ACT for Life: a Brief Intervention for Maximizing Recovery After Suicidal Crises

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 DESCRIPTION (provided by applicant): 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.9 Although VHA now requires the provision of evidence-based, recovery-oriented inpatient psychotherapy,9 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.10 Similarly, inpatient psychiatric treatment has traditionally focused on medical management of acute illness, not on improving patient functioning.11 Preventing suicide during a crisis is only a short-term solution i we 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 promot functional recovery.12 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.5 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.5 ACT has been successfully adapted for inpatient use among patients with psychosis,1,2,13 but 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.] If funded, the proposed two arm, randomized, controlled pilot study would 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. The performance of validated measures will be assessed, along with selected NIH Patient Reported Outcomes Measurement Information System (PROMIS) modules.14 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. The proposed study is a critical first step in a line of research likely to yield a recovery-oriented, empirically-supported intervention designed for inpatient use with Veterans at risk of suicide. ACT for Life's objectives are directly in line ith Rehabilitation Research and Development Service's goal to optimize Veteran functioning and community reintegration. By doing so, this intervention may assist Veterans in building lives they deem worth living, reduce the risk of decompensation, and ultimately prevent suicide.