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

精神病住院治疗是提供治疗以降低自杀风险的关键机会， 为功能恢复打下基础事实上，精神病住院治疗后的一段时间， 退伍军人自杀的最大风险。尽管精神病住院是一个重要的时间， 干预，没有自杀特异性循证心理疗法（EBP）可以切实可行地提供 在典型的VHA住院期间。重要的是，针对自杀的住院干预措施主要集中在 减少自杀行为的再次发生，并有限或没有直接针对其他方面的重点 功能恢复。如果我们不能帮助病人，在危机期间防止自杀只是一个短期的解决方案 建立一个他们认为值得过的生活 我们过去几年的研究一直集中在解决这一差距和克服障碍 to implementing实施psychosocial心理interventions干预in an injured住院setting设置.接受和承诺疗法（ACT） 是一种心理社会干预，既能预防自杀，又能增强功能，但我们没有。 了解任何以ACT为基础的治疗方案，专门针对自杀风险。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”，一个简短的，transdiagnosis， 康复导向，住院，对因自杀风险住院的退伍军人进行干预。个人 干预包括3至6次住院治疗和1至4次门诊治疗，重点是技能推广， 治疗参与。我们进行了一项随机对照的初步研究，评估ACT的可接受性。 以及拟定随机对照疗效试验计划设计的可行性。结果 这项严格的试点研究支持ACT for Life的可接受性和可行性。几乎所有的退伍军人报告说， 他们相信，他们的生活是幸福的。初步结果表明，ACT for Life可能 改善功能并减少因自杀风险而住院后的自杀行为。然而，一个完整的- 大规模的临床试验将是必要的，以明确评估ACT for Life的疗效。 为了实现这一目标，我们建议进行一项ACT for Life与 278例因自杀风险住院的退伍军人的现代中心疗法，以检查自杀行为的结局 以及精神病住院后一年内功能的变化。具体目标是 研究旨在确定ACT for Life预防自杀行为和最大化功能的有效性。 恢复，并检查候选ACT for Life治疗机制。参与者将完成评估 治疗前、出院前以及1个月、3个月、6个月和12个月时 出院后。拟议的ACT for Life随机对照试验有可能填补VHA的 需要在典型住院期间提供外科支持的住院干预措施， 以康复为导向，防止未来的自杀行为。如果结果支持ACT for Life的疗效， 干预，ACT for Life将是第一个也是唯一一个住院的，以证据为基础的心理治疗已知，以防止 退伍军人中的自杀行为

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.