Suicide marks an extreme along a continuum of self-inflicted injury (SII) and is a
leading cause of death among adolescents. Although psychologists have evidence-supported
interventions for youth SII, the biosocial mechanisms supporting change are
underexplored. Lack of innovation in this area has led to statis, rather than decline, in
population-level suicide rates. The field also lacks vital data on: if/when adolescents
apply therapeutic skills in daily life, the neural and physiological factors influencing
skill uptake, and whether such skills are effective in reducing SII and related risk and
vulnerability factors.
When identifying key intervention targets, theoretical and empirical work implicate
emotion dysregulation and interpersonal stressors in SII etiology and maintenance.
Adaptive emotion regulation strategies and strong social ties each reduce the likelihood
of suicidal ideation and SII among otherwise vulnerable individuals, and improvements in
emotion regulation are associated with SII cessation. Yet, the specific skills and
mechanisms promoting self-regulatory improvements are not well understood.
This study is designed to rigorously examine two competing SII intervention mechanisms.
The research plan and aims are devoted to identifying youth who may benefit from a brief
skill-building intervention and biosocial mechanisms supporting skill acquisition. The
investigator use a within-subjects design to directly compare the effects of teaching an
intra- vs. interpersonal skill from Dialectical Behavior Therapy (DBT; a widely-used
intervention for SII). Adolescents with a history of repeated SII (n = 100) will
participate in 4 laboratory visits with a primary caregiver. At Visit 1, participants
will complete interviews and questionnaires assessing psychiatric diagnoses, SII, and
life stress, and 50 will complete two functional MRI paradigms to tap neural processes
underlying perspective taking and empathy, and approach/avoidance. Adolescents will then
complete a 2-week EMA protocol (EMA1, Training Aim 2) to measure daily affect, perceived
stressors, SII, and suicidal thoughts, pre-intervention. At Visit 2, dyads will be
randomly assigned to learn and practice GIVE (interpersonal skills training) or
opposite-to-emotion action (OA; intrapersonal skill). The investigator will assess
behavioral, affective, and physiological regulatory processes (respiratory sinus
arrythmia [RSA]) during two conflict discussions: (1) pre- skills training, and (2)
post-training, while dyads use their assigned skill. This laboratory assessment will be
followed by a second EMA period (EMA2) to assess skill use and EMA1 variables. Post EMA2,
dyads will return for Visit 3 to repeat fMRI assessment before undergoing training in the
alternate skill ⎯ followed by another 2-week EMA protocol (EMA3). Finally, participants
will complete a remote follow-up visit 6 months post-EMA3, where the investigator will
reassess SII, symptom severity, and life stressors as well as barriers to skill use. This
study will assess and integrate multimodal responses to core intervention mechanisms in a
high-risk sample.
Aim 1: Examine within-person mechanistic (brain, RSA) changes as a function of skills
training in the laboratory (Training Aim 1).
H1a: Participants will show less RSA withdrawal during skill-practice relative to a
pre-training conflict task. H1b: Such intervention changes will translate to increased
left ventro-lateral prefrontal cortex engagement during an fMRI paradigm tapping OA; and
increased medial pre-frontal cortex engagement during a task tapping perspective taking
and empathy (corresponding to GIVE).
H1c: Compared with the OA condition, GIVE training will result in less RSA withdrawal
during skills practice.
H1d: The investigator will test whether skill practice effects (H1a, b) are moderated by
recent life stressors (Training Aim 3) and expect severe stressors in the 6 months
preceding study participation will be associated with less improvement during skills
practice across outcome measures.
Aim 2: Examine the effects of skills training on outcomes relevant to suicide risk in
daily life.
H2a: Changes observed post-skills training in the GIVE and OA conditions will extend into
social and affective improvements in participants' daily lives as reported via EMA -
especially in the context of momentary skills use.
H2b: Further, the investigator hypothesize that skill use during laboratory visits and
EMA will predict subsequent reductions in life stressors that are dependent on adolescent
characteristics and/or behaviors.
Aim 3: Examine persistence/decay effects of skill in daily life following initial skill
exposure and a "booster" call.
H3a: Skill use will be most frequent immediately following training and decline over
time. H3b: A brief booster call 1 week post-skill exposure will predict increases in EMA
reported skill use. The investigator will examine potential moderation effects to
determine who may benefit from repeated skill exposure.
H3c: Youth skill use over the EMA period will predict changes in stressor severity
experienced over 6-month followup. Specifically, GIVE use will predict less severe
dependent stress.