The Influence of Childhood Adversity on Psychotherapy Skill Acquisition in Adolescent Depression

项目摘要/摘要 在美国，近60%的青少年暴露在童年逆境中，包括接触暴力、虐待、 忽视，失去照顾者，生活在贫困中。全球和国家的数据表明，逆境是 30%-50%的抑郁风险始于童年至青春期，对循证的反应 一线干预(例如，认知行为疗法和抗抑郁药)在以下方面明显较差 暴露在逆境中的年轻人。研究表明，暴露在逆境中会扰乱一般的学习 过程，包括更高层次的认知过程(即认知控制)。学习障碍可能会阻碍 循证心理疗法中最常见和最关键的中介治疗过程之一： 获得治疗技能。这项提案使用了一种创新的方法来调查童年的逆境。 暴露作为抑郁青年中最常用的CBT技能获得的预测因素， 认知重组。要改进干预措施并优化有效性，关键是要确定现有的 治疗失败了。本研究将使用重复测量、多层次分析的方法来评估 在抑郁人群中获得和保持实验者引入的认知结构调整技能 一生暴露于逆境中具有人口水平变异性的青少年(n=90)。候选人提议 研究逆境暴露与学习相关认知控制过程之间的关系 青少年抑郁的背景(目标1)。逆境暴露和认知控制将被视为直接 六个月CBT技能习得和技能保持的预测因素；从逆境到技能的间接途径 还将研究通过认知控制获得知识(目标2)。候选人将进一步探索关键 逆境的特征，即类型(危害威胁与资源被剥夺)和发展 暴露的时机，作为技能获得的明确预测因素(探索性目标3)。拟议的K23是建立在 应聘者在精神病理学的环境和生物行为风险方面的先前培训，以及对 治疗效果，1)实验治疗学；2)发展概念化 3)认知和情感学习过程的行为评估。这个 匹兹堡大学精神病学系是实现这一建议的理想科学环境 职业发展目标，候选人将接受一个导师团队的培训(戈尔茨坦博士，卢比， 以及在靶向干预方面具有专业知识的顾问(福布斯、林迪姆和华莱士博士) 青少年抑郁症的研究，儿童逆境和不良临床病程的风险，以及发展认知和 情感科学。该奖项的近期目标是确定抑郁症干预的敏感标志。 暴露在逆境中的年轻人的反应。这将提供一个关键的工具来推动候选人的 主要职业目标：开发一个利用基础科学进步的翻译研究计划 向高危青少年提供个性化和最优化抑郁症治疗的实验疗法。

PROJECT SUMMARY/ABSTRACT Nearly 60% of youths in the U.S. are exposed to childhood adversity, including violence exposure, abuse, neglect, loss of caregivers, and living in poverty. Global and national data indicate that adversity accounts for 30-50% of the risk for depression onset from childhood through adolescence, and response to evidence-based front-line interventions (e.g., cognitive behavioral therapy [CBT] and antidepressants) is notably poor among adversity-exposed youths. Research demonstrates that exposure to adversity disrupts general learning processes, including higher-order cognitive processes (i.e., cognitive control). Learning impairments may impede one of the most common and critical intermediary treatment processes across evidence-based psychotherapies: the acquisition of therapy skills. This proposal uses an innovative approach to investigate childhood adversity exposure as a predictor of skill acquisition for the most commonly implemented CBT skill with depressed youths, cognitive restructuring. To refine interventions and optimize effectiveness, it is critical to identify how existing treatments break down. This study will use a repeated-measures, multiple levels of analysis approach to assess acquisition and retention of an experimenter-introduced cognitive restructuring skill, among depressed adolescents with population-level variability in lifetime adversity exposure (n=90). The candidate proposes to investigate associations between adversity exposure and learning-related cognitive control processes in the context of adolescent depression (Aim 1). Adversity exposure and cognitive control will be examined as direct predictors of CBT skill acquisition and skill retention over six-months; an indirect pathway from adversity to skill acquisition through cognitive control will also be examined (Aim 2). The candidate will further explore key characteristics of adversity, namely the type (threat of harm versus deprivation of resources) and developmental timing of exposure, as distinct predictors of skill acquisition (exploratory Aim 3). The proposed K23 builds on the candidate’s prior training in environmental and biobehavioral risk for psychopathology, and evaluation of treatment effectiveness, with new training in 1) experimental therapeutics; 2) developmental conceptualizations of childhood adversity, and 3) behavioral assessments of cognitive and affective learning processes. The Department of Psychiatry at the University of Pittsburgh is an ideal scientific setting to achieve the proposed career development goals, and the candidate will receive training from a team of mentors (Drs. Goldstein, Luby, and Sheridan) and consultants (Drs. Forbes, Lindhiem, and Wallace) with expertise in target-focused intervention research, child adversity and risk for poor clinical course in youth depression, and developmental cognitive and affective science. The near-term goal of this award is to identify sensitive markers of depression intervention response among adversity-exposed youths. This will provide a crucial vehicle to advance the candidate’s overarching career objective: to develop a translational research program leveraging advances in basic science to inform experimental therapeutics for personalizing and optimizing depression treatment in high-risk youths.