(PS11-58) From Death to Life: Changes in Suicide Implicit Association in a Prolonged Exposure Treatment

Abstract Text: Intro: Prolonged exposure (PE) therapy is a first-line treatment for PTSD, and it has recently yielded positive efficacy and feasibility for serious mental illnesses. Bipolar patients present with higher rates of PTSD compared to the general population, along with worsened quality of life and increased suicidality, yet no treatment for this comorbidity exists. This study examined the feasibility and preliminary efficacy of PE in a comorbid Bipolar and PTSD outpatient sample. Results indicated significantly lowered suicide risk following treatment, and improvements in suicide implicit associations were durable at 6 months follow-up. In this post-hoc exploratory analysis, we aim to further understand the differences between those who changed their implicit association from life to death vs. death to life, by examining the role of previous suicide attempts and depressive episodes.

Methods: Participants (N=32) were enrolled in a 10-week PE treatment. At baseline, participants self-reported number of depressive episodes in the past year, percentage of last year spent depressed, and number of suicide attempts. Participants also completed measures of implicit suicide association (Suicide Implicit Association Test [SIAT]) at baseline, end-of-treatment (week 10), and at 6-month follow-up. We have clustered the participants who completed SIAT measures at both baseline and week-10 (n=21) into two groups 1) Change towards life vs. 2) Change towards death, based on the trajectory of their SIAT changes from baseline to end of treatment (week-10). Fisher’s exact tests and independent t-tests were conducted to evaluate potential subgroup differences in baseline characteristics.

Results: There were no differences between the change towards life vs. change towards death groups in the number of depressive episodes in the past year or the percentage of last year spent depressed. The Change towards life group reported significantly more suicide attempts at baseline (M=2.75 SD=1.58) compared to the Change towards death group (M=1, SD=0) p = .017.

Discussion: Results suggest that within our sample, participants who reported previous suicide attempts experienced the greatest changes from death to life, compared to those who did not report previous suicide attempts. Individuals with a history of suicide attempts may benefit from PE to reduce their implicit suicide-related thoughts. However, this must be interpreted carefully, as only half of the participants (n=10) reported a previous suicide attempt. Future studies should further examine the effects of PE on suicide risk in individuals with a history of previous suicide attempts.