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

有自杀症状的退伍军人的心理健康护理对退伍军人管理局至关重要。不幸的是，弗吉尼亚州 自杀报告显示自杀率上升，这表明有必要加强目前退伍军人的自杀心理 医疗保健方面的努力。虽然有几种心理治疗方法可以治疗急性自杀，但在以下方面存在不足 旨在帮助退伍军人在急性自杀事件后(急性自杀后)的有效治疗 发作；PASE)，例如在急性风险下降后发生非致命性自杀未遂，但当他们仍有 持续的精神健康需求，有时还会出现慢性自杀症状。现有的自杀治疗方法不是 旨在促进PASE退伍军人的康复和康复。这是一个很大的差距 全面的以自杀为重点的精神卫生保健。缩小这一差距的一个途径是通过 为退伍军人开发以康复为导向的心理疗法。发展以康复为导向的护理，“a 改变的过程，通过这个过程，个人改善他们的健康和健康，过着自我指导的生活，以及 努力发挥他们的全部潜力“是退伍军人管理局的优先事项；然而，对有自杀倾向的退伍军人 有限的恢复导向。几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希望的重要性，培养积极的自我 认同感，促进退伍军人的自我赋权意识和改善关系。连续的同一性- 认知疗法(CI-CT)是一种很有前途的新的手动自杀干预方法，专注于改善退伍军人 对他们的生活故事和个人未来的感觉，目标类似于以康复为导向的护理。CI-CT被开发出来 作为一种集体治疗，在患有SMI的退伍军人中试行减少自杀，并被发现 有很高的可行性、可接受性和(在探索性分析中)导致更大的希望 关于未来和减少自杀症状。然而，CI-CT需要进一步调整以用于 PASE退伍军人协会，并加强其与面向康复的护理的基本原则的一致性。 建议的研究分为三个主要阶段： 第一：开发最初的CI-CT临床医生手册和老兵版面向恢复的改进版本 工作簿，以进一步解决被确定为对PASE恢复至关重要的组件，使用(1)持续的 利益相关者研究退伍军人的需求，(2)恢复文献，(3)科学和退伍军人消费者 咨询委员会和(4)来自在线资深PASE样本(N=25)的迭代反馈 工作簿。这一过程将由科学和PASE资深消费者咨询委员会指导 第二：使用在第一阶段开发的材料进行3个单臂治疗开发试验(每个试验都有一个 4-6名退伍军人)利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，在我们科学和经验丰富的消费者咨询的指导下 董事会，使用这些结果来更新治疗方法。 第三：进行一项试验性随机对照试验(N=30)，将退伍军人CI-CT与AC(健康教育)进行比较，以评估 治疗材料和研究方案的可行性和可接受性，包括结果衡量标准 选择和评估策略。我们将评估招聘、干预参与率和期次 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 探讨对CI-CT的反应。调查结果将被用来对治疗材料进行最终调整，并 为PASE退伍军人制定大规模CI-CT随机对照试验的研究方案。 这项研究将开发和试点测试一种明确的、以群体为基础的干预措施，以满足儿童的独特需求 退伍军人队。拟议研究的结果将为1)确定所需的适应提供数据 为PASE退伍军人优化CI-CT：2)确定CI-CT的可能好处；3)为大型 PASE退伍军人CI-CT量表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.