Provider Training and Implementation Experiences Following Engagement with a Web-Based Training for TF-CBT.

Suicidal thoughts and behaviors (STBs) constitute a major public health concern, with more than 700,000 people dying by suicide every year and high lifetime prevalence rates of suicidal thoughts in the general population (15.5% in Germany ()). In an effort to understand the proximal development of STBs, several influential theoretical models have been proposed. Prominent suicide theories conceptualize STBs as emerging through relatively linear processes driven by specific risk factors, such as hopelessness, thwarted belongingness, or feelings of entrapment (–). Despite their substantial contributions to the field, the prediction of suicidal behavior is still challenging (). Moreover, both existing theories and the empirical evidence provide comparatively limited insights into the underlying proximal psychological processes that characterize the emergence and subjective experience of a suicidal crisis. Among the psychological factors implicated in suicidal crises, affective states appear to play a central role. A growing body of evidence indicates that elevated negative affective states have been consistently associated with increases in suicidal thoughts (, ). In a study by May and colleagues (), 95% of individuals experiencing suicidal thoughts reported a desire to escape from negative affect as a main reason for contemplating suicide. Together, these findings suggest that the ability to regulate intense negative emotions may be central to understanding the emergence and maintenance of suicidal thoughts. Emotion regulation broadly refers to the processes by which individuals influence the experience, intensity, duration, and expression of their emotions. It has been conceptualized as a goal-directed process involving the identification, selection, and implementation of strategies aimed at modifying emotional experiences (). Regarding STBs, evidence indicates that emotion regulation difficulties, including limited emotional awareness, are associated with the frequency of suicidal thoughts and attempts (, ). Moreover, meta-analytic evidence showed that ERS that are typically considered as maladaptive (e.g., rumination, expressive suppression) are positively associated with STBs, whereas strategies that are considered as adaptive (e.g., cognitive reappraisal, mindfulness) are negatively associated with STBs (). However, most studies on emotion regulation and STBs have relied on self-report questionnaires (, , ), thereby providing only limited insights into how emotion regulation unfolds in the onset and during suicidal crises and which strategies individuals experiencing STBs actually employ.