Acceptance and commitment therapy reduces perceived ostracism in suicidal patients

Ostracism increases the risk of depression and suicidal behaviors. Mindfulness training, which is at the core of third-wave behavioral therapies such as acceptance and commitment therapy (ACT), might reduce social distress and inhibit negative affect.

This randomized controlled trial included 32 patients with a history of suicide attempt in the past year who followed seven weekly sessions of ACT or progressive relaxation therapy (PRT). To assess and compare the effects of ACT and PRT on social distress, patients performed a validated paradigm of social exclusion (the Cyberball Game) followed by completion of the Need Threat Scale (NTS) at inclusion (baseline) and within two weeks after the intervention ended (posttherapy).

The included patients were mainly women (N = 28; 87.5%), and their mean age was 40 years (SD: 12 years). Twenty-six patients (81%) experienced current depression. The postintervention NTS score was greater (lower social distress) in the ACT group than in the PRT group (group × time interaction; β = 0.47, p < 0.05), even after controlling for depressive symptoms (β = 0.27, p < 0.05). The NTS score change (between baseline and posttherapy) was correlated with changes in dispositional mindfulness (r = 0.46, p = 0.03), cognitive fusion (r = - 0.61, p < 10^-3) and acceptance (r = 0.57, p < 10^-2).

ACT decreased social pain independently of its effect on depression. Reduced social pain was correlated with improved therapeutic processes and decreased suicidal ideation, highlighting the therapeutic potential of ACT for managing ostracism and suicide risk.