Focused Acceptance and Commitment Therapy Group Development Utilized to Decrease Rates of Suicidal Ideation During Hospitalization

Background: Suicide is a concerning problem. Suicidality is linked to avoidance of mental health problems such as rising depression, anxiety, and suicidal ideation (SI). Psychotherapy and healthy coping skills can be used to lessen avoidance of mental health problems. There are limited therapeutic modalities developed to aid in reducing SI in a brief approach. Of greater concern, some therapeutic modalities that have shown benefit in reducing SI in a brief approach have yet to be implemented within psychiatric treatment programs. Focused Acceptance and Commitment Therapy (FACT) is a form of therapy that has been used in a brief approach to improve healthy coping skills, anxiety, depression, suicidality, and well-being. Purpose: The purpose of this quality improvement project was to implement a FACT-based group in an inpatient psychiatric (IPSY) setting at Utah Valley Hospital (UVH) to reduce rates of SI. Methods: 103 participants over 30 days. Participants attended one to three FACT session(s). Sessions were comprised using the outlines from Brief Interventions for Radical Change: Principles & Practice of Focused Acceptance & Commitment Therapy by Strosahl, Robinson, and Gustavsson (2012). Session one included mindfulness and reflection of participants life path. Session two included acceptance, developing new perspectives on suffering, and facing challenges. Session three included awareness of things participants value, making realistic commitments, and following-through. Interventions: SI ratings were assessed by nurses upon admission and during hospitalization using the Columbia Suicide Severity Rating Scale (C-SSRS). Conclusions evaluated C-SSRS scores between FACT participants and non-participants and interdisciplinary team implementation of FACT assessing pros, cons, and barriers to implementation. Results: Of 103 patients approached in this project, 73 (70.9%) participated in the FACT groups and 30 (29.1%) refused to participate. The average pre-intervention C-SSRS score was 4.42 and the post-intervention C-SSRS score was 0.94 among participant and non-participant groups combined. Both groups scores significantly improved over time (p<0.001). Neither group improved faster than the other. Those that participated in the FACT groups did not have a significant change in C-SSRS scores compared to those that did not participate in FACT groups (p=0.979). The number of sessions participants attended did not significantly affect C-SSRS scores (p>0.05). Conclusions: The implementation of this project was successful. The overall ratings for suicide were significant pre- and post-intervention. The study did not show a significant difference in participant scores versus non-participants. There was not a significant difference among the number of sessions participants attended. The next steps to take are to identify the overall effectiveness of current psychotherapy groups taught on IPSY compared to the FACT groups.