Testing the Efficacy of ACT for Life: A Brief Inpatient Intervention to Maximize Recovery and Prevent Future Suicidal Behavior

测试 ACT 的终生功效：简短的住院干预，以最大限度地恢复并预防未来的自杀行为

• 批准号: 10189336
• 负责人: SEAN BARNES
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10189336
• 关键词: Acute; Address; Ambulatory Care; Behavior; Clinical; Clinical Trials; Consult; Data; Emotions; Esthesia; Evidence based treatment; Exercise; Future; Goals; Grant; Hospitalization; Hour; Individual; Inpatients; Interruption; Intervention; Learning; Life; Literature; Maintenance; Medical Records; Mental Health; Metaphor; Outcome; Outpatients; Participant; Pathway interactions; Patients; Pilot Projects; Population; Process; Psychiatric therapeutic procedure; Psychoses; Psychotherapy; Questionnaires; Randomized; Randomized Controlled Trials; Recovery; Recovery of Function; Reporting; Research; Research Personnel; Research Support; Risk; Severities; Suicide; Suicide attempt; Suicide prevention; Testing; Therapeutic Intervention; Thinking; Time; Treatment Protocols; Value of Life; Veterans; acceptability and feasibility; arm; base; behavior change; brief intervention; community reintegration; design; distress tolerance; efficacy evaluation; efficacy testing; efficacy trial; evidence base; feasibility trial; flexibility; high risk; hospital readmission; improved functioning; inpatient psychiatric settings; inpatient service; mortality risk; prevent; protective factors; psychologic; psychosocial; randomized controlled design; reduce symptoms; rehabilitation research; research and development; research study; skills; suicidal; suicidal behavior; suicidal morbidity; suicidal risk; treatment as usual

Psychiatric hospitalization is a critical opportunity to provide treatment to reduce the risk of suicide and lay the groundwork for functional recovery. In fact, the period following psychiatric hospitalization presents the greatest risk of death by suicide for Veterans. Despite psychiatric hospitalization being a vital time for intervention, there are no suicide-specific evidence-based psychotherapies (EBPs) that can be feasibly delivered during a typical VHA inpatient stay. Importantly, suicide-specific inpatient interventions are primarily focused on reducing the reoccurrence of suicidal behavior and have limited or no focus on directly targeting other aspects of functional recovery. Preventing suicide during a crisis is only a short-term solution if we fail to assist patients in building a life they deem worth living. Our research over the past several years has been focused on addressing this gap and overcoming barriers to implementing psychosocial interventions in an inpatient setting. Acceptance and Commitment Therapy (ACT) is a psychosocial intervention well suited to both preventing suicide and enhancing functioning, but we were not aware of any ACT-based treatment protocols designed to specifically target suicide risk. We consulted with leading ACT clinicians and researchers to develop and manualize “ACT for Life”, a brief, transdiagnostic, recovery-oriented, inpatient, intervention for Veterans hospitalized due to suicide risk. The individual intervention involves 3 to 6 inpatient sessions and 1 to 4 outpatient sessions focused on skills generalization and treatment engagement. We conducted a randomized controlled pilot study evaluating the acceptability of ACT for Life and the feasibility of the planned design for the proposed randomized controlled efficacy trial. Results of this rigorous pilot study support the acceptability and feasibility of ACT for Life. Nearly all Veterans reported that they believed they benefitted from ACT for Life. Preliminary outcomes suggest that ACT for Life may improve functioning and reduce suicidal behavior following hospitalization due to suicide risk. However, a full- scale clinical trial will be necessary to definitively evaluate the efficacy of ACT for Life. To accomplish this goal, we are proposing to conduct a randomized controlled trial of ACT for Life versus Present Centered Therapy in 278 Veterans hospitalized for suicide risk to examine outcomes of suicidal behavior and changes in functioning over a one-year period following psychiatric hospitalization. The specific aims of this study are to determine the efficacy of ACT for Life for preventing suicidal behavior and maximizing functional recovery, and to examine candidate ACT for Life treatment mechanisms. Participants will complete assessments prior to treatment, before discharge from the inpatient unit, and at one-, three-, six-, and twelve-months following discharge. The proposed randomized controlled trial of ACT for Life has the potential to fill the VHA’s need for empirically-supported inpatient interventions that can be delivered during a typical inpatient stay, are recovery oriented, and prevent future suicidal behavior. If results support the efficacy of the ACT for Life intervention, ACT for Life will be the first and only inpatient, evidence-based psychotherapy known to prevent suicidal behavior among Veterans.

精神科住院是提供治疗以降低自杀风险和 为功能恢复奠定基础。事实上，精神科住院后的一段时间呈现出 退伍军人自杀死亡的最大风险。尽管精神科住院是一个至关重要的时间 干预，目前还没有针对自杀的循证心理疗法(EBPS)可以可行地提供 在典型的VHA住院期间。重要的是，针对自杀的住院干预主要集中在 关于减少自杀行为的再次发生，以及有限或不专注于直接针对其他方面 功能恢复的可能性。如果我们不能帮助病人，在危机中防止自杀只是一个短期的解决方案 在建立他们认为值得活下去的生活中。 在过去的几年里，我们的研究一直集中在解决这一差距和克服障碍上 在住院环境中实施心理社会干预。接纳与承诺疗法(ACT) 是一种既适合预防自杀又能增强功能的心理社会干预措施，但我们没有 了解任何专门针对自杀风险而设计的基于ACT的治疗方案。我们咨询了 领导ACT临床医生和研究人员开发和手册“ACT for Life”，一种简短的，跨诊断的， 对因自杀风险住院的退伍军人进行以康复为导向的住院干预。个人 干预包括3至6次住院会议和1至4次门诊会议，重点是技能推广和 治疗约定。我们进行了一项随机对照试点研究，评估ACT的可接受性。 和拟议的随机对照疗效试验的计划设计的可行性。结果： 这项严格的初步研究支持了ACT for Life的可接受性和可行性。几乎所有退伍军人都报告说 他们相信自己受益于ACT for Life。初步结果表明，终身ACT可能会 改善功能，减少因自杀风险住院后的自杀行为。然而，一个完整的- 需要进行大规模的临床试验，以最终评估ACT的终生疗效。 为了实现这一目标，我们提议进行一项随机对照试验，将ACT for Life与 278例有自杀危险住院的退伍军人自杀行为结局的当前中心治疗 以及在精神科住院后一年内的功能变化。这样做的具体目的是 研究旨在确定ACT对预防自杀行为和最大化功能的有效性 恢复，并审查生命治疗机制的候选ACT。参与者将完成评估 在治疗前、出院前以及1、3、6和12个月时 出院后。拟议的ACT终身随机对照试验有可能填补VHA的 需要在典型住院期间提供的经验支持的住院干预措施，包括 以康复为导向，防止未来的自杀行为。如果结果支持ACT的终生疗效 干预，ACT for Life将是第一个也是唯一一个已知的住院患者、循证心理疗法 退伍军人中的自杀行为。