Development of a Recovery Oriented Treatment for Post Acute Suicidal Episode (PASE) Veterans

对有自杀症状的退伍军人的心理健康护理对退伍军人事务部来说是至关重要的。不幸的是，VA 自杀报告显示自杀率上升，这表明需要加强目前的退伍军人自杀心理 保健工作。虽然有几种心理治疗急性自杀，有一个赤字， 旨在帮助退伍军人在急性自杀事件后（急性自杀后） 发作; PASE），例如在急性风险下降后发生非致命性自杀企图，但当他们仍然有 持续的心理健康需求，有时还有慢性自杀症状。现有的自杀治疗方法不是 旨在促进PASE退伍军人的恢复和康复。这是一个巨大的差距， 全面的以自杀为重点的心理健康护理。缩小这一差距的一个途径是通过 为PASE退伍军人制定以恢复为导向的心理治疗。发展以康复为导向的护理，“a 个人通过改变过程来改善他们的健康和健康，过着自我导向的生活， 努力发挥他们的全部潜力”是退伍军人事务部的优先事项;然而，自杀退伍军人的现有治疗方法 有限的恢复方向。数十年来对自杀的发展和康复过程的研究 强调增加退伍军人对未来的信心的重要性，发展积极的自我， 身份，促进退伍军人的自我赋权感和改善关系。连续的身份- 认知疗法（CI-CT）是一种很有前途的新的手动自杀干预，专注于改善退伍军人 他们的生活故事和个人未来的意义，与目标类似的康复为导向的护理。CI-CT的开发 作为一种团体治疗，在患有SMI的退伍军人中进行了减少自杀的试点， 具有高水平的可行性、可接受性和（在探索性分析中）导致增加的可接受性 关于未来和减少自杀症状。然而，CI-CT需要进一步调整以与 PASE退伍军人，并加强其与恢复为导向的护理基本面的一致性。 拟议的研究有三个主要阶段： 第一：开发初始CI-CT临床医生手册和退伍军人手册的改进的面向恢复的版本 工作簿，以进一步解决被确定为PASE恢复的关键组件，（1）持续 利益相关者对PASE退伍军人需求的研究，（2）恢复文献，（3）科学和退伍军人消费者 咨询委员会和（4）来自在线退伍军人PASE样本（N=25）的迭代反馈， 练习册这一过程将由科学和PASE资深消费者咨询委员会指导 第二：使用第一阶段开发的材料进行3项单组治疗开发试验（每项试验均包含一个 4-6名PASE退伍军人），使用退伍军人反馈测试和增强CI-CT治疗材料， 可接受性和可行性数据。然后，在我们科学的指导下， 董事会，使用这些结果来更新治疗。 第三：进行一项试点RCT（N=30），将PASE退伍军人的CI-CT与AC（健康教育）进行比较，以评估 治疗材料和研究方案（包括结局指标）的可行性和可接受性 选择和评估策略。我们将评估招募率、干预参与率和会话率。 出勤率（可行性），退伍军人满意度（可接受性），治疗依从性（保真度）和初步 探索对CI-CT的反应。调查结果将用于对治疗材料进行最后调整， 为PASE退伍军人的CI-CT大规模RCT制定研究方案。 这项研究将开发和试点测试一个明确的，基于群体的干预措施，适合的独特需求， 退伍军人。拟议研究的结果将提供数据，以1）确定所需的调整， 为PASE退伍军人优化CI-CT：2）确定CI-CT的可能益处; 3）为大型 PASE退伍军人CI-CT的规模RCT。

Mental health care for Veterans with suicidal symptoms is of paramount import to the VA. Unfortunately, VA suicide reports show suicide rates increasing, suggesting a need for enhancing current VA suicide mental health care efforts. While several psychotherapeutic treatments exist for acute suicidality, there is a deficit in validated treatments designed to help Veterans following an acute suicidal episode (Post Acute Suicidal Episode; PASE) such as following a non-fatal suicide attempt after acute risk declines but when they still have ongoing mental health needs and, at times, chronic suicidal symptoms. Available suicide treatments are not designed to promote the recovery and rehabilitation of PASE Veterans. This is a significant gap in comprehensive suicide-focused mental health care. One avenue to close this gap lies through the development of a recovery-oriented psychotherapy for PASE Veterans. Developing recovery-oriented care, “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential” is a VA priority; however, available treatments for suicidal Veterans have limited recovery-orientation. Decades of research into the development of suicide and processes of recovery highlight the importance of increasing Veterans hopefulness about the future, developing a positive self- identity, promoting Veterans’ sense of self-empowerment and improved relationships. Continuous Identity- Cognitive Therapy (CI-CT) is a promising new manualized suicide intervention focused on improving Veterans sense of their life story and personal future, with goals similar to recovery-oriented care. CI-CT was developed by the applicant and, as a group therapy, piloted for suicide reduction in Veterans with SMI and was found to have high levels of feasibility, acceptability and (in exploratory analyses) to lead to increased hopefulness about the future and decreased suicidal symptoms. However, CI-CT needs further adaptation for use with PASE Veterans and to enhance its alignment with the fundamentals of recovery-oriented care. The proposed study has three primary stages: First: develop an improved recovery-oriented version of the initial CI-CT Clinician Manual and Veteran workbook to further address components identified as critical for PASE recovery using, (1) an ongoing stakeholder study into the needs of PASE Veterans, (2) recovery literature, (3) scientific and Veteran consumer advisory boards and (4) iterative feedback from an online Veteran PASE sample (N=25) on each section of the workbook. This process will be guided by scientific and PASE Veteran Consumer advisory boards Second: use the materials developed in phase 1 to run 3 one-arm treatment development trials (each with an N of 4-6 PASE Veterans) to test and enhance the CI-CT treatment materials using Veteran feedback and acceptability and feasibility data. Then, with the guidance of our scientific and Veteran consumer advisory boards, use these results to update the treatment. Third: conduct a pilot RCT (N=30) comparing CI-CT for PASE Veterans to an AC (health education) to assess feasibility and acceptability of the treatment materials and research protocol including outcome measures selected and assessment strategy. We will assess rates of recruitment, intervention engagement, and session attendance (feasibility), Veteran satisfaction (acceptability), treatment adherence (fidelity) and preliminarily explore response to CI-CT. Findings will be used to make a final adaptation of the treatment materials and to develop a research protocol for a large scale RCT of CI-CT for PASE Veterans. This study will develop and pilot test a well-specified, group-based intervention tailored to the unique needs of PASE Veterans. The results of the proposed study will provide data to 1) identify adaptations needed to optimize CI-CT for PASE Veterans: 2) identify possible benefits of CI-CT; 3) inform development of a large scale RCT of CI-CT for PASE Veterans.