Examining Mechanisms of Change in Adolescent Self-Inflicted Injury

PROJECT SUMMARY/ABSTRACT Suicide is a global public health concern that marks an extreme along a spectrum of self-inflicted injury (SII) and is the leading cause of death among adolescents. Although we have evidence-based interventions for youth SII, mechanisms of change are underexplored, and suicide rates have not appreciably declined. Efficacious treatments like Dialectical Behavior Therapy (DBT) are intensive, expensive, and require extensive therapist training, making it inaccessible for many adolescents in need. We also lack vital data on whether and how adolescents apply and retain therapeutic skills in daily life. There are too few researchers interested in and trained to develop mechanistic innovations in this area. The candidate will complete training in the neural underpinnings of skill acquisition (fMRI, Training Aim 1), measurement in everyday life (Ecological momentary assessment; EMA, Training Aim 2), and factors (life stress) that may impede skill acquisition (Training Aim 3). This training is embedded within a research study that uses a rigorous multi-method approach to: compare intra- vs. interpersonal skills targeting emotion dysregulation (Aim 1); assess the potency of intervention effects in daily life (Aim 2); and examine persistence/decay effects of skill use in daily life following initial skill exposure and a “booster” call (Aim 3). We will also examine bi-directional effects of life-stress and underlying mechanisms of risk and change. Adolescents with a history of repeated SII (N = 100) will attend 4 study visits with a parent. At Visit 1, participants will complete baseline assessments of psychiatric diagnoses, SII, and life stress. Fifty-six of the 100 youth will be randomly assigned to complete fMRI paradigms to tap neural processes underlying perspective taking and empathy, and approach/avoidance (Training Aim 1). Adolescents will then complete a 2-week EMA (EMA1, Training Aim 2) to measure daily affect, perceived stressors, SII, and suicidal thoughts. At Visit 2, dyads will be randomly assigned to learn and practice GIVE (interpersonal skills training) or opposite-to-emotion action (OA; intrapersonal skill). We will assess behavioral, affective, and physiological regulatory processes during two conflict discussions: (1) pre- skills training, and (2) post-training, while dyads use their assigned skill. A second EMA period (EMA2) will assess skill use along with all variables from EMA1. Dyads will return for Visit 3 to repeat fMRI assessment before crossing over to learn the alternate skill ⎯ followed by another 2-week EMA (EMA3). Visit 4 is completed 6 months post-EMA3, where we will reassess SII, symptom severity, and life stressors. The candidate has existing expertise in adolescent SII, DBT, and cardiac psychophysiological measures of emotion regulation. The mentorship team will support her in growing her skill set to include fMRI task design, data acquisition, and analysis, EMA methods and analysis, and life stress assessment. By achieving the aims of this proposal, the candidate will develop a unique program of research that can inevitably lead to more effective and targeted interventions for SII in youth.