4 - (SYM 62) Stakeholder Perspectives on Ecological Momentary and Just-in-time Adaptive Interventions for Individuals Who Self-injure and Seek Treatment

NSSI rates are highest in clinical populations and are linked to increased risk for rehospitalization and suicide attempts (Van Alphen et al., 2017; Horwitz et al., 2015). A meta-analysis of RCTs found that conventional treatment alone does not reduce NSSI frequency (Fox et al., 2020), partly because traditional approaches rely on static interventions at periodic intervals. In contrast, NSSI is highly dynamic, fluctuating within hours and peaking in the evening—outside regular treatment hours (Kiekens et al., 2024). EMIs and JITAIs offer a potential solution by delivering support when needed (Coppersmith et al., 2022; Kruzan et al., 2024). However, despite growing enthusiasm, little is known about how key stakeholders perceive these interventions.

This study examines stakeholder perspectives by conducting semi-structured interviews with 30 treatment-seeking individuals (ages 18–39; 80% female, 46.7% non-heterosexual, 70% without a college degree) and 14 clinicians (ages 25–60; 78.6% female). All participants were part of the Detection of Acute Risk of Self-Injury Project (Kiekens et al., 2023), a 28-day EMA study in which patients in Belgium monitored their social context, affective-cognitive states, and NSSI-related cognitions and behaviors. We will use reflexive thematic analysis to examine stakeholder perspectives across four key domains.

First, we will assess stakeholder attitudes toward EMIs as treatment adjuncts, focusing on anticipated benefits and challenges. Second, we will investigate intervention targets, evaluating whether stakeholders prioritize NSSI, other self-damaging behaviors (e.g., disordered eating, suicidality), or transdiagnostic factors (e.g., emotion dysregulation). Third, we will consider the timing of delivery, determining how and when interventions should be deployed in the risk process. Finally, we will explore the perceived feasibility of JITAIs, including automated (push vs. pull) delivery and engagement barriers. The objectives and analysis plan have been registered on the Open-Science Framework and will be completed prior to the meeting.

Findings will provide critical insights into stakeholder perspectives, guiding the development of EMIs and JITAIs for individuals who engage in NSSI. Incorporating these perspectives ensures that interventions are aligned with user needs, enhance therapy engagement, and reduce risk in real time. Future research should assess the generalizability of findings to non-treatment-seeking individuals and those in different healthcare settings.