2 - (IOP 22) How Decades of Research on Exposure Therapy Can Help Clinicians Improve Their Suicide Prevention Practices

Background: Heightened clinician anxiety and low self-efficacy leads clinicians to avoid suicide prevention evidence-based practices (EBPs), including screening and brief interventions that reduce unnecessary hospitalizations. Using gold-standard anxiety interventions to help clinicians better manage their anxiety may improve EBP implementation. We assessed the acceptability, feasibility, and preliminary effectiveness of delivering exposure therapy to clinicians to improve their anxiety management and fidelity to recommended practices when working with patients at-risk for suicide.

Method: With a community advisory board, we developed and refined an exposure-based implementation strategy (EBIS) that incorporated gold standard imaginal and in vivo exposure therapy techniques into workshop training and consultation. We tested the EBIS compared to Implementation as Usual (IAU; 4-hour workshop plus 6 hours of group consultation sessions) in a 12-week pilot randomized clinical trial (n = 36 clinicians; 89% female, M age = 37.0). We measured acceptability, feasibility, target mechanism engagement (clinician anxiety and self-efficacy), and implementation outcomes (intentions, use of routine suicide risk screening, and fidelity to the Safety Planning Intervention [SPI] in a standardized role play) over the trial period, using mixed methods.

Results: Clinicians viewed EBIS as highly acceptable and feasible, evidenced through survey and semi-structured interviews. The conditions did not differ with respect to drop out, consultation attendance, or measure completion. There were no adverse events or clinician concerns about participating in exposure tasks. Post trial, clinicians randomized to receive EBIS had higher intentions to intervene with patients identified as at-risk trial, showed higher rates of routine suicide screening, and demonstrated higher SPI fidelity than those randomized to IAU, with small to medium effect sizes. Qualitative data suggested that clinicians randomized to EBIS appreciated and benefited from the explicit focus on emotional reactions associated with suicide prevention work, with some requesting more exposure-oriented content.

Conclusion: Augmenting traditional suicide prevention training with exposure tasks for clinicians holds promise as an implementation strategy to improve suicide prevention EBP use. Increasing the dose of exposure delivered to clinicians may increase impact.