Preliminary efficacy of prolonged exposure therapy to reduce suicide risk in co-occurring bipolar disorder & trauma symptoms.

Bipolar disorder (BD) and trauma symptoms commonly co-occur and present a high rate of suicidality. Prolonged exposure (PE) is a well-established and efficacious treatment for symptoms of PTSD, untested in patients with co-occurring BD but promising in its effectiveness for reducing suicidal thoughts and behaviors. The current study evaluates the preliminary efficacy of PE in reducing suicide risk in patients with co-occurring BD and trauma symptoms. Participants (N = 32) were enrolled in a 10-session, weekly PE program and completed assessments of trauma symptoms, suicidality, state and trait anxiety, depression, and mania at baseline, Sessions 5 and 10, and at 6 months post-treatment. 75 % (24/32) of participants completed all ten PE sessions and 50 % completed 6-month follow-up assessments. Total Concise Health Risk Tracking Form (CHRT) scores, and pessimism subscale scores declined meaningfully from baseline to session 10, partially rebounding from session 10 to 6-month follow-up. CHRT despair and helplessness showed reductions throughout treatment that were mostly retained at 6 months post-treatment. CHRT suicidal thoughts declined during treatment but rebounded to near baseline levels at follow-up. These findings suggest that 10-session PE may reduce suicide risk in individuals with co-occurring BD and trauma symptoms, and that PE does not increase suicide risk in individuals with BD.