1 - (SYM 110) Development of an Acceptance-based Positive Affect Intervention: Background and Rationale

Most interventions for suicidal thoughts and behavior (STB) target negative affect or risk reduction. However, data from a sample of adolescents (n=119) recruited from an inpatient psychiatric unit due to suicide risk indicated low positive affect at baseline, as assessed by the Affective Intensity Measure (AIM), was a robust predictor of suicide events in the six months post-discharge, even after controlling for depression severity and anhedonia (Yen et al., 2013). This novel finding prompted the question of whether positive affect should be a target of interventions.

We examined whether we should adapt an existing intervention, such as Positive Psychotherapy (PPT), or develop something new. While there were many compelling elements to PPT (which have been incorporated into STEP), we decided to develop a new intervention because: 1) PPT had not yet been examined in teens and transportability of the PPT intervention to this population was unclear; 2) PPT was not specifically developed to target individuals with suicidal behaviors and those at suicide risk may require a different approach to positive psychology interventions; and, 3) our data was specific to low positive affect whereas PPT had a greater focus on cognition. 

The decision to develop a new intervention required an integration of our empirically derived target (positive affect) with theoretical principles based in affective science. We relied on three specific theories: 1) negativity bias whereby during times of stress our attention will more likely be restricted to a perceived threat; 2) broaden and build theory of positive affect which asserts that positive emotions have evolutionary functions to broaden our attentional scope and awareness, which are opposite to those of negative affect; and 3) the concept of an optimal ratio of positive to negative affect. With these theories in mind, we developed an acceptance- and affect-based intervention that incorporates these principles and specific strategies that increase attention to positive emotions and experiences that might be otherwise discounted due to the negativity bias: mindfulness meditation, savoring, and gratitude.

Other treatment development decisions included: intensity and duration of the intervention, parent engagement, treatment modality (individual vs. group), and mechanism of delivery (in-person, text messaging, or app). Each of these key decisions will be discussed in the following presentations.