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.

Veterans have the greatest risk of death by suicide immediately following psychiatric hospitalization. Despite hospitalization being a vital time for intervention, there are no suicide-specific research-supported psychotherapies that can be feasibly delivered during a typical VHA inpatient stay. Our research over the past several years has been focused on Acceptance and Commitment Therapy (ACT) as a psychosocial intervention well suited to both preventing suicide and enhancing functioning. The current study will determine whether a brief ACT intervention can enhance recovery after hospitalization for suicide risk and prevent suicidal behavior in the year following inpatient hospitalization. We will determine if benefits are due specifically to ACT, by comparing ACT to Present Centered Therapy. If ACT is found to be efficacious, it will be the first and only evidence-based psychotherapy for Veteran inpatients known to prevent suicidal behavior.