Disorders - Non-suicidal self-harm behaviours
Kennedy, G. A., Jean-Forney, K., Pinner, D., Martinez, K. M., Buchman-Schmitt, J. M., Keel, P. K.
Objective: Research suggests that weight suppression (WS) is linked to non-suicidal self-injury (NSSI) and that drive for thinness and depression may explain this association. We conducted a proof-of-concept study using a randomized control trial design to determine if improving body esteem and reducing depressive symptoms reduced NSSI in individuals with WS. Method(s): Weight suppressed participants (N = 60) who engaged in NSSI were recruited from the community and randomly assigned to an on-line intervention or control condition. The on-line intervention was adapted from a cognitive-dissonance intervention originally designed to reduce thin-ideal internalization in females to an intervention to reduce internalization of unhealthy body ideals in both genders. Participants' weight/shape concerns, depressive symptoms, and NSSI were assessed at pre- and post-intervention, or at baseline and 2-week follow-up for controls. Result(s): Compared to controls, participants in the treatment condition reported greater decreases in likelihood of future NSSI [Cohen's d (95% CI) = -0.38 (-0.90-0.15)], weight/shape concerns [-1.19 (-1.75 to -0.62)], depressive symptoms [-1.00 (-1.56 to -0.45)], and significant improvements in appearance [1.27 (0.70-1.84)] and weight esteem [1.38 (0.80-1.96)]. Discussion(s): Future work could test this intervention in a larger trial with an active alternative treatment condition. Copyright © 2019 Wiley Periodicals, Inc.
International Journal of Eating Disorders, 52(2) : 206-210
- Year: 2019
- Problem: Depressive Disorders, Non-suicidal self-harm behaviours
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive dissonance therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Maugeri, A., Fava, G., Fioriello, F., Perrotti, G., Pacifici, S., Terrinoni, A.
SCOPO DEL LAVORO: Non-suicidal self-injury (NSSI) is a clinical condition defined as the intentional, self-inflicted damage to the surface of the body without suicidal intent, which is not socially sanctioned (Nock, 2009; Favazza). This disorder involves about 12-35% of the adolescent community. Several findings show that the psychopathological dimension more related to NSSI concerns personality functioning. Regarding therapeutic approach, studies about the effectiveness of psychotherapeutic treatment are reported in literature; on the other hand poor evidence about psychopharmacological treatment is available, although some psychiatric drugs, frequently prescribed as off-label, are currently used in clinical practice. The goal of our study is to assess the outcome of self-harming adolescents treated with atypical antipsychotic drug (aripiprazole or quetiapine), or in add-on with mood stabilizer (lithium), and to identify possible different degrees of effectiveness between drugs. MATERIALI E METODI: 43 adolescent patients between 13 and 18 years have been enrolled in the study. They were assessed for NSSI disorder as they were treated with off-label psychiatric drugs. Patients with Intellectual disability, Autism spectrum disorders or Psychotic disorders have been excluded from the sample. In order to investigate the NSSI, the partecipants were administered the study measures including the Repetitive Non Suicidal Self Injury Questionary (R-NSSIQ) to evaluate the repetitiveness of self-injuring acts, and Deliberate Self-Harm Inventory (DSHI) to assess their severity according to the scoring in the Clinician-Rated Severity of Non Suicidal Self-Injury. Afterwards, all patients enrolled have been treated pharmacologically with one atypical antipsychotic drug (aripiprazole or quetiapine), or in add-on with lithium. At the 6-month follow-up all patients were administered a DSHI re-test to assess possible changes in the severity degree of their self-injuring behavior. RISULTATI: Patients in the sample received a diagnosis of Unipolar or Bipolar mood disorder, Post-traumatic stress disorder and Borderline personality features. At the first assessment, most of the sample examined showed a severe degree of self-injuring behavior (level 4 according to CRS). Patients who had a lower level of severity of self-injurious conduct, treated with antipsychotic monotherapy, showed a better response to pharmacological treatment, resulting in a reduction of the CRS severity level. Patients with a severe initial clinical condition (CRS level 4), who required surgical treatment or used more than one self-injuring method, treated with pharmacological polytherapy, showed a worse outcome. CONCLUSIONI: No significant differences were found between Aripiprazole and Quetiapine. The association lithium + antipsychotic led to a switch to a lower CRS level in the 75% of patients. This result is suggestive of a variability of severity of NSSI, depending on emotional lability. According to these results, additional studies are needed to improve current knowledge about the pharmacological treatment of NSSI and to develop an evidence-based treatment protocol for these patients.
Journal of Psychopathology, 25 (Supplement 2) : 65-66
- Year: 2019
- Problem: Non-suicidal self-harm behaviours
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Lithium
Glenn, C. R., Esposito, E. C., Porter, A. C., Robinson, D. J.
The current review provides an evidence base update of psychosocial treatments for self-injurious thoughts and behaviors (SITBs) in youth. A systematic search was conducted of 2 major scientific databases (PsycInfo and PubMed) and ClinicalTrials.gov for relevant randomized controlled trials (RCTs) published prior to June 2018. The search identified 26 RCTs examining interventions for SITBs in youth: 17 were included in the 2015 review and 9 trials were new to this update. The biggest change since the prior review was the evaluation of Dialectical Behavior Therapy for adolescents (DBT-A) as the first Level 1: Well-established intervention for reducing deliberate self-harm (composite of nonsuicidal and suicidal self-injury) and suicide ideation in youth and Level 2: Probably efficacious for reducing nonsuicidal self-injury and suicide attempts. Five other interventions were rated as Level 2: Probably efficacious for reducing SITBs in youth, with the new addition of Integrated Family Therapy. This evidence base update indicates that there are a few promising treatments for reducing SITBs in youth. Efficacious interventions typically include a significant family or parent training component as well as skills training (e.g., emotion regulation skills). Aside from DBT-A, few treatments have been examined in more than one RCT. Given that replication by independent research groups is needed to evaluate an intervention as Well-established, future research should focus on replicating the five promising interventions currently evaluated as Probably efficacious. In addition, an important future direction is to develop brief efficacious interventions that may be scalable to reach large numbers of youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Clinical Child and Adolescent Psychology, 48(3) : 357-392
- Year: 2019
- Problem: Non-suicidal self-harm behaviours
, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other service delivery and improvement interventions
Hooley, J. M., Fox, K. R., Wang, S. B., Kwashie, A. N. D.
Background: Nonsuicidal self-injury (NSSI), which involves self-damaging behavior (e.g., cutting) causes tissue damage and places people at elevated risk for future suicidal behaviors. Yet few specific treatments for NSSI currently exist. Extreme self-criticism is implicated in the development and maintenance of NSSI. We conducted a randomized controlled trial to evaluate Autobiographical Self-Enhancement Training (ASET), a novel, cognitive intervention for NSSI focused on reducing self-criticism and enhancing positive self-worth. We also examined whether Expressive Writing (EW) was a helpful treatment for NSSI. Method(s): Participants (N = 144) who had engaged in NSSI at least twice in the past month were recruited online and then randomly assigned via Qualtrics to receive the ASET intervention (N = 49), the EW intervention (N = 49), or Daily Journaling [JNL; N = 46]), an active comparison condition. Treatments were designed as month-long daily diaries. Participants in ASET wrote about something that made them feel good about themselves that day, participants in EW described something that had been on their mind that day, and participants in JNL reported on the events of the day in a factually descriptive manner without emotional content. Result(s): Intent-to-treat analyses revealed that, regardless of treatment group, participants showed significant reductions in self-criticism, NSSI episodes, depression, and suicide ideation from baseline to the end of active treatment. Relative to the JNL group, the ASET group reported significantly less self-criticism at post-treatment; this was not maintained at follow-up. There was also a trend toward ASET being associated with less suicide ideation at the end of treatment compared to EW. This difference was significant at the 3-month follow-up. Unexpectedly, the JNL group reported significantly less suicide ideation than the EW group at post-treatment; this was maintained at 3-month follow-up. No significant treatment effects were detected for suicide plans, suicidal behaviors, desire to discontinue NSSI, or likelihood of future NSSI. Conclusion(s): Self-criticism is an important treatment target in NSSI, but changing self-criticism in people with an established history of NSSI presents challenges. Nonetheless, all approaches provided benefits. This study also established the feasibility of inexpensive and easily disseminated treatments for NSSI. Copyright © 2018 The Author(s).
BMC Psychiatry, 18 (1) (no pagination)(264) :
- Year: 2018
- Problem: Non-suicidal self-harm behaviours
, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Service Delivery & Improvement, Creative expression: music, dance, drama, art
, Technology, interventions delivered using technology (e.g. online, SMS)
Plener, P. L., Kaess, M., Schmahl, C., Pollak, S., Fegert, J. M., Brown, R. C.
Deutsches Arzteblatt International, 115(3) : 23-30
- Year: 2018
- Problem: Non-suicidal self-harm behaviours
, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Fukumori, T., Kuroda, H., Ito, M., Kashimura, M.
AIMS: This study investigated the efficacy of structured writing on reducing self-harm ideations and enhancing emotion regulation.
METHODS: Japanese university students (N=22) participated in the study. Participants were randomly assigned to the structured writing group (n=10; 70% female), or an assessment only control group (n=12; 67% female). For three consecutive days, participants in the intervention group performed structured writing that included psycho-education and self-reflection about emotions. The Self-Harm Ideation Scale, the Generalized Expectancy for Negative Mood Regulation Scale, and the Acceptance and Action Questionnaire-II were used to assess outcomes.
RESULTS: Structured writing had a short-term effect on expectancies for self-regulation of negative moods and acceptance of negative emotions, but had a limited effect on self-harm ideations.
CONCLUSION: This study presents preliminary evidence that increasing awareness, learning, and reflection about emotions resulting from using a structured writing program is particularly useful for regulating emotions. J. Med. Invest. 64: 74-78, February, 2017.
Journal of Medical Investigation, 64(1.2) : 74-78
- Year: 2017
- Problem: Non-suicidal self-harm behaviours
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Psychoeducation, Creative expression: music, dance, drama, art
Andover, M. S., Schatten, H. T., Morris, B. W., Holman, C. S., Miller, I. W.
Objective: Nonsuicidal self-injury (NSSI) is prevalent among young adults and associated with negative medical and psychological consequences, necessitating its treatment. However, few treatments have been developed to treat NSSI specifically, or to treat the behavior among individuals without borderline personality disorder. The purpose of this study was to investigate the Treatment for Self-Injurious Behaviors (T-SIB), a brief, behavioral intervention specifically developed to treat NSSI among young adults, in a pilot randomized controlled trial (RCT). Method: Young adults (N = 33; age: M = 22.36 years, SD = 3.40) meeting inclusion and exclusion criteria were randomly assigned to the treatment (T-SIB; n = 15) or treatment as usual (n = 18) condition. The sample was 93.9% female, 42.4% Caucasian, and 30.3% Hispanic/Latino. Results: Feasibility and acceptability of the study and intervention were supported, and medium effects were found for decreased NSSI frequency in the T-SIB group using intent-to-treat analyses. Conclusion: Results of this study support the further evaluation of T-SIB in a larger RCT. Copyright © 2017 APA, all rights reserved.
Journal of Consulting and Clinical Psychology, 85(6) : 620-631
- Year: 2017
- Problem: Non-suicidal self-harm behaviours
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Asarnow, J. R., Hughes, J. L., Babeva, K. N., Sugar, C. A.
Objective: Suicide is a leading cause of death. New data indicate alarming increases in suicide death rates, yet no treatments with replicated efficacy or effectiveness exist for youths with self-harm presentations, a high-risk group for both fatal and nonfatal suicide attempts. We addressed this gap by evaluating Safe Alternatives for Teens and Youths (SAFETY), a cognitive-behavioral, dialectical behavior therapy-informed family treatment designed to promote safety. Method: Randomized controlled trial for adolescents (12-18 years of age) with recent (past 3 months) suicide attempts or other self-harm. Youth were randomized either to SAFETY or to treatment as usual enhanced by parent education and support accessing community treatment (E-TAU). Outcomes were evaluated at baseline, 3 months, or end of treatment period, and were followed up through 6 to 12 months. The primary outcome was youth-reported incident suicide attempts through the 3-month follow-up. Results: Survival analyses indicated a significantly higher probability of survival without a suicide attempt by the 3-month follow-up point among SAFETY youths (cumulative estimated probability of survival without suicide attempt = 1.00, standard error = 0), compared to E-TAU youths (cumulative estimated probability of survival without suicide attempt = 0.67, standard error = 0.14; z = 2.45, p = .02, number needed to treat = 3) and for the overall survival curves (Wilcoxon chi21 = 5.81, p = .02). Sensitivity analyses using parent report when youth report was unavailable and conservative assumptions regarding missing data yielded similar results for 3-month outcomes. Conclusion: Results support the efficacy of SAFETY for preventing suicide attempts in adolescents presenting with recent self-harm. This is the second randomized trial to demonstrate that treatment including cognitive-behavioral and family components can provide some protection from suicide attempt risk in these high-risk youths. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Journal of the American Academy of Child & Adolescent Psychiatry, 56(6) : 506-514
- Year: 2017
- Problem: Non-suicidal self-harm behaviours
, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Bentley, K. H., Nock, M. K., Sauer-Zavala, S., Gorman, B. S., Barlow, D. H.
Objective: Nonsuicidal self-injury (NSSI) is prevalent and associated with clinically significant consequences. Developing time-efficient and cost-effective interventions for NSSI has proven difficult given that the critical components for NSSI treatment remain largely unknown. The aim of this study was to examine the specific effects of mindful emotion awareness training and cognitive reappraisal, 2 transdiagnostic treatment strategies that purportedly address the functional processes thought to maintain self-injurious behavior, on NSSI urges and acts. Method: Using a counterbalanced, combined series (multiple baseline and data-driven phase change) aggregated single-case experimental design, the unique and combined impact of these 2 4-week interventions was evaluated among 10 diagnostically heterogeneous self-injuring adults. Ecological momentary assessment was used to provide daily ratings of NSSI urges and acts during all study phases. Results: Eight of 10 participants demonstrated clinically meaningful reductions in NSSI; 6 participants responded to 1 intervention alone, whereas 2 participants responded after the addition of the alternative intervention. Group analyses indicated statistically significant overall effects of study phase on NSSI, with fewer NSSI urges and acts occurring after the interventions were introduced. The interventions were also associated with moderate to large reductions in self-reported levels of anxiety and depression, and large improvements in mindful emotion awareness and cognitive reappraisal skills. Conclusions: Findings suggest that brief mindful emotion awareness and cognitive reappraisal interventions can lead to reductions in NSSI urges and acts. Transdiagnostic, emotion-focused therapeutic strategies delivered in time-limited formats may serve as practical yet powerful treatment approaches, especially for lower-risk self-injuring individuals. Copyright © 2017 APA, all rights reserved.
Journal of Consulting and Clinical Psychology, 85(6) : 632-646
- Year: 2017
- Problem: Non-suicidal self-harm behaviours
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Calati, R., Courtet, P.
Objective: To determine the efficacy of psychotherapy interventions for reducing suicidal attempts (SA) and non-suicidal self-injury (NSSI). Methods: Meta-analysis of randomized controlled trials (RCTs) comparing psychotherapy interventions and treatment as usual (TAU; including also enhanced usual care, psychotropic treatment alone, cognitive remediation, short-term problem-oriented approach, supportive relationship treatment, community treatment by non-behavioral psychotherapy experts, emergency care enhanced by provider education, no treatment) for SA/NSSI. RCTs were extracted from MEDLINE, EMBASE, PsycINFO and Cochrane Library and analyzed using the Cochrane Collaboration Review Manager Software and Comprehensive Meta-analysis. Results: In the 32 included RCTs, 4114 patients were randomly assigned to receive psychotherapy (n = 2106) or TAU (n = 2008). Patients who received psychotherapy were less likely to attempt suicide during the follow-up. The pooled risk difference for SA was -0.08 (95% confidence intervals = -0.04 to -0.11). The absolute risk reduction was 6.59% (psychotherapy: 9.12%; TAU: 15.71%), yielding an estimated number needed to treat of 15. Sensitivity analyses showed that psychotherapy was effective for SA mainly in adults, outpatients, patients with borderline personality disorder, previously and non-previously suicidal patients (heterogeneous variable that included past history of SA, NSSI, deliberate self-harm, imminent suicidal risk or suicidal ideation), long- and short-term therapies, TAU only as a control condition, and mentalization-based treatment (MBT). No evidence of efficacy was found for NSSI, with the exception of MBT. Between-study heterogeneity and publication bias were detected. In the presence of publication bias, the Duval and Tweedie's "trim and fill" method was applied. Conclusion: Psychotherapy seems to be effective for SA treatment. However, trials with lower risk of bias, more homogeneous outcome measures and longer follow-up are needed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Journal of Psychiatric Research, 79 : 8-20
- Year: 2016
- Problem: Non-suicidal self-harm behaviours
, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Carter, G., Page, A., Large, M., Hetrick, S., Milner, A. J., Bendit, N., Walton, C., Draper, B., Hazell, P., Fortune, S., Burns, J., Patton, G., Lawrence, M., Dadd, L., Robinson, J., Christensen, H.
OBJECTIVE: To provide guidance for the organisation and delivery of clinical services and the clinical management of patients who deliberately self-harm, based on scientific evidence supplemented by expert clinical consensus and expressed as recommendations.
METHOD: Articles and information were sourced from search engines including PubMed, EMBASE, MEDLINE and PsycINFO for several systematic reviews, which were supplemented by literature known to the deliberate self-harm working group, and from published systematic reviews and guidelines for deliberate self-harm. Information was reviewed by members of the deliberate self-harm working group, and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to successive consultation and external review involving expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest and expertise in deliberate self-harm.
RESULTS: The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for deliberate self-harm provide up-to-date guidance and advice regarding the management of deliberate self-harm patients, which is informed by evidence and clinical experience. The clinical practice guidelines for deliberate self-harm is intended for clinical use and service development by psychiatrists, psychologists, physicians and others with an interest in mental health care.
CONCLUSION: The clinical practice guidelines for deliberate self-harm address self-harm within specific population sub-groups and provide up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus.
Copyright © The Royal Australian and New Zealand College of Psychiatrists 2016.
Australian & New Zealand Journal of Psychiatry, 50(10) : 939-1000
- Year: 2016
- Problem: Non-suicidal self-harm behaviours
, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Cheng, F. K.
Childhood mental health problems not only incur a financial burden but more importantly damages individual and family well-being, which compels mental care practitioners to search for solutions, among which meditation is a more economical method. This integrative review investigates the effectiveness of meditation on psychological problems for adolescents under age of 20 through different types of meditation, though mainly mindfulness-based modes. The 36 reviewed publications include quantitative, qualitative and mixed methods research, conducted in North America, Europe, and the Asia Pacific region, related to developmental disabilities, emotional problems, and mental illnesses. Outcomes indicate a decrease in self-harm thoughts, disruptive behaviour, stress, anxiety, impulsivity, and psychological distress; and improvements in self-control, quality of sleep, emotional regulation, executive function, anger management, and social competence, resulting in better academic performance, quality of life, mental wellness, and child-parent relationships. This review suggests the integration of meditation into physical activities, and music and art therapies, as well as randomised controlled trials to examine such synthesis of these disciplines. In conclusion, meditation is a potential curative and preventive measure, both low cost and non-intrusive, for the promotion of adolescent mental wellness. This sheds light on nurses who look after children with mental health. Copyright © 2016 The Author.
International Journal of Africa Nursing Sciences, 4 : 7-19
- Year: 2016
- Problem: Anxiety Disorders (any), Depressive Disorders, Non-suicidal self-harm behaviours
, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Mindfulness based therapy, Meditation