Targeting Emotion Dysregulation to Reduce Suicide in People with Psychosis

项目摘要 对于精神病患者来说，自杀是一种令人担忧的常见死因。保守的估计表明 至少5%的精神病谱系障碍患者完成自杀，约占自杀人数的11% 全世界每年有近10万人自杀。自杀的绝对风险仍然很高，即使对那些 从事专门的精神病治疗，以及专门为防止自杀而设计的干预措施 精神病患者表现出的影响有限。 精神病患者的一个重要自杀因素是情绪失调，这就是无法调节 情绪导致有问题的情绪状态。情绪失调是精神障碍的一个核心特征， 然而，在为这一人群提供的治疗中，这一因素通常被忽视。研究表明，情绪 调节失调与精神病患者的自杀密切相关，情绪调节是一些精神病患者的主要目标 针对其他人群自杀的最成熟和最有效的心理社会干预措施，最值得注意的是 辩证行为疗法(DBT)，但相关的临床试验通常排除精神病患者。这样做的目的是 K23是进行预试者和先导者随机对照试验的小组DBT技能培训(DBT-ST)的一种干预措施 这项研究针对的是精神错乱和高度自杀倾向患者的情绪调节。这项初步研究将 使我们能够确定可行性、可接受性，并获得DBT-ST对KEY影响的初步估计 结果。 这项工作的一个关键组成部分是使用一种严格的方法来衡量情绪失调。是这样的 近年来，测量以生态瞬时评估(EMA)的形式取得了进展， 实现情绪失调的直接统计建模，而不依赖回溯性自我报告。为了进一步 增加严密性和可重复性，我们建议将这种生态测量与对 EMA数据收集的参与者经验，帮助构建和解释复杂的统计 精神病患者情绪失调模型解释非随机性缺失和外生变量 这可能会扰乱对DBT对情绪失调影响的衡量。这种混合方法方法将 使我们能够更好地评估DBT-ST如何改善精神病患者的情绪调节。建议进行的研究 将为一项更大规模的试验铺平道路，该试验评估情绪失调的治疗是否可以降低患者的自杀风险 精神错乱。 上述研究提案将在马里兰大学精神病学服务部内进行 研究-一家在成功的临床试验研究方面有着良好记录的机构，研究对象是患有严重精神疾病的人 疾病--并将与以下领域的指导和培训相结合：(1)开展实验性临床试验 严重精神疾病，(2)以自杀为重点的临床研究，以及(3)多模式测量和建模 干预效果。

Project Summary Suicide is an alarmingly common cause of death for people living with psychosis. Conservative estimates suggest that at least 5% of people with psychotic spectrum disorders complete suicide, accounting for approximately 11% of suicides worldwide or nearly 100,000 suicides each year. The absolute risk of suicide remains high even for people who are engaged in specialty psychosis treatment, and interventions that have been designed specifically to prevent suicide in people with psychosis have shown limited impact. One important suicidogenic factor for people with psychosis is emotion dysregulation, which is the failure to regulate emotion resulting in problematic emotional states. Emotion dysregulation is a core feature of psychotic disorders and yet this factor is commonly neglected in treatments provided to this population. Research has shown that emotion dysregulation is closely linked to suicide in people with psychosis and emotion regulation is a primary target of some of the best-established and most effective psychosocial interventions for suicidality in other populations, most notably Dialectical Behavior Therapy (DBT), but relevant clinical trials routinely exclude people with psychosis. The goal of this K23 is to conduct a prepilot and pilot randomized controlled trial of group DBT skills training (DBT-ST), an intervention that targets emotion regulation, in a sample of people with psychosis and heightened suicidality. This pilot study would allow us to determine feasibility, acceptability, and obtain preliminary estimates of the impact of DBT-ST on key outcomes. A critical component of this work is the use of a rigorous methodology for measuring emotion dysregulation. Such measurement has seen advances in recent years in the form of ecological momentary assessment (EMA) which enables the direct statistical modeling of emotion dysregulation without reliance on retrospective self-report. To further increase rigor and reproducibility, we propose to pair such ecological measurements with qualitative assessments of participant experiences of EMA data collection to aid in the construction and interpretation of sophisticated statistical models of emotion dysregulation in psychosis that account for non-random missingness as well as exogenous variables that may confound measurement of the impact of DBT on emotion dysregulation. This mixed methods approach will allow us to better assess how DBT-ST might improve emotion regulation in people with psychosis. The proposed study will pave the way for a larger trial evaluating whether treatment of emotion dysregulation can decrease suicide risk in psychosis. The above research proposal will be carried out within the University of Maryland Division of Psychiatric Services Research—an institution with a strong track record of successful clinical trials research with people with serious mental illness—and will be paired with mentorship and training in the areas of (1) the conduct of experimental clinical trials with serious mental illness, (2) suicide-focused clinical research, and (3) the multimodal measurement and modeling of intervention effects.