(PS3-C57) Prolonged Benefits of Prolonged Exposure: Reduction in Suicidality Following Prolonged Exposure Therapy in Patients with Comorbid PTSD and Bipolar Disorder

Introduction

Post-traumatic stress disorder (PTSD) and bipolar disorder commonly co-occur, which negatively impacts the course of illness and treatment effectiveness. Prolonged exposure (PE) is a well-established and efficacious treatment for PTSD and has been examined less in bipolar disorder, but has promising data for depression, especially suicidal thoughts and behaviors. We examined the impact of PE therapy on suicidal thoughts and behaviors in individuals with comorbid PTSD and bipolar disorder.

Methods

Participants (N=32) were enrolled into a 10-session, weekly PE program. Most participants, 75% (n=24), completed all the PE sessions and 50% (n=16) completed assessments at the 6-month follow-up. Suicide was assessed with the Suicide Implicit Association Task scores (SIAT) which measures implicit associations between oneself, death concepts, and life concepts, as well as the Concise Health Risk Tracking form (CHRT), a self-report measure assessing suicidal thinking and associated thoughts and symptoms over the past 24 hours.

Results

CHRT scores decreased significantly from baseline (mean = 19.61, SD = 7.09) through Session 10 (mean = 14.71, SD = 5.11) and then rebounded slightly by 6-month follow-up (mean = 17.50, SD = 9.03). Post-hoc analyses of the CHRT subdomains showed that all subdomain scores decreased from baseline to session 10. From session 10 to 6 months post-treatment, helplessness and despair scores stayed stable while pessimism and suicidal thoughts scores rebounded. While the difference was not significant, we found that baseline SIAT scores (-0.47, SD = 0.36) improved during treatment (-0.64, SD = 0.31) and continued to improve during the 6-month follow-up (-0.72, SD = 0.29).

Discussion

PE for comorbid PTSD and bipolar disorder is preliminarily efficacious for lowering suicidal thinking in this population during treatment, but some aspects of suicidal thinking (i.e., pessimism, suicidal thoughts) rebound post-treatment. These findings also demonstrate that PE is a safe form of treatment for this population and did not increase risk of self-harm or symptom exacerbation. Further research is needed to examine the efficacy of PE for patients with bipolar disorder and to understand the mechanisms through which this treatment reduces suicidal thoughts and behaviors.