Acceptance and Commitment Therapy to Promote Recovery from suicidal crises: A Randomized Controlled Acceptability and Feasibility Trial of ACT for life
Section snippets
Design
This was a two-arm, single blind (assessor), randomized controlled pilot trial. Seventy veterans hospitalized due to suicide risk were randomized to receive ACT for Life plus Treatment as Usual (referred to as ACT for Life) or Treatment as Usual (TAU) alone. All participants were asked to complete a baseline assessment prior to randomization and follow-up assessments at one- and three-months following enrollment. Participants randomized to ACT for Life were also asked to complete a
Treatment as usual
All participants, regardless of randomization, received TAU. TAU consisted of access to all services typically delivered on the psychiatric inpatient unit; including psychopharmacology and individual and group psychotherapy; and all mental health services accessible following discharge. All inpatients were required to complete a VA Safety Plan (Stanley & Brown, 2008) as a component of TAU prior to discharge. Participation in inpatient group and individual psychotherapy is optional. Treatment
Participants
Seventy veterans hospitalized for suicide risk enrolled in the study. The average participant was an unemployed/retired, middle-aged, Caucasian male (See Table 3). Forty percent of the sample was homeless. Participants across treatment groups were similar, with the exception that more participants in the ACT for Life group were homeless and more participants in the TAU group reported unwanted sexual attention while serving in the military.
Acceptability
Thirty of the 35 participants randomized to ACT for Life
Referral, eligibility, & participation
Patients referred for study participation were typically eligible (91 out of 99 patients; 91.9%; ≥50% eligible criterion; See Fig. 1). Only 10 potential participants declined study participation due to lack of interest. An additional 11 potential participants declined because they did not think they would have adequate time to participate prior to discharge even though their treatment team believed that they would. Seventy out of 91 potential participants enrolled in the study (76.9%; ≥30%
Discussion
ACT for Life was acceptable to a diverse group of veterans hospitalized due to suicide risk, and presenting with a variety of psychosocial stressors, mental health diagnoses, and levels of functional impairment. Gaps in current inpatient psychiatric care are addressed through ACT for Life in that it provides an acceptable transdiagnostic inpatient intervention that directly targets functional recovery and has the potential to prevent suicidal behavior. The intervention was intensive, with an
Conclusion
This study is the first to report on the development and evaluation of a suicide-specific ACT treatment protocol for patients hospitalized due to suicide risk. Results of this rigorous pilot study support the acceptability and feasibility of ACT for Life, and more generally the potential utility of ACT for patients at risk of suicide. Participants perceived the intervention as beneficial, and preliminary outcomes related to life satisfaction, functioning, treatment engagement, and suicidal
Declaration of competing interest
None.
Acknowledgments
This work was supported by the Veterans Affairs Department of Rehabilitation Research and Development Award #I21 RX002048-01 and the Rocky Mountain Mental Illness Research, Education, and Clinical Center. This paper is based on work supported by the Department of Veterans Affairs, but does not necessarily represent the views of the Department of Veterans Affairs or the United States Government.The authors wish to thank the study clinicians Caroline Kelly, Amy Starosta, and Matthias
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