Acceptance and Commitment Therapy to Promote Recovery from suicidal crises: A Randomized Controlled Acceptability and Feasibility Trial of ACT for life

https://doi.org/10.1016/j.jcbs.2021.02.003Get rights and content

Highlights

  • •

    ACT for Life shows promise for maximizing recovery after suicidal crises.

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    Veterans on an inpatient unit found ACT for Life to be acceptable and beneficial.

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    ACT for Life was feasible to administer during psychiatric inpatient stays.

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    Veterans appreciated the simple yet intensive nature of the 3–6 session treatment.

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    Results add to literature supporting ACT for patients at high risk of suicide.

Abstract

Objectives

ACT for Life was developed to guide the application of Acceptance and Commitment Therapy (ACT) to maximize recovery from suicidal crises. The current study tested the acceptability of ACT for Life and evaluated the feasibility of the research design for a future efficacy trial.

Method

Seventy veterans were randomized to treatment as usual (TAU) or ACT for Life plus TAU. Participants were assessed at baseline, post-treatment, and one- and three-months post enrollment.

Results

The mean Client Satisfaction Questionnaire-8 score was 29.1 (SD = 4.2; 95% CI: 27.6, 30.8). Qualitative data further supported acceptability. Feasibility was demonstrated by 74.3% of participants completing the treatment per protocol and clinicians delivering the treatment with 95% fidelity. Preliminary data suggest that ACT for Life may improve recovery following suicidal crises.

Conclusions

ACT for Life was highly acceptable and feasible. Future research is warranted to establish the efficacy 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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