(PS11-20) Cognitive Flexibility as a Mechanism of Change in Reducing Suicidal Thinking in a Smartphone-based Cognitive Behavioral Intervention

Suicide risk is highest during the period immediately following discharge from inpatient psychiatric care (Chung et al., 2017). This suggests that we may lack a nuanced understanding of how treatments given during inpatient care work during the outpatient period. Cognitive-behavioral protocols are widely used for individuals with suicidal thoughts and behaviors, including during the post-inpatient discharge period (Diefenbach et al., 2021, LaCroix et al., 2018). Previous research on mechanisms of change in cognitive behavioral therapy (CBT) (Khakpoor et al., 2019, Schaeuffele et al., 2022) suggests cognitive flexibility may be a key mechanism in the effectiveness of some components of CBT (Sauer-Zavala et al., 2021). However, little research exists which focuses on uptake of cognitive flexibility as a mechanism for treatments whose goal is to reduce suicidal thinking and behaviors during the high risk post-discharge period. The present study will test whether cognitive flexibility, measured weekly using a validated measure of use of cognitive skills in CBT, are a mechanism of effectiveness using ecological momentary intervention (EMI) to deliver therapeutic content based on the Unified Protocol (UP) within a sample of suicidal psychiatric inpatients. The EMI app allows real-time skills practice and momentary suicidal thinking is assessed before and after each exercise practice. Analyses will investigate whether improvements in cognitive flexibility are the mechanism of change in reduction of suicidal thoughts and behaviors. Our preliminary analysis of ongoing data collection finds that cognitive flexibility varies from week to week (ICC = .73). Once the study concludes, we will examine a model predicting average slope, for each participant, each week of the pre- to post-exercise practice ratings of suicidal thinking will be predicted by weekly assessments of cognitive flexibility.