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

 描述(由申请人提供)： 精神科住院为提供有针对性的治疗以降低自杀风险和促进功能恢复提供了一个关键机会。9虽然退伍军人健康事务部现在要求提供以证据为基础、以康复为导向的住院患者心理治疗，但现有的9种针对高自杀风险患者的经验式干预措施是为在门诊环境中使用而制定的，这些干预措施过于耗费时间和资源，无法在住院精神科环境中按预期实施，因为住院时间较短。此外，这些干预措施几乎完全侧重于预防自杀行为，而没有针对功能恢复。10同样，住院精神病治疗传统上侧重于急性疾病的医疗管理，而不是改善患者的功能。11在危机期间防止自杀只是一种短期的解决办法，因为我们无法帮助患者了解如何重建他们认为值得生活的生活。鉴于约50%的住院患者没有接受建议的门诊精神卫生保健，而且自杀死亡的风险最高，因此住院护理促进功能恢复至关重要。12对于有自杀风险的退伍军人来说，理想的短期干预需要降低自杀行为的风险，同时促进康复。接受与承诺疗法(ACT)是一种面向康复的心理社会治疗方法，非常适合因自杀风险住院的退伍军人使用。5 ACT教授处理痛苦的想法、情绪和感觉的心理技能，但不是专注于减轻症状，而是直接针对功能恢复，通过帮助患者识别并参与价值一致的行为，尽管存在潜在的痛苦。5 ACT已成功地适用于精神病患者的住院使用，1，2，13，但没有基于ACT的简明、跨诊断的治疗方案，旨在解决自杀风险。为了填补这一空白，调查人员咨询了ACT的主要专家，开发并制作了“ACT for Life”，这是一种针对因自杀风险而住院的退伍军人的简短、跨诊断、面向康复的干预措施。ACT for Life手册详细说明了ACT在自杀危机中的康复应用，由三个模块组成[设计用于三至四个60分钟的个人课程]。如果获得资金，拟议的两组随机对照试点研究将提供关键信息，为治疗手册的最终修订和未来ACT终身有效性研究的研究设计提供信息。参加这项研究的退伍军人将被随机分为：(A)照常治疗或(B)照常治疗加ACT。本研究的具体目的是：(1)确定ACT对生活的可接受性。(二)确定研究的可行性 设计和研究程序。(3)在未来的疗效试验中使用候选结果测量来表征参与者的心理社会功能和自我定向暴力。将评估有效措施的绩效，以及选定的NIH患者报告结果衡量信息系统(PROIS)模块。14所有参与者将在出院后1个月和3个月完成基线评估和后续评估。ACT组的参与者还将完成对干预可接受性的治疗后评估。这项拟议的研究是一系列研究中至关重要的第一步，该研究可能会产生一种以康复为导向、有经验支持的干预措施，用于住院治疗有自杀风险的退伍军人。为生命行动的目标与康复研究和发展服务的目标直接一致，即优化退伍军人的职能和重新融入社区。通过这样做，这种干预可能会帮助退伍军人建立他们认为值得生活的生活，降低失代偿的风险，并最终防止自杀。

 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.