ACT for Life: a Brief Intervention for Maximizing Recovery After Suicidal Crises
Condition: Suicide; Psychiatric Rehabilitation
MeSH terms: Suicide
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): ACT for Life; Treatment as usual
Intervention type(s): Behavioral; Other
Intervention description(s): A novel protocol detailing the application of Acceptance and Commitment Therapy (ACT) to recovery from suicidal crises. Consists of three modules designed to be delivered in three to four 60-minute individual talk therapy sessions. Nearly all of the metaphors and experiential exercises are adaptations of core ACT techniques included in various empirically-supported applications of ACT to other health conditions. Additionally, the adjunctive intervention is designed to augment safety planning (a hierarchical list of strategies to recognize and cope with a suicidal crisis).; All participants will be able to engage in treatment as usual. Psychiatric inpatient care typically consists of behavioral mental health group and/or individual therapy and pharmacological treatment. Outpatient care is offered upon discharge. This typically consists of both group and individual therapy and medication management.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Suicide; Psychiatric Rehabilitation; Acceptance and Commitment Therapy; Brief Psychotherapy; Inpatients