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

 描述（由申请人提供）： 精神病住院治疗提供了一个关键的机会，提供有针对性的治疗，以减少自杀风险和促进功能恢复。然而，在典型的退伍军人健康事务部（VHA）住院期间，没有自杀特异性的精神支持干预措施可以切实可行。9尽管VHA现在要求提供以证据为基础的，以恢复为导向的住院心理治疗，针对自杀高风险患者的9种现有医疗支持干预措施是为门诊患者开发的，时间和资源都太多-在预期住院时间较短的住院精神病患者中，此外，这些干预措施几乎完全集中在预防自杀行为上，而没有针对功能恢复。10同样，住院精神病治疗传统上集中在急性疾病的医疗管理上，而不是改善患者的功能。11在危机期间预防自杀只是一个短期解决方案，我们无法帮助患者了解他们如何重建他们认为值得过的生活。鉴于约50%的住院患者不接受推荐的门诊心理健康护理，并且自杀死亡的风险最高，住院护理促进功能恢复至关重要。 接受和承诺疗法（ACT）是一种以恢复为导向的心理社会治疗方法，非常适合用于因自杀风险住院的退伍军人。ACT教授心理技能来处理痛苦的想法，情绪和感觉，但不是专注于症状减轻，ACT通过帮助患者识别和参与价值，直接针对功能恢复-5 ACT已成功地适用于精神病患者的住院使用，1，2，13但没有简短的，基于ACT的，旨在解决自杀风险的跨诊断治疗方案。为了填补这一空白，研究人员咨询了ACT的主要专家，以开发和手册化“ACT for Life”，这是一种针对因自杀风险住院的退伍军人的简短、跨诊断、以恢复为导向的干预措施。ACT for Life手册详细介绍了ACT在自杀危机恢复中的应用，包括三个模块，[设计用于三到四个60分钟的单独会议。如果获得资助，拟议的两组、随机、对照初步研究将提供关键信息，为未来ACT for Life疗效研究的治疗手册和研究设计的最终修订提供信息。入组本研究的退伍军人将随机分配至：（a）常规治疗组或（B）常规治疗加ACT组。 本研究的具体目的是：（1）确定ACT终身的可接受性。(2)确定研究的可行性 设计和研究程序。(3)描述参与者的心理社会功能和自我导向的暴力使用候选结果的措施，为未来的疗效试验。沿着选定的NIH患者报告结局测量信息系统（PROMIS）模块，将评估经验证的测量指标的性能。14所有参与者将完成基线评估，并在出院后1个月和3个月进行随访评估。ACT组的受试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的关键第一步，这些研究可能会产生一种以恢复为导向的，为有自杀风险的退伍军人住院使用而设计的医疗支持干预措施。ACT for Life的目标与康复研究和发展服务的目标直接一致，即优化退伍军人的功能和重返社区。通过这样做，这种干预可以帮助退伍军人建立他们认为值得生活的生活，减少失代偿的风险，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.