Examine the moderating role of distress about emotions (i.e., emotion-related distress) in the relationship between specific negative emotions and suicidal ideation (SI) among adults hospitalized for psychiatric reasons in an RCT of a brief cognitive-behavioral therapy (CBT)-based intervention. Specifically, we investigate how randomization to the study intervention versus control condition impacts these relationships. Participants ( N = 64) were recruited from psychiatric inpatient units at two hospitals as part of a larger RCT. Participants in the treatment group completed three 1:1 structured therapy sessions focused on CBT skills for managing emotions and a 28-day ecological momentary assessment/intervention (EMA/EMI) protocol facilitating skills practice after discharge. Participants in the control condition completed post-discharge EMA only. Both groups received treatment as usual. Multi-level modeling examined the relationships between each emotion assessed via EMA (i.e., anxious, sad, overall negative emotion) with SI, moderated by emotion-related distress and study condition. The three-way interactions between study condition, emotion-related distress, and emotion predicting contemporaneous SI were significant (anxiety: b = 0.05 95% CI = 0.02–0.09, p = .006; sadness: b = 0.05 95% CI = 0.02–0.09, p = .006; negative affect: b = 0.05 95% CI = 0.02–0.09, p = .006). Among intervention condition participants, emotion-related distress was a significant moderator between each emotion and SI, with stronger associations at higher levels of emotion-related distress, compared to average and low levels of emotion-related distress. Emotion-related distress moderated associations between negative emotions and SI in an intervention-specific manner, suggesting CBT-based EMI may target proximal risk processes for SI among individuals with high emotion-related distress. • Higher anxiety, sadness, and negative affect were associated with increased SI. • Emotion-related distress moderated associations between each emotion and SI. • EMI to support real-time use of CBT skills is a promising clinical strategy.
Mournet et al. (Sun,) studied this question.