ACT for Life: a Brief Intervention for Maximizing Recovery After Suicidal Crises
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 89 |
| Updated: | 2/14/2019 |
| Start Date: | November 15, 2016 |
| End Date: | December 31, 2018 |
An estimated 20 Veterans kill themselves every day. Suicide prevention literature and public
health policy both call for treatment targeting high-risk populations, such as Veterans
hospitalized due to suicidal intent and/or attempts. Psychiatric hospitalization is a
critical opportunity to provide treatment to reduce the risk of suicide and lay the
groundwork for functional recovery. Yet, there are no interventions specifically for suicide
prevention that meet Veterans Health Affairs' quality recommendations requiring the provision
of evidence-based, recovery-oriented psychotherapy, which are also feasible to use during a
typical inpatient stay. The proposed study seeks to take a first step toward filling this
gap. In consultation with experts in the field, the authors have developed a protocol
applying a recovery-oriented, evidence-based treatment approach to Veteran inpatient care.
The proposed pilot study will provide critical information to inform final revisions of the
treatment manual and research design for a future study evaluating the efficacy of the
intervention.
health policy both call for treatment targeting high-risk populations, such as Veterans
hospitalized due to suicidal intent and/or attempts. Psychiatric hospitalization is a
critical opportunity to provide treatment to reduce the risk of suicide and lay the
groundwork for functional recovery. Yet, there are no interventions specifically for suicide
prevention that meet Veterans Health Affairs' quality recommendations requiring the provision
of evidence-based, recovery-oriented psychotherapy, which are also feasible to use during a
typical inpatient stay. The proposed study seeks to take a first step toward filling this
gap. In consultation with experts in the field, the authors have developed a protocol
applying a recovery-oriented, evidence-based treatment approach to Veteran inpatient care.
The proposed pilot study will provide critical information to inform final revisions of the
treatment manual and research design for a future study evaluating the efficacy of the
intervention.
Psychiatric hospitalization presents a critical opportunity for delivering targeted treatment
to reduce suicide risk and promote functional recovery. Yet, there are no suicide-specific
empirically-supported interventions that can be feasibly delivered during a typical Veterans
Health Affairs (VHA) inpatient stay. Although VHA now requires the provision of
evidence-based, recovery-oriented inpatient psychotherapy, extant empirically-supported
interventions for patients at high risk of suicide were developed for use in outpatient
settings and are too time- and resource-intensive to implement as intended in inpatient
psychiatric settings, where shorter lengths of stay are expected. Furthermore, these
interventions focus nearly entirely on preventing suicidal behavior without also targeting
functional recovery. Similarly, inpatient psychiatric treatment has traditionally focused on
medical management of acute illness, not on improving patient functioning. Preventing suicide
during a crisis is only a short-term solution if the investigators fail to assist patients in
understanding how they can rebuild a life they deem worth living. Given that approximately
50% of inpatients do not engage in recommended outpatient mental health care and are at the
highest risk of death by suicide, it is vital that inpatient care promote functional
recovery. The ideal brief intervention for Veterans at risk for suicide needs to reduce risk
of suicidal behavior while simultaneously fostering recovery.
Acceptance and Commitment Therapy (ACT) is a recovery-oriented, psychosocial treatment
approach ideally suited for utilization among Veterans hospitalized for suicide risk. ACT
teaches psychological skills to handle painful thoughts, emotions, and sensations, but rather
than focusing on symptom reduction, ACT directly targets functional recovery by assisting
patients in identifying and engaging in value-consistent behaviors despite the potential for
distress. There are no brief, ACT-based, transdiagnostic treatment protocols designed to
address suicide risk. In order to fill this gap, the investigators consulted with leading
experts in ACT to develop and manualize "ACT for Life", a brief, transdiagnostic,
recovery-oriented intervention for Veterans hospitalized due to suicide risk. The ACT for
Life manual details the application of ACT to recovery from suicidal crises and consists of
three modules, [designed to be utilized in three to four 60-minute individual sessions.] This
two arm, randomized, controlled pilot study will provide critical information to inform final
revisions to the treatment manual and research design for a future efficacy study of ACT for
Life. Veterans who enroll in the study will be randomized to: (a) treatment as usual or (b)
treatment as usual plus ACT. The specific aims of this study are to: (1) Determine the
acceptability of ACT for Life. (2) Determine the feasibility of the study design and research
procedures. (3) Characterize participants' psychosocial functioning and self-directed
violence using candidate outcome measures for a future efficacy trial. All participants will
complete a baseline assessment, and follow-up assessments one and three months after hospital
discharge. Participants in the ACT group will also complete a post-treatment assessment on
acceptability of the intervention.
to reduce suicide risk and promote functional recovery. Yet, there are no suicide-specific
empirically-supported interventions that can be feasibly delivered during a typical Veterans
Health Affairs (VHA) inpatient stay. Although VHA now requires the provision of
evidence-based, recovery-oriented inpatient psychotherapy, extant empirically-supported
interventions for patients at high risk of suicide were developed for use in outpatient
settings and are too time- and resource-intensive to implement as intended in inpatient
psychiatric settings, where shorter lengths of stay are expected. Furthermore, these
interventions focus nearly entirely on preventing suicidal behavior without also targeting
functional recovery. Similarly, inpatient psychiatric treatment has traditionally focused on
medical management of acute illness, not on improving patient functioning. Preventing suicide
during a crisis is only a short-term solution if the investigators fail to assist patients in
understanding how they can rebuild a life they deem worth living. Given that approximately
50% of inpatients do not engage in recommended outpatient mental health care and are at the
highest risk of death by suicide, it is vital that inpatient care promote functional
recovery. The ideal brief intervention for Veterans at risk for suicide needs to reduce risk
of suicidal behavior while simultaneously fostering recovery.
Acceptance and Commitment Therapy (ACT) is a recovery-oriented, psychosocial treatment
approach ideally suited for utilization among Veterans hospitalized for suicide risk. ACT
teaches psychological skills to handle painful thoughts, emotions, and sensations, but rather
than focusing on symptom reduction, ACT directly targets functional recovery by assisting
patients in identifying and engaging in value-consistent behaviors despite the potential for
distress. There are no brief, ACT-based, transdiagnostic treatment protocols designed to
address suicide risk. In order to fill this gap, the investigators consulted with leading
experts in ACT to develop and manualize "ACT for Life", a brief, transdiagnostic,
recovery-oriented intervention for Veterans hospitalized due to suicide risk. The ACT for
Life manual details the application of ACT to recovery from suicidal crises and consists of
three modules, [designed to be utilized in three to four 60-minute individual sessions.] This
two arm, randomized, controlled pilot study will provide critical information to inform final
revisions to the treatment manual and research design for a future efficacy study of ACT for
Life. Veterans who enroll in the study will be randomized to: (a) treatment as usual or (b)
treatment as usual plus ACT. The specific aims of this study are to: (1) Determine the
acceptability of ACT for Life. (2) Determine the feasibility of the study design and research
procedures. (3) Characterize participants' psychosocial functioning and self-directed
violence using candidate outcome measures for a future efficacy trial. All participants will
complete a baseline assessment, and follow-up assessments one and three months after hospital
discharge. Participants in the ACT group will also complete a post-treatment assessment on
acceptability of the intervention.
Inclusion Criteria:
- Eligible for Veterans Health Administration care
- Age 18-89
- Currently hospitalized due to suicide risk
- Willing to be randomized and participate in the two conditions
Exclusion Criteria:
- Inability to provide informed consent
- Inability to complete study measures, e.g.:
- due to significant acute intoxication/withdrawal symptoms
- mania
- psychosis
- aggression
- catatonia
- cognitive impairment
- membership in vulnerable population, e.g.:
- prisoners
We found this trial at
1
site
Click here to add this to my saved trials
