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Symposia

Suicide and Self-Injury

Bridging Treatment and Daily Life: Future Directions, Stakeholder Perspectives, and Evaluation of Ecological Momentary Interventions for Self-Injurious Thoughts and Behaviors

2 - (SYM 62) Pilot RCT of a Smartphone-based Inpatient-to-outpatient Suicide Prevention Intervention

Sunday, November 23, 2025
12:18 PM - 12:32 PM CST
Location: Strand 13A&B, Level 2
Keywords: Self-Injury, Suicide, Technology / Mobile Health
Recommended Readings: Ammerman, B. A., & Law, K. C. (2022). Using intensive time sampling methods to capture daily suicidal ideation: A systematic review. Journal of Affective Disorders, 299, 108-117. https://doi.org/10.1016/j.jad.2021.10.121,   Coppersmith, D. D., Dempsey, W., Kleiman, E. M., Bentley, K. H., Murphy, S. A., & Nock, M. K. (2022). Just-in-time adaptive interventions for suicide prevention: Promise, challenges, and future directions. Psychiatry, 85(4), 317-333. https://doi.org/10.1080/00332747.2022.2092828,   Kiekens, G., Claes, L., Kleiman, E. M., Luyckx, K., Coppersmith, D. D., Fortgang, R. G., ... & Nock, M. K. (2024). The short-term course of nonsuicidal self-injury among individuals seeking psychiatric treatment. JAMA Network Open, 7(10), e2440510-e2440510. https://doi.org/10.1001/jamanetworkopen.2024.40510,   Kleiman, E. M., Glenn, C. R., & Liu, R. T. (2023). The use of advanced technology and statistical methods to predict and prevent suicide. Nature reviews psychology, 2(6), 347-359. https://doi.org/10.1038/s44159-023-00175-y,   Turner, B. J. (2022). Detecting and managing non‐suicidal self‐damaging behaviors. World Psychiatry, 21(3), 461-462. https://doi.org/10.1002/wps.21022
Abstract Body

The period following discharge from inpatient care is the highest-risk time for suicide, highlighting the need for interventions that support the transition to outpatient treatment. Our team developed an add-on intervention to treatment as usual (TAU) that begins with brief inpatient sessions teaching three transdiagnostic cognitive-behavioral skills for emotion management— mindful awareness of emotion, thinking flexibly, and challenging emotional behaviors. This is paired with a mobile app that helps patients practice these emotion management skills in real-world settings after inpatient discharge.

This presentation will share findings from a recent pilot randomized controlled trial (RCT) testing the preliminary effectiveness of this intervention. We hypothesized that participants receiving the intervention would show greater reductions in suicidal thinking intensity over a 28-day follow-up period compared to a control group.

The RCT included 40 participants recruited from an inpatient unit in the Northeastern United States. Those in the intervention group received TAU plus the three CBT-based skills training and app access, which included four daily Ecological Momentary Assessments (EMA) and embedded opportunities for guided automated real-time skills practice. The control group received TAU and the app with EMA only (without guided automated real-time skill practice). Of the 40 participants, 38 completed at least four EMA surveys and were included in the final analysis (n=21 in experimental condition; M age = 38.1 years; 59% White, 15.4% Black/African American; 48.7% male).

A multilevel conditional growth curve model examined the time (observation number) by condition interaction. Results showed a significant interaction (b = -0.008, 95% CI = [-0.01, -0.003], p < .001). When plotted, this indicated a significant decrease in momentary suicidal thinking intensity (assessed with EMA) over time for the intervention group (b = -0.076, t = -4.29, p < .001) but not the control group (b = 0.004, t = 0.23, p = .817).

These findings provide promising preliminary evidence that our intervention effectively reduces momentary suicidal thinking. This presentation will discuss implications for clinical practice and next steps for further research.