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

ACT for Life：自杀危机后最大限度恢复的简短干预

• 批准号: 9282296
• 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: 2016
• 资助国家: 美国
• 起止时间: 2016-06-01 至 2018-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9282296
• 关键词: Acute; Address; Adherence; Aftercare; Area; Behavior; Caring; Client satisfaction; Clinical; Consult; Consultations; Distress; Dose; Eligibility Determination; Emotions; Enrollment; Ensure; Equipment and supply inventories; Esthesia; Evaluation; Evidence based treatment; Exercise; Feasibility Studies; Fostering; Funding; Future; Goals; Health; Health Policy; Healthcare; Hospitalization; Hospitals; Hour; Individual; Information Systems; Inpatients; Intervention; Interview; Learning; Length of Stay; Life; Literature; Manuals; Measurement; Measures; Medical; Medical Records; Mental Health; Metaphor; Modification; Outcome; Outcome Measure; Outpatients; Pain; Participant; Pathway interactions; Patient Outcomes Assessments; Patients; Performance; Pilot Projects; Population; Problem Solving; Procedures; Process; Protocols documentation; Provider; Psychiatric therapeutic procedure; Psychotherapy; Psychotic Disorders; Public Health; Questionnaires; Randomized; Randomized Clinical Trials; Recommendation; Recovery; Recovery of Function; Rehabilitation Research; Research; Research Design; Research Personnel; Resources; Risk; Sample Size; Sampling; Self-Direction; Services; Severities; Specific qualifier value; Suicide; Suicide prevention; Testing; Therapeutic Intervention; Thinking; Time; Treatment Efficacy; Treatment Protocols; United States National Institutes of Health; Value of Life; Veterans; Violence; Visit; arm; base; brief intervention; community reintegration; design; efficacy study; efficacy trial; evidence base; experience; follow up assessment; follow-up; functional outcomes; high risk; high risk population; improved; inpatient psychiatric treatment; interest; killings; medication compliance; novel; prevent; psychologic; psychosocial; public health relevance; reduce symptoms; reducing suicide; research and development; research study; response; retention rate; skills; suicidal; suicidal behavior; suicidal morbidity; suicidal risk; targeted treatment; therapy design; treatment as usual

 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.

 描述（由申请人提供）： 精神病医院为提供有针对性的治疗以降低自杀风险并促进功能恢复提供了关键的机会。然而，在典型的退伍军人卫生事务（VHA）住院住院期间，没有可行的自杀特异性的急诊干预措施，可以可行地提供。9尽管VHA现在需要提供基于循证的，以恢复为基础的循证，面向康复的心理治疗，为9种较高的患者进行了高风险，并且在SUIDIDS上进行了高风险，并且在SUIDIDS上进行了高风险，并且在SUIDIDS上进行了高风险。在住院精神科环境中预计住院时间较短的住院精神病环境中的资源密集型实施。此外，这些干预措施几乎完全集中于预防自杀行为而不针对功能恢复。10同样，住院的精神病治疗传统上关注的是急性疾病的医疗管理，而不是改善患者的功能。11防止危机期间的自杀只是一种短期解决方案，我无法帮助患者了解他们的生活，他们会为他们的生活做出挑战。鉴于大约50％的住院患者不参与建议的门诊精神卫生保健，并且自杀死亡风险最高，因此，至关重要的是，住院护理促进功能恢复至关重要。1212在自杀式治疗中的自杀风险降低自杀的风险，利用恢复性恢复的习惯疗法，对自杀的风险进行了理想的短暂干预，是恢复性恢复的风险，是恢复性的效率。 5 ACT教授心理技能来处理痛苦的思想，情绪和感觉，而不是专注于减轻症状，而不是通过协助患者识别和参与价值持续的行为来直接针对功能恢复。自杀风险。为了填补这一空白，调查人员与行为领域的主要专家进行了咨询，以开发和手动化“生命法案”，这是由于自杀风险而住院的退伍军人的短暂，经诊断，面向恢复的干预措施。 《生命手册法》详细介绍了法案在自杀危机中恢复的应用，由三个模块组成，[旨在在三到四个60分钟的个人会议中使用。参加该研究的退伍军人将被随机分配给：（a）照常治疗或（b）像往常一样的处理法案。这项研究的具体目的是：（1）确定生命行为的可接受性。 （2）确定研究的可行性 设计和研究程序。 （3）表征参与者的社会心理功能和自我指导的暴力，使用候选结果指标进行未来的效率试验。将评估经过验证的措施的性能，以及选定的NIH患者报告的结果测量信息系统（Promis）模块。14所有参与者将完成基线评估，并在出院后一个月和三个月后进行后续评估。 ACT小组的参与者还将完成有关干预可接受性的治疗后评估。拟议的研究是一系列研究的关键第一步，可能会产生一种恢复，紧急支持的干预措施，旨在与有自杀风险的退伍军人使用住院。为人生目标而采取的行动是直接融入了康复研究与发展服务局的目标，以优化退伍军人的功能和社区重返社会。通过这样做，这种干预措施可以帮助退伍军人建立他们认为值得生活的生活，降低代偿性的风险并最终防止自杀。