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防止未来的自杀行为

• 批准号: 10396473
• 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 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10396473
• 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.

精神病住院是提供治疗以降低自杀风险和的关键机会 为功能恢复奠定基础。实际上，精神科住院后的时期提出了 退伍军人自杀的最大风险。尽管精神科住院是至关重要的时间 干预，没有特定于自杀的循证心理治疗（EBP）可以可行地交付 在典型的VHA住院期间。重要的是，自杀特异性的住院干预措施主要集中在 在减少自杀行为的重新发生，并且不关注直接针对其他方面 功能恢复。如果我们无法帮助患者，则在危机中预防自杀只是一种短期解决方案 在建立他们认为值得生活的生活中。 在过去的几年中，我们的研究一直集中在解决这一差距和克服障碍上 在住院环境中实施社会心理干预措施。接受和承诺疗法（法案） 是一种社会心理干预措施，非常适合防止自杀和增强功能，但我们不是 意识到任何旨在针对自杀风险的基于ACT的治疗方案。我们咨询了 领先的ACT临床医生和研究人员开发和手动使“终身行动”，简短的经诊断， 因自杀风险而导致的，面向恢复，住院治疗的退伍军人。个人 干预涉及3至6次住院会议和1至4次门诊会议，重点是技能概括和 治疗参与。我们进行了一项随机控制的试点研究，评估了ACT的可接受性 对于拟议的随机对照效率试验，计划设计的生命以及计划设计的可行性。结果 这项严格的试点研究支持行为生命的可接受性和可行性。几乎所有退伍军人报告 他们认为自己从终身行为中受益。初步结果表明，生命的行为可能 由于自杀风险而改善住院后的自杀行为并减少自杀行为。但是，一个完整的 规模临床试验对于确定评估生命的行为效率将是必要的。 为了实现这一目标，我们建议进行生命与生命行为的随机对照试验 现有的以278名退伍军人为中心的治疗，因自杀风险住院治疗以检查自杀行为的结果 并在精神病住院后一年内的功能变化。这个特定的目的 研究是为了确定终身行为的效率，以防止自杀行为和最大化功能 恢复，并检查候选人的生命治疗机制。参与者将完成评估 在处理之前，从住院单元出院之前，在一个，三，六个月和十二个月处 出院后。拟议的生命行为随机对照试验有可能填补VHA的 需要在典型住院期间可以提供的经验支持的住院干预措施 以恢复为导向，并防止将来的自杀行为。如果结果支持该法案的生命效率 干预，一生的行为将是第一个也是唯一的住院，循证心理治疗，以防止 退伍军人的自杀行为。