(PS11-35) Examining the Acceptability and Feasibility of a Just-in-time Adaptive Intervention for Suicidal Adolescents

Suicide is a leading cause of death in children and adolescents (CDC, 2022). Dialectical behavior therapy (DBT) has been shown to be efficacious (Saito et al., 2020), but low skills engagement is common and a barrier to improvement. To increase skill use, we designed a novel just-in-time adaptive intervention in which we send personalized reminders to use DBT skills. Here, we present results of a pilot study testing the feasibility and effectiveness of this intervention. Participants were adolescents (N = 25) admitted to an inpatient unit for self-injurious thoughts and behaviors (60% White, 20% Hispanic, 56% cisgendered female, 52% bisexual, mean age = 16.0, SD = 1.22). Participants completed a one-time DBT skills training at enrollment. While on the inpatient unit, participants completed smartphone-based surveys multiple times a day assessing for distress and self-injurious thoughts (rated on a scale of 0-10). After completing these surveys, participants were randomized to receive a reminder to use a skill tailored to their reported distress. Follow-up surveys reassessed symptoms and skill use. We assessed feasibility and acceptability in a qualitative interview at the participant’s hospital discharge. On average, participants reported low levels of distress (M=3.85, SD=1.51), urge to self-injure (M=2.82, SD=2.83), and suicidal desire (M=2.64, SD=3.16). Across 25 participants, 618 check-ins skill reminders were sent, but only 149 were completed. In completed follow-up surveys (n=75), participants reported engaging in the suggested skill 74% of the time and reported using another skill 18% of the time. We were missing data from 74 follow-up surveys. Skill reminders suggesting the building mastery skill (e.g., completing a difficult task) resulted in the highest completion rate (50%), whereas radical acceptance (17%) and ice-dives (20%) had the lowest completion rates. If the participant engaged in the suggested skill, distress, urge to self-injure, and suicidal desire all decreased at follow-up. Largest decreases in self-injurious urges and desire were observed following use of distress tolerance skills. In the closing interview, when asked how they felt about skills generally, 88% (n = 22) of participants reported a positive association or that their opinions about skills had improved due to the study. Some participants reported that they enjoyed trying out new skills (20%; n =5). However, more than half of participants reported difficulty with remembering to use the phone for check ins and skills reminders (n=14). Additionally, some participants reported that their intense symptoms made it difficult to use the skills (20%; n = 5). Results of this pilot study suggest that sending regular reminders to use DBT skills is feasible and acceptable in adolescents, given the consistently positive responses received from adolescents during the closing interviews and adolescents’ reported use of suggested skills during the study. We identified some areas for improvement, such as missing follow-up surveys data, which will inform modifications in a larger micro randomized trial testing this skills intervention.