Therapy (CBT), they require individuals to be able to recognize their automatic interpretations and use complex techniques to reappraise them. Individuals with SMI who are experiencing symptoms acute enough to require hospitalization are often treatment refractory and may experience particular difficulty applying these techniques. It is therefore critical to more efficiently and effectively engage this target. Over the past 14 years, the PI has developed and validated a training task that utilizes repetition and feedback to reinforce a healthier interpretive style. The computer-delivered version of the task was acceptable to an SMI population and led to better treatment response than a placebo task in patients who exhibited interpretation bias at baseline. We seek to develop this task into a personalized smart-phone delivered intervention. We will harness smart-phone technology to enhance skill acquisition and generalization by improving user engagement and prompting patients to complete a session at set times to ensure adequate dosage and spacing of sessions. We will conduct an open trial (n = 16) and RCT (n = 64) to confirm target engagement (improvement in interpretation bias), evaluate the feasibility and acceptability of delivering I- Change during and following discharge from a partial hospital, and examine clinical outcomes (global improvement, functioning) related to changes in interpretation. We expect that I-Change will shift interpretation bias, be acceptable to patients with SMI, and lead to greater global improvement compared to a Symptom Tracking control. Results will support a fully-powered R01 effectiveness trial.