(PS9-17) Momentary distress is a key consideration for developing just in time adaptive interventions (JITAIs) to encourage safety plan use – future directions following qualitative post-study interviews.

Abstract Text: The safety planning intervention (SPI) is an evidence-based strategy for reducing suicidal behavior. Despite the efficacy of this intervention, approximately 40% of patients with a safety plan report never having used it. In an effort to better develop just-in-time adaptive interventions (JITAIs) to encourage safety plan usage, our team interviewed 11 individuals who recently participated in a smartphone monitoring study following hospitalization for suicidal thinking about their experience using the mobile safety plan developed as part of the study. Among the possible barriers explored was degree of emotional distress. Although the SPI is designed for managing severe suicidal thoughts and distress, intense negative emotion can degrade motivation and self-control for healthful behaviors and may reduce willingness to engage with the intervention.

Participants were asked to provide their impressions regarding potential barriers to safety plan use, including the intensity of distressing emotions (e.g. feeling "too distressed" to use the safety plan). Then, they were asked to provide their opinions on several proposed interventions to encourage safety plan use. We conducted qualitative coding using thematic analysis approach, and discrepancies were resolved through discussion. Nine of the 11 participants were also ask to rate the relevance of several barriers to safety plan use on a scale of 1-5 and, of those nine, six rated feeling "too distressed" 3 or higher. Some participants noted that the experience of intense distress was so exhausting that turning to the safety plan did not feel feasible. Conversely, some participants felt that they were equipped to use coping strategies when experiencing distress and identified the intensity of their negative emotions as their main facilitator for using the safety plan, rather than a barrier.

Following these interviews, we developed prototypes of several automated smartphone intervention components that promote SPI use by addressing momentary barriers, including intense distress. Exercises designed to target distress involved guiding participants through a brief breathing exercise before prompting safety plan review, and an acknowledgement that using the safety plan when it is needed most can be difficult due to intense distress. Though some proposed interventions were consistently rated higher than others, overall diversity in opinions validates the precise, participant-specific nature of JITAIs. Prototypes and feedback will be presented. Incorporating qualitative impressions, we plan to continue refining these interventions and deploy them in a real-time delivery platform to assess their efficacy and feasibility as real-time digital ecological momentary interventions (EMI) to increase SPI use in times of distress.