Affect labeling: a promising new neuroscience-based approach to treating combat-related PTSD in veterans.

Introduction: A significant portion of individuals exposed to combat-related trauma will develop posttraumatic stress disorder (PTSD), a severe, debilitating disorder with adverse impacts on both mental and physical functioning. Current treatments are effective for many individuals, however, there is a need for new treatment approaches to improve outcomes in PTSD and address the many existing barriers to seeking or completing treatment. Methods: In this open trial pilot study, we tested a novel, brief, computer-based intervention for PTSD utilizing "affect labeling" that was inspired by recent advances in neuroscience with U.S. veterans. Results: As expected, pre-intervention clinical and fMRI neuroimaging data indicated that U.S. veterans with combat-related PTSD (N = 20) had significantly higher PTSD symptoms, depression symptoms, and amygdala reactivity to trauma cues than trauma-exposed healthy control veterans (N = 20). Veterans with PTSD who completed the affect labeling intervention (N = 13) evidenced reduced PTSD symptoms and these reductions were correlated with reductions in amygdala reactivity. Discussion: Results from this initial proof-of-concept study are intriguing and suggest that affect labeling training offers significant potential as a novel, cost-effective, computer-based intervention for PTSD. Implications and next steps for further developing affect labeling interventions for PTSD are discussed. Clinical Trial Registration: https://clinicaltrials.gov/, identifier NCT05924399.

Climate Change and Mental Health.

This JAMA Insights discusses the adverse effects of climate change on mental health and proposes solutions to help mitigate those effects.

Linguistic and affective characteristics of script-driven imagery for adults with posttraumatic stress order: Associations with clinical outcomes during deep transcranial magnetic stimulation.

Brief exposure to traumatic memories using script-driven imagery (SDI) has been proposed as a promising treatment for posttraumatic stress disorder (PTSD). This study investigated the effect of SDI plus active versus sham deep transcranial magnetic stimulation (TMS) in a secondary analysis of a randomized controlled trial for adults with PTSD (N = 134). Linguistic features of scripts and self-reported distress during a 12-session deep TMS treatment protocol were examined as they related to (a) baseline PTSD symptom severity, (b) trauma characteristics, and (c) treatment outcomes. Linguistic Inquiry and Word Count (LIWC) software was used to analyze the following linguistic features of SDIs: negative emotion, authenticity, and cognitive processing. More use of negative emotion words was associated with less severe self-reported and clinician-rated baseline PTSD symptom severity, r = -.18, p = .038. LIWC features did not differ based on index trauma type, range: F(3, 125) = 0.29-0.49, ps = .688-.831. Between-session reductions in self-reported distress across SDI trials predicted PTSD symptom improvement across both conditions at 5-week, B = -15.68, p = .010, and 9-week endpoints, B = -16.38, p = .011. Initial self-reported distress and linguistic features were not associated with treatment outcomes. The findings suggest that individuals with PTSD who experience between-session habituation to SDI-related distress are likely to experience a corresponding improvement in PTSD symptoms.

A dynamical systems analysis of change in PTSD symptoms, depression symptoms, and suicidal ideation among military personnel during treatment for PTSD.

OBJECTIVE: The connections among posttraumatic stress disorder (PTSD), depression, and suicidal ideation are elusive because of an overreliance on cross-sectional studies. In this secondary analysis of pooled data from three clinical trials of 742 military personnel, we examined the dynamic relationships among PTSD, depression, and suicidal ideation severity assessed repeatedly during and after outpatient treatment for PTSD. METHODS: We conducted dynamical systems analyses to explore the potential for coordinated change over time in psychotherapy for PTSD. RESULTS: Over the course of psychotherapy, PTSD, depression, and suicidal ideation severity changed in coordinated ways, consistent with an interdependent network. Results of eigenvalue decomposition analysis indicated the dominant change dynamic involved high stability and resistance to change but indicators of cycling were also observed, indicating participants "switched" between states that resisted change and states that promoted change. Depression (B = 0.48, SE = 0.11) and suicidal desire (B = 0.15, SE = 0.01) at a given assessment were associated with greater change in PTSD symptom severity at the next assessment. Suicidal desire (B = 0.001, SE < 0.001) at a given assessment was associated with greater change in depression symptom severity at the next assessment. Neither PTSD (B = -0.004, SE = 0.007) nor depression symptom severity (B = 0.000, SE = 0.001) was associated with subsequent change in suicidal ideation severity. CONCLUSIONS: In a sample of treatment-seeking military personnel with PTSD, change in suicidal ideation and depression may precede change in PTSD symptoms but change in suicidal ideation was not preceded by change in PTSD or depression symptoms.

Inflammatory Bowel Diseases-related Disability: Risk Factors, Outcomes, and Interventions.

The diagnosis of inflammatory bowel disease (IBD) is a life-changing moment for most adults. Biomedical advances over the past 2 decades have resulted in unprecedented growth of therapeutic options for IBD. However, due to the incurable nature of IBD, medical and surgical intervention alone may not be adequate to completely normalize health status and prevent long-term disability. In the biopsychosocial model of health and disease, a person's health and function result from complex physical, psychosocial, and environmental interactions. Adapting the World Health Organization definition, IBD-related disability encompasses limitations in educational and employment opportunities, exclusions in economic and social activities, and impairments in physical and psychosocial function. Although the concept of IBD-related disability is a long-term treatment end point in the updated Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE-II) treatment guideline, it has received limited attention in the literature. This review article explores an etiological framework of the physical and psychosocial aspects that contribute to IBD-related disability. We also explore the impact of IBD-related disability on the direct and indirect costs of IBD. Lastly, we present the available evidence for interventions with the potential to improve function and reduce IBD-related disability.

Collective trauma: Childhood abuse, perceived discrimination, and COVID-19.

OBJECTIVE: Few studies have examined the interplay between collective trauma (e.g., the COVID-19 pandemic) and personal trauma (e.g., child abuse and discrimination). In a longitudinal child maltreatment study, with a community sample added, negative COVID impact (e.g., financial and mental health difficulties due to COVID) was examined in relation to childhood abuse exposure and perceived discrimination. METHOD: Adults (N = 135) completed an online survey about trauma- and pandemic-related experiences. Regressions examined predictors of negative COVID impact and posttraumatic stress disorder (PTSD) symptoms during the pandemic. RESULTS: Although cumulative maltreatment contributed to negative COVID impact, when high levels of cumulative maltreatment had been experienced in childhood, greater negative COVID impact did not significantly relate to PTSD symptoms: For these participants, PTSD symptoms were relatively high (but not at ceiling) in adulthood overall. Negative COVID impact predicted PTSD symptoms only at low levels of cumulative child abuse. Perceived discrimination was associated with negative COVID impact and PTSD symptomatology. CONCLUSIONS: Cumulative childhood abuse at high levels likely set the stage for PTSD symptoms in adulthood, regardless of negative COVID impact. Individuals with lower levels of cumulative childhood abuse had fewer PTSD symptoms unless COVID had a stronger negative impact on their lives. Discrimination contributed to lower pandemic-related well-being. Insight is provided into special vulnerabilities associated with maltreatment backgrounds and discrimination at times of collective challenges. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Increased Risks for Suicide, Self-Harm, Substance Use, and Psychiatric Disorders in Adults With Inflammatory Bowel Disease: A Nationwide Study in the United States From 2007 to 2017.

In an analysis of over 260 million emergency department visits across the United States from 2007 to 2017, inflammatory bowel disease conferred >10-fold risk for suicide deaths, self-harm, substance use, and psychiatric disorders, though the overall self-harm rates were low (<1% of all-cause inflammatory bowel disease emergency department visits; total 56 suicide deaths).

Role of the intraparietal sulcus (IPS) in anxiety and cognition: Opportunities for intervention for anxiety-related disorders

Our objective was to review the literature on the parietal cortex and intraparietal sulcus (IPS) in anxiety-related disorders, as well as opportunities for using neuromodulation to target this region and reduce anxiety. We provide an overview of prior research demonstrating: 1) the importance of the IPS in attention, vigilance, and anxious arousal, 2) the potential for neuromodulation of the IPS to reduce unnecessary attention toward threat and anxious arousal as demonstrated in healthy samples; and 3) limited data on the potential for neuromodulation of the IPS to reduce hyper-attention toward threat and anxious arousal among clinical samples with anxiety-related disorders. Future research should evaluate the efficacy of IPS neuromodulation in fully powered clinical trials, as well as the value in augmenting evidence-based treatments for anxiety with IPS neuromodulation. (AU)

A Suicide Prevention Intervention for Emerging Adult Sexual and Gender Minority Groups: Protocol for a Pilot Hybrid Effectiveness Randomized Controlled Trial.

BACKGROUND: Suicide attempts and suicide death disproportionately affect sexual and gender minority emerging adults (age 18-24 years). However, suicide prevention strategies tailored for emerging adult sexual and gender minority (EA-SGM) groups are not widely available. The Safety Planning Intervention (SPI) has strong evidence for reducing the risk for suicide in the general population, but it is unclear how best to support EA-SGM groups in their use of a safety plan. Our intervention (Supporting Transitions to Adulthood and Reducing Suicide [STARS]) builds on content from an existing life skills mobile app for adolescent men who have sex with men (iREACH) and seeks to target core risk factors for suicide among EA-SGM groups, namely, positive affect, discrimination, and social disconnection. The mobile app is delivered to participants randomized to STARS alongside 6 peer mentoring sessions to support the use of the safety plan and other life skills from the app to ultimately reduce suicide risk. OBJECTIVE: We will pilot-test the combination of peer mentoring alongside an app-based intervention (STARS) designed to reduce suicidal ideation and behaviors. STARS will include suicide prevention content and will target positive affect, discrimination, and social support. After an in-person SPI with a clinician, STARS users can access content and activities to increase their intention to use SPI and overcome obstacles to its use. EA-SGM groups will be randomized to receive either SPI alone or STARS and will be assessed for 6 months. METHODS: Guided by the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework, we will recruit and enroll a racially and ethnically diverse sample of 60 EA-SGM individuals reporting past-month suicidal ideation. Using a type-1 effectiveness-implementation hybrid design, participants will be randomized to receive SPI (control arm) or to receive SPI alongside STARS (intervention arm). We will follow the participants for 6 months, with evaluations at 2, 4, and 6 months. Preliminary effectiveness outcomes (suicidal ideation and behavior) and hypothesized mechanisms of change (positive affect, coping with discrimination, and social support) will serve as our primary outcomes. Secondary outcomes include key implementation indicators, including participants' willingness and adoption of SPI and STARS and staff's experiences with delivering the program. RESULTS: Study activities began in September 2021 and are ongoing. The study was approved by the institutional review board of the University of Pennsylvania (protocol number 849500). Study recruitment began on October 14, 2022. CONCLUSIONS: This project will be among the first tailored, mobile-based interventions for EA-SGM groups at risk for suicide. This project is responsive to the documented gaps for this population: approaches that address chosen family, focus on a life-course perspective, web approaches, and focus on health equity and provision of additional services relevant to sexual and gender minority youth. TRIAL REGISTRATION: ClinicalTrials.gov NCT05018143; https://classic.clinicaltrials.gov/ct2/show/NCT05018143. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48177.

Exposure Therapy and Its Mechanisms.

Exposure therapy is the gold-standard treatment approach for pathological anxiety. This therapeutic approach builds on principles of extinction training from traditional fear conditioning and extinction protocols. In this chapter, we discuss principles of exposure therapy in the clinic and the laboratory experimental results that guide our decisions in the therapy. We discuss emotional processing theory and inhibitory learning principles, with a focus on expectation violation. We conclude with future research directions needed to improve exposure therapy outcomes among patients with anxiety-related disorders.

Role of the intraparietal sulcus (IPS) in anxiety and cognition: Opportunities for intervention for anxiety-related disorders.

Our objective was to review the literature on the parietal cortex and intraparietal sulcus (IPS) in anxiety-related disorders, as well as opportunities for using neuromodulation to target this region and reduce anxiety. We provide an overview of prior research demonstrating: 1) the importance of the IPS in attention, vigilance, and anxious arousal, 2) the potential for neuromodulation of the IPS to reduce unnecessary attention toward threat and anxious arousal as demonstrated in healthy samples; and 3) limited data on the potential for neuromodulation of the IPS to reduce hyper-attention toward threat and anxious arousal among clinical samples with anxiety-related disorders. Future research should evaluate the efficacy of IPS neuromodulation in fully powered clinical trials, as well as the value in augmenting evidence-based treatments for anxiety with IPS neuromodulation.

COVID-19 Worries and Insomnia: A Follow-Up Study.

The COVID-19 pandemic was associated with significant increases in sleep disorder symptoms and chronic worry. We previously demonstrated that worry about the pandemic was more strongly associated with subsequent insomnia than the converse during the acute (first 6 months) phase of the pandemic. In this report, we evaluated whether that association held over one year of the pandemic. Participants (n = 3560) completed self-reported surveys of worries about the pandemic, exposure to virus risk factors, and the Insomnia Severity Index on five occasions throughout the course of one year. In cross-sectional analyses, insomnia was more consistently associated with worries about the pandemic than exposure to COVID-19 risk factors. In mixed-effects models, changes in worries predicted changes in insomnia and vice versa. This bidirectional relationship was further confirmed in cross-lagged panel models. Clinically, these findings suggest that during a global disaster, patients who report elevations in either worry or insomnia should be considered for evidence-based treatments for these symptoms to prevent secondary symptoms in the future. Future research should evaluate the extent to which dissemination of evidence-based practices for chronic worry (a core feature of generalized anxiety disorder or illness anxiety disorder) or insomnia reduces the development of co-occurring symptoms during a global disaster.

Phenotypic predictors of suicide subtypes from pre-to postdeployment in active duty military personnel.

Military service members are at increased risk for suicide, but there are few strategies for detecting those who are at highest risk after a deployment. Using all available data collected from 4119 Military service members before and after their deployment to Iraq for Operation Iraqi Freedom, we tested whether predeployment characteristics clustered together to predict postdeployment suicidal risk. Latent class analysis showed that three classes best characterized the sample at predeployment. Class 1 had significantly higher scores on PTSD severity pre- and postdeployment than Classes 2 and 3 (Ps < .001). At postdeployment, Class 1 also had a greater proportion of endorsement of lifetime and past year suicidal ideation than Classes 2 and 3 (Ps < .05) and a greater proportion of lifetime suicide attempts than Class 3 (P < .001). Class 1 also had a greater proportion of endorsement of past-30-days intention to act on suicidal thoughts than Classes 2 and 3 (Ps < .05) and past-30-days specific plan for suicide than Classes 2 and 3 (Ps < .05). The study showed that based only on predeployment data, it is possible to determine which service members might be at highest risk for suicidal ideation and behavior at postdeployment.

Contribution of risk and resilience factors to anxiety trajectories during the early stages of the COVID-19 pandemic: A longitudinal study.

The COVID-19 pandemic, and the response of governments to mitigate the pandemic's spread, resulted in exceptional circumstances that comprised a major global stressor, with broad implications for mental health. We aimed to delineate anxiety trajectories over three time-points in the first 6 months of the pandemic and identify baseline risk and resilience factors that predicted anxiety trajectories. Within weeks of the pandemic onset, we established a website (covid19resilience.org), and enrolled 1362 participants (n = 1064 from US; n = 222 from Israel) who provided longitudinal data between April-September 2020. We used latent growth mixture modelling to identify anxiety trajectories and ran multivariate regression models to compare characteristics between trajectory classes. A four-class model best fit the data, including a resilient trajectory (stable low anxiety) the most common (n = 961, 75.08%), and chronic anxiety (n = 149, 11.64%), recovery (n = 96, 7.50%) and delayed anxiety (n = 74, 5.78%) trajectories. Resilient participants were older, not living alone, with higher income, more education, and reported fewer COVID-19 worries and better sleep quality. Higher resilience factors' scores, specifically greater emotion regulation and lower conflict relationships, also uniquely distinguished the resilient trajectory. Results are consistent with the pre-pandemic resilience literature suggesting that most individuals show stable mental health in the face of stressful events. Findings can inform preventative interventions for improved mental health.

Psychometric Properties of the Self-Injurious Thoughts and Behaviors Interview-Short Form Among U.S. Active Duty Military Service Members and Veterans.

We assessed the interrater reliability, convergent validity, and discriminant validity of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF) in a sample of 1,944 active duty service members and veterans seeking services for posttraumatic stress disorder (PTSD) and related conditions. The SITBI-SF demonstrated high interrater reliability and good convergent and discriminant validity. The measurement properties of the SITBI-SF were comparable across service members and veterans. Approximately 8% of participants who denied a history of suicidal ideation on the SITBI-SF reported suicidal ideation on a separate self-report questionnaire (i.e., discordant responders). Discordant responders reported significantly higher levels of PTSD symptoms than those who denied suicidal ideation on both response formats. Findings suggest that the SITBI-SF is a reliable and valid interview-based measure of suicide-related thoughts and behaviors for use with military service members and veterans. Suicide risk assessment might be optimized if the SITBI-SF interview is combined with a self-report measure of related constructs.

The impact of COVID-19 on treatment seeking and interest in internet-based therapy for anxiety-related disorders: An interrupted time-series analysis.

AIMS: To examine whether the onset of the COVID-19 pandemic led to a change in demand for psychiatric treatment, interest in internet-based therapy, and differences in treatment requests by self-reported diagnoses (e.g., Posttraumatic Stress Disorder, Obsessive Compulsive Disorder, Generalized Anxiety Disorder, and Social Anxiety Disorder). METHODS: Using an interrupted time series design, we analyzed intake questionnaires of treatment-seeking patients (N = 1,954) at an anxiety treatment center between June 6, 2019 through September 13, 2021. RESULTS: The change in general treatment-seeking from before to immediately after the global pandemic declaration was not statistically significant. However, there was a steady increase in treatment seeking, with a more pronounced increase from 2020 into 2021. Interest in internet-based therapy increased significantly after the onset of COVID-19. The number of treatment-seeking individuals who self-reported "concerns or diagnoses" of PTSD increased significantly. CONCLUSION: The study supports anecdotal reports from clinics across the country about unprecedented demand for services. It highlights that many patients experienced an immediate impact of the pandemic on their self-reported concerns about trauma and PTSD symptoms, which has important clinical implications. It also highlights a shifting openness to internet-based services during the pandemic.

Massed vs Intensive Outpatient Prolonged Exposure for Combat-Related Posttraumatic Stress Disorder: A Randomized Clinical Trial.

Importance: Improved, efficient, and acceptable treatments are needed for combat-related posttraumatic stress disorder (PTSD). Objective: To determine the efficacy of 2 compressed prolonged exposure (PE) therapy outpatient treatments for combat-related PTSD. Design, Setting, and Participants: This randomized clinical trial was conducted among military personnel and veterans at 4 sites in Texas from 2017 to 2019. Assessors were blinded to conditions. Data were analyzed from November 2020 to October 2022. Interventions: The interventions were massed-PE, which included 15 therapy sessions of 90 minutes each over 3 weeks, vs intensive outpatient program PE (IOP-PE), which included 15 full-day therapy sessions over 3 weeks with 8 treatment augmentations. The IOP-PE intervention was hypothesized to be superior to massed-PE. Main Outcomes and Measures: Coprimary outcomes included the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5) administered at baseline and posttreatment follow-ups. Measures ranged from 0 to 80, with higher scores indicating greater severity. Diagnostic remission and reliable change were secondary outcomes. Results: Among 319 military personnel and veterans screened, 234 were randomized (mean [SD] age, 39.20 [7.72] years; 182 [78%] male participants), with 117 participants randomized to IOP-PE and 117 participants randomized to massed-PE. A total of 61 participants (26%) were African American, 58 participants (25%) were Hispanic, and 102 participants (44%) were White; 151 participants (65%) were married. Linear mixed-effects models found that CAPS-5 scores decreased in both treatment groups at the 1-month follow-up (IOP-PE: mean difference, -13.85 [95% CI, -16.47 to -11.23]; P < .001; massed-PE: mean difference, -14.13 [95% CI, -16.63 to -11.62]; P < .001). CAPS-5 change scores differed from 1- to 6-month follow-ups (mean difference, 4.44 [95% CI, 0.89 to 8.01]; P = .02). PTSD symptoms increased in massed-PE participants during follow-up (mean difference, 3.21 [95% CI, 0.65 to 5.77]; P = .01), whereas IOP-PE participants maintained treatment gains (mean difference, 1.23 [95% CI, -3.72 to 1.27]; P = .33). PCL-5 scores decreased in both groups from baseline to 1-month follow-up (IOP-PE: mean difference, -21.81 [95% CI, -25.57 to -18.04]; P < .001; massed-PE: mean difference, -19.96 [95% CI, -23.56 to -16.35]; P < .001) and were maintained at 6 months (IOP-PE: mean change, -0.21 [95% CI, -3.47 to 3.06]; P = .90; massed-PE: mean change, 3.02 [95% CI, -0.36 to 6.40]; P = .08). Both groups had notable PTSD diagnostic remission at posttreatment (IOP-PE: 48% [95% CI, 36% to 61%] of participants; massed-PE: 62% [95% CI, 51% to 73%] of participants), which was maintained at 6 months (IOP-PE: 53% [95% CI, 40% to 66%] of participants; massed-PE: 52% [95% CI, 38% to 66%] of participants). Most participants demonstrated reliable change on the CAPS-5 (61% [95% CI, 52% to 69%] of participants) and the PCL-5 (74% [95% CI, 66% to 81%] of participants) at the 1-month follow-up. Conclusions and Relevance: These findings suggest that PE can be adapted into compressed treatment formats that effectively reduce PTSD symptoms. Trial Registration: ClinicalTrials.gov Identifier: NCT03529435.

Memory Accuracy After 20 Years for Interviews About Child Maltreatment.

When adults allege childhood victimization, their long-term memory comes under scrutiny. This scrutiny can extend to the adults' memory of childhood interviews. The concerns raise important theoretical and applied issues regarding memory for long-past discussions of child maltreatment and trauma. In this longitudinal study, 104 adults, who as children (ages 3-15 years) were interviewed in child maltreatment investigations (Time 1), were questioned 20 years later (Time 2) about the Time 1 interviews. Verbatim documentation from Time 1 permitted scoring of memory accuracy. A subset of the participants (36%) reported no memory for the Time 1 interviews. Of the 64% who remembered being interviewed at Time 1, those who had been adolescents at Time 1 remembered the forensic interview discussion about abuse incidents better than discussion about general psychological issues. Adult trauma symptoms were associated with more accurate memory for interview content that directly concerned abuse experiences but not for non-abuse-specific information. Findings indicate that the veracity of adults' long-term memory for clinical/forensic conversations about childhood maltreatment depends on age at interview, interview content, and traumatization factors. Implications are discussed.

Knowledge of evidence-based practices for PTSD among mental health court judges.

Mental health courts offer access to community-based care for defendants with psychiatric disorders, including posttraumatic stress disorder (PTSD). However, limited information is available on how judges make treatment decisions about evidence-based practices. In this qualitative study, we interviewed mental health court judges to evaluate: (1) perspectives toward the role of PTSD in criminal behavior; (2) knowledge about evidence-based practice for PTSD; (3) treatment decisions for defendants with PTSD; and (4) treatment decisions for defendants at risk for suicide, a common comorbidity with PTSD. We hypothesized that mental health court judges would report low familiarity with evidence-based practices for PTSD despite wide recognition of the impact of trauma on criminal behavior. Methods: Mental health court judges (N = 11, 60% women, 60% between 50-59 years) were recruited from 7 states in the US and completed a demographics questionnaire and semi-structured qualitative interview that was transcribed and double-coded. Results: Judges in mental health court unanimously agreed that PTSD is highly prevalent among their defendants, but that they had not having received formal education about evidence-based practices for PTSD. They reported relying on their team members to provide recommendations for treatment planning and viewed their role as the enforcer of the treatment teams' suggestions. Finally, judges also reported that suicide prevention is an important consideration and that there is a need for universal suicide risk assessments. Conclusions: These findings have implications for continuing education among judges in mental health court, and we recommend mandated training to increase awareness of evidence-based practices for PTSD and suicide prevention.

Development of a patient-centered text message-based platform for the self-management of interstitial cystitis/bladder pain syndrome symptoms.

OBJECTIVE: To develop a patient-centered text message-based platform that promotes self-management of symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS: Adult women with IC/BPS interested in initiating a first- or second-line treatments per American Urological Association guidelines (recategorized as "behavioral/non-pharmacologic treatments" and "oral medicines" in the 2022 version) participated in rapid cycle innovation consisting of iterative cycles of contextual inquiry, prototype design and development. We delivered treatment modules and supportive messages using an algorithm-driven interactive messaging prototype through a HIPAA-compliant texting platform. Patients provided feedback through narrative text messages and an exit interview. Feedback was analyzed qualitatively and used to iteratively revise the platform until engagement ≥ 85% and accuracy ≥ 80% were achieved. The final version consisted of four treatment module categories (patient education and behavioral modification, cognitive behavioral therapy, pelvic floor physical therapy, and guided mindfulness practices) and supportive messages delivered through an automated algorithm over 6 weeks. RESULTS: Thirty IC/BPS patients with moderate symptom bother (median IC Problem Index score 9, range 6-12) participated in five cycles of contextual inquiry. Qualitative analysis identified three overarching concepts that informed the development of the platform: preference for patient centered terms, desire to gain self-efficacy in managing symptoms, and need for provider support. Patients preferred the term "interstitial cystitis" to "bladder pain syndrome" which carried the stigma of chronic pain. Patients reported greater self-efficacy in managing symptoms through improved access to mind-body and behavioral treatment modules that helped them to gain insight into their motivations and behaviors. The concept of provider support was informed by shared decision making (patients could choose preferred treatment modules) and reduced sense of isolation (weekly check in messages to check on symptom bother). CONCLUSION: A patient centered text message-based platform may be clinically useful in the self-management of IC/BPS symptoms.