Are There Treatments for Self-Injury?

Until recently, few treatments were developed specifically for self-injury. Although there is currently no “gold-standard” treatment for self-injury, several treatments show promise in helping people decrease or stop these behaviors.

Dialectical Behavior Therapy (DBT) is one of the most well-known treatments for people engaging in self-injury. DBT is a psychotherapeutic treatment designed to treat Borderline Personality Disorder, of which non-suicidal self-injury is a common symptom [1]. DBT integrates behavioral strategies (e.g., behavior analysis, problem-solving strategies, skills training in emotion regulation and interpersonal effectiveness, contingency management) with mindfulness (e.g., nonjudgmental, present-focused attention), and dialectical strategies (e.g., balancing acceptance and change) [2]. DBT addresses self-injury by targeting instability in one’s emotions and sense of self, as well as increasing control over one’s behavior. DBT is an intensive treatment, which typically involves weekly individual therapy and group-based skills training, as well as coaching between sessions, for one to two years.

Several well-designed studies have shown DBT to be effective in treating borderline personality disorder, including reducing non-suicidal self-injury [1, 3, 4]. It is important to note, however, that some research shows that DBT is not superior to other treatments in reducing self-injury [5]. Further, DBT is designed to treat self-injury in the context of Borderline Personality Disorder; it is not clear how effective DBT may be for treating self-injury among individuals who do not have Borderline Personality Disorder.

Emotion Regulation Group Therapy (ERGT) is another treatment that was designed for people with Borderline Personality Disorder; however, unlike DBT, ERGT is intended specifically to treat non-suicidal self-injury [6]. ERGT was intended as a briefer alternative to DBT that includes 14 weeks of group-based psychotherapy integrating components of DBT and Acceptance and Commitment Therapy. Further, ERGT was designed as an adjunctive treatment, meaning it is best used in conjunction with, rather than instead of, other types of treatment (such as individual psychotherapy). ERGT specifically addresses emotion dysregulation and the use of self-injury to manage emotions by increasing emotional awareness, understanding, and acceptance, facilitating goal-directed behaviors, inhibiting impulsive behaviors in response to negative emotions, modulating emotional intensity and duration, and tolerating and experiencing negative emotions.

Several well-designed studies have shown that ERGT is effective in reducing self-injury in adult women with Borderline Personality Disorder [6, 7]. A recent feasibility study also suggests that ERGT may be effective in adolescent girls engaging in non-suicidal self-injury [8]. Importantly, research on ERGT has been limited to studies on women; more research is needed to determine whether ERGT is equally effective for men.

Treatment for Self-Injurious Behaviors (T-SIB) is a brief (9 session) intervention conducted during weekly individual therapy designed for young adults engaging in non-suicidal self-injury [9]. T-SIB is a behavioral intervention which uses motivational enhancement strategies, functional analysis, and skills training for problem-solving, distress tolerance, cognitive distortions, and interpersonal communication to address self-injury. An initial pilot study of T-SIB found decreased self-injury over the course of treatment [10]; however, further research is needed to see if T-SIB will be effective in other groups of people and to compare T-SIB to other treatments that address self-injury.

[1] Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., . . . Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757-66. doi:10.1001/archpsyc.63.7.757

[2] Linehan, M. M. (1993). Cognitive-Behavioral treatment of borderline personality disorder. New York: Guilford Press.

[3] Stanley, B., Brodsky, B., Nelson, J. D., & Dulit, R. (2007). Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury. Archives of Suicide Research, 11(4), 337-41. doi:10.1080/13811110701542069

[4] Pasieczny, N., & Connor, J. (2011). The effectiveness of dialectical behaviour therapy in routine public mental health settings: An australian controlled trial. Behaviour Research and Therapy, 49(1), 4-10. doi:10.1016/j.brat.2010.09.006

[5] Andreasson, K., Krogh, J., Wenneberg, C., Jessen, H. K. L., Krakauer, K., Gluud, C., . . . Nordentoft, M. (2016). Effectiveness of dialectical behavior therapy versus collaborative assessment and management of suicidality treatment for reduction of self-harm in adults with borderline personality disorder - A randomized observer-blinded clinical trial. Depression and Anxiety, 33(6), 520-30. doi:10.1002/da.2247

[6] Gratz, K. L., & Tull, M. T. (2011). Extending research on the utility of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality pathology. Personality Disorders: Theory, Research, and Treatment, 2(4), 316-26. doi:10.1037/a002214

[7] Gratz, K. L., Tull, M. T., & Levy, R. (2014). Randomized controlled trial and uncontrolled 9-month follow-up of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. Psychological Medicine, 44(10), 2099-2112. doi:10.1017/S003329171300213

[8] Bjureberg, J., Sahlin, H., Hellner, C., Hedman-Lagerlöf, E., Gratz, K.L., Bjärehed, J., Jokinen, J., Tull, M.T., Ljótsson, B. (2017). Emotion regulation individual therapy for adolescents with nonsuicidal self-injury disorder: A feasibility study. BMC Psychiatry, 17, 411. Doi: 10.1186/s12888-017-1527-4

[9] Andover, M. S., Schatten, H. T., Morris, B. W., & Miller, I. W. (2015). Development of an intervention for nonsuicidal self-injury in young adults: An open pilot trial. Cognitive and Behavioral Practice, 22(4), 491-503

[10] Andover, M. S., Schatten, H. T., Morris, B. W., Holman, C. S., & Miller, I. W. (2017). An intervention for nonsuicidal self-injury in young adults: A pilot randomized controlled trial. Journal of Consulting and Clinical Psychology, 85(6), 620-631. doi:10.1037/ccp0000206

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