Development of an Intervention for Non-Suicidal Self-Injury in Young Adults

描述(申请人提供)：非自杀性自残(NSSI)，指的是没有自杀意图的故意伤害身体，在年轻人中非常普遍，每10名大学生中就有1人一生中有100次以上的发作。NSSI的后果是严重的，包括严重的身体伤害，与行为相关的羞耻困扰，社会孤立，心理症状，以及随着时间的推移NSSI的风险和致命性增加，导致更严重的伤害，自杀企图，甚至死亡。尽管这种行为的流行率和严重后果，目前还没有针对NSSI的经验支持的治疗方法。K23职业发展奖的研究计划的目的是开发、实施和评估一项专门针对年轻人NSSI的干预措施，即自我伤害行为治疗(T-SIB)。这一有时间限制的干预将整合基于理论的策略，其效用已通过实证研究确定，包括NSSI的功能分析、动机访谈技术和个性化行为治疗，目的是减少NSSI的频率和严重程度。研究计划分为两个阶段。在第一阶段，我将为T-SIB制定一份全面的治疗手册和治疗师培训计划，并在一项开放的试点试验中治疗12名患者。在进一步细化干预措施后，第二阶段将在随机对照试验研究中对60名患者进行治疗，以确定T-SIB的可行性和可接受性，通过3个月的随访期调查T-SIB和常规治疗(TAU)之间NSSI频率和严重程度的变化，并评估随机对照试验的研究设计，以告知更大规模随机临床试验的实用性和设计，该试验将在颁奖第5年作为R01提出。在这份申请中提出的培训计划将使我有机会发展和完善必要的技能，以继续我的职业生涯，作为一名研究自我伤害的个人的临床科学家。通过正式培训、建议的研究计划、与Miller和Spirito博士的指导经验，以及与我的顾问(他们都是各自领域的领导者)的定期会议，我将能够实现以下培训目标：1)获得治疗开发、设计和结果研究方面的经验，包括临床试验的方法和分析；2)增加对NSSI现象学和治疗的专门知识和知识，特别是在年轻人中；3)促进我在临床研究试验和多样性培训的伦理方面的教育；4)增加我在拨款撰写和手稿准备方面的经验；以及5)在激励性访谈和自我伤害个体的治疗方面获得进一步的临床培训和监督。这项K23奖将促进我的训练，也是为我成为一名专门研究自我伤害行为的独立临床研究人员做准备的下一步。

DESCRIPTION (provided by applicant): Non-suicidal self-injury (NSSI), deliberate harm to the body without suicidal intent, is highly prevalent in young adults, with 1 in 10 college students engaging in over 100 episodes in their lifetimes. Consequences of NSSI are severe, including physical injury ranging in medical severity, distress from shame associated with the behavior, social isolation, psychological symptoms, and increased risk and lethality of NSSI over time, resulting in more severe injuries, suicide attempts, and even death. Despite the prevalence and significant consequences of the behavior, no empirically supported treatments specific to NSSI exist. The purpose of the research plan included in this K23 Career Development Award is to develop, implement, and evaluate an intervention specifically for NSSI in young adults, the Treatment for Self- Injurious Behaviors (T-SIB). This time-limited intervention will integrate theoretically-based strategies whose utility has been identified through empirical research, including a functional analysis of NSSI, motivational interviewing techniques, and individualized behavior therapy with the goal of reducing frequency and severity of NSSI. The research plan consists of 2 phases. During Phase 1, I will develop a comprehensive treatment manual and therapist training program for T-SIB and treat 12 patients in an open pilot trial. After further refinement of the intervention, Phase 2 will involve the treatment of 60 patients in a randomized controlled pilot study to determine the feasibility and acceptability of T-SIB, investigate change in NSSI frequency and severity between T-SIB and treatment as usual (TAU) through a 3-month follow up period, and evaluate the research design of the randomized controlled pilot study to inform both the utility and design of a larger randomized clinical trial, to be proposed as an R01 in Year 5 of the award. The training plan proposed in this application will allow me the opportunity to develop and refine the skills necessary to continue my career as a clinical scientist working with self-harming individuals. Through formal training, the proposed research plan, mentorship experiences with Drs. Miller and Spirito, and regular meetings with my consultants, all leaders in their fields, I will be able to fulfill the following training goals: 1) to gain experience in treatment development, design, and outcome studies, including the methodology and analysis of clinical trials; 2) to increase expertise in and knowledge of the phenomenology and treatment of NSSI specifically and self-harm in general in young adults; 3) to advance my education in the ethics of clinical research trials and diversity training; 4) to increase my experience in grant writing and manuscript preparation; and 5) to gain further clinical training and supervision in motivational interviewing and the treatment of self-harming individuals. This K23 Award will advance my training and is the logical next step in preparing me for a career as an independent clinical researcher specializing in self-harm behaviors.