Disorders - Non-suicidal self-harm behaviours
Ougrin,
D., Tranah, T., Stahl, D., Moran, P., Asarnow, J. R.
Objective: Suicidal behavior and
self-harm are common in adolescents and are associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite
recent advances in the understanding and treatment of self-harm and links between self-harm and suicide and risk of suicide attempt, progress in
reducing suicide death rates has been elusive, with no substantive reduction in suicide death rates over the past 60 years. Extending prior reviews
of the literature on treatments for suicidal behavior and repetitive self-harm in youth, this article provides a meta-analysis of randomized
controlled trials (RCTs) reporting efficacy of specific pharmacological, social, or psychological therapeutic interventions (TIs) in reducing both
suicidal and nonsuicidal self-harm in adolescents. Method: Data sources were identified by searching the Cochrane, Medline, PsychINFO, EMBASE, and
PubMed databases as of May 2014. RCTs comparing specific therapeutic interventions versus treatment as usual (TAU) or placebo in adolescents (through
age 18 years) with self-harm were included. Results: Nineteen RCTs including 2,176 youth were analyzed. TIs included psychological and social
interventions and no pharmacological interventions. The proportion of the adolescents who self-harmed over the follow-up period was lower in the
intervention groups (28%) than in controls (33%) (test for overall effect z = 2.31; p = .02). TIs with the largest effect sizes were dialectical
behavior therapy (DBT), cognitive-behavioral therapy (CBT), and mentalization-based therapy (MBT). There were no independent replications of efficacy
of any TI. The pooled risk difference between TIs and TAU for suicide attempts and nonsuicidal self-harm considered separately was not statistically
significant. Conclusion: TIs to prevent self-harm appear to be effective. Independent replication of the results achieved by DBT, MBT, and CBT is a
research priority. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Journal
of the American Academy of Child & Adolescent Psychiatry, 54(2) : 97-107
- Year: 2015
- 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)
Turner, B. J., Austin, S.
B., Chapman, A. L.
Objective:
Nonsuicidal self-injury (NSSI), the deliberate, self-inflicted damage of bodily tissue without the intent to die, is associated with various negative
outcomes. Although basic and epidemiologic research on NSSI has increased during the last 2 decades, literature on effective interventions targeting
NSSI is still emerging. Here, we present a comprehensive, systematic review of existing psychological and pharmacological treatments designed
specifically for NSSI, or including outcome assessments examining change in NSSI.; Method: We conducted a systematic search of PsycINFO, MEDLINE, and
ERIC databases to retrieve relevant articles that met inclusion criteria; specifically, uncontrolled and controlled trials that 1) presented
quantitative outcome data on NSSI, and 2) clearly differentiated NSSI from suicidal self-injury (SSI). Consistent with the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition, definition of NSSI, we excluded studies examining populations with developmental or intellectual
disabilities, or with psychotic disorders.; Results: Several interventions appear to hold promise for reducing NSSI, including dialectical behaviour
therapy, emotion regulation group therapy, manual-assisted cognitive therapy, dynamic deconstructive psychotherapy, atypical antipsychotics
(aripiprazole), naltrexone, and selective serotonin reuptake inhibitors (with or without cognitive-behavioural therapy). Nevertheless, there remains
a paucity of well-controlled studies investigating treatment efficacy for NSSI.; Conclusions: Structured psychotherapeutic approaches focusing on
collaborative therapeutic relationships, motivation for change, and directly addressing NSSI behaviours seem to be most effective in reducing NSSI.
Medications targeting the serotonergic, dopaminergic and opioid systems also have demonstrated some benefits. Future studies employing controlled
designs as well as a clear delineation of NSSI and SSI will improve knowledge regarding treatment effects.;
Canadian Journal of Psychiatry, 59(11) : 576-
585
- Year: 2014
- Problem: Non-suicidal self-harm behaviours
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Gonzales, A. H., Bergstrom, L.
Topic: Evidence-based treatment of non-suicidal self-injury (NSSI) in
adolescents.; Purpose: To review the evidence base supporting current interventions for NSSI.; Sources Used: PubMed searches and ancestry analysis.;
Conclusions: All treatments studied-developmental group therapy, individual cognitive-behavioral therapy, and dialectical behavioral therapy for
adolescents-were found to be comparable to the typical treatments offered in the treatment settings where the research was conducted. Additional
strategies such as harm reduction have very limited evidence suggesting they may be helpful. A few common interventions including relaxation
techniques have extremely limited evidence suggesting they may be perceived as harmful by clients.; © 2013 Wiley Periodicals, Inc.
Journal of Child & Adolescent Psychiatric Nursing, 26(2) : 124-
130
- Year: 2013
- Problem: Non-suicidal self-harm behaviours
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
De Silva, S., Parker, A., Purcell, R., Callahan, P., Liu, P., Hetrick, S.
Background: Suicide and self-harm (SSH) in young people is a major cause of disability-adjusted life years. Effective
interventions are of critical importance to reducing the mortality and morbidity associated with SSH. Aims: To investigate the extent and nature of
research on interventions to prevent and treat SSH in young people using evidence mapping. Method: A systematic search for SSH intervention studies
was conducted (participant mean age between 6 - 25 years). The studies were restricted to high-quality evidence in the form of systematic reviews,
meta-analyses, and controlled trials. Results: Thirty-eight controlled studies and six systematic reviews met the study inclusion criteria. The
majority (n = 32) involved psychological interventions. Few studies (n = 9) involved treating young people with recognized mental disorders or
substance abuse (n = 1) which also addressed SSH. Conclusion: The map was restricted to RCTs, CCTs, systematic reviews, and meta-analyses, and thus
might have neglected important information from other study designs. The effectiveness of interventions within the trials was not evaluated. The
evidence base for SSH interventions in young people is not well established, which hampers best-practice efforts in this area. Promising
interventions that need further research include school-based prevention programs with a skills training component, individual CBT interventions,
interpersonal psychotherapy, and attachment-based family therapy. Gaps in the research exist in evaluations of interventions for SSH in young people
with identifiable psychopathology, particularly substance use disorder, and research that classifies participants on the basis of their suicidal
intent. (PsycINFO Database Record (c) 2013 APA, all rights reserved). (journal abstract)
Crisis, 34(4) : 223-
232
- Year: 2013
- Problem: 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: Biological Interventions
(any), Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any)
Brausch, A. M., Girresch, S. K.
Nonsuicidal self-injury (NSSI) is a concern in the adolescent population given its relationship to suicidal behavior, pointing to the
serious need for adequate treatments for this high-risk population. This review examined empirical studies that evaluated treatments for NSSI among
adolescents, and evaluated how the components of each treatment address common underlying and concurrent factors of NSSI. Among the available
treatments, cognitive-behavioral therapy (CBT) interventions that integrate a problem-solving component and dialectical behavior therapy (DBT) have
received the most empirical attention. However, studies examining the utility of cognitive-behavioral problem-solving interventions for adolescents,
and randomized controlled trials examining the efficacy of DBT are lacking. Overall, CBT-based treatments improved underlying or maintaining factors
of NSSI, such as depression, hopelessness, and problem-solving skills. DBT was effective for reducing hospitalizations. No existing studies evaluated
treatment effectiveness for NSSI exclusively, and few studies used a purely adolescent sample. This review highlights the gap in knowledge regarding
adolescent NSSI-there is no strong evidence for the efficacy of any specific treatment. (copyright) 2012 Springer Publishing Company.
Journal of Cognitive Psychotherapy, 26(1) : 3-
18
- Year: 2012
- Problem: Non-suicidal self-harm behaviours
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Ougrin, D., Zundel, T., Kyriakopoulos, M., Banarsee,
R., Stahl, D., Taylor, E.
Self-harm is one of the best predictors of death by
suicide, but few studies directly compare adolescents with suicidal versus nonsuicidal self-harm. Seventy adolescents presenting with self-harm (71%
young women, ages 12-18 years) who participated in a randomized controlled trial were divided into suicidal and nonsuicidal self-harm categories
using the Columbia Classification Algorithm of Suicide Assessment. Adolescents with suicidal self-harm were more likely than those with nonsuicidal
self-harm to be young women, 22/23 (96%) versus 34/47 (72%), odds ratio (OR) = 8.33, 95% confidence interval (CI) [1.03, 50.0]; had a later age of
onset of self-harm, 15.4 years vs. 13.8 years, mean difference = 1.6, 95% CI [.8, 2.43]; and used self-poisoning more often, 18/23 (78%) versus 11/47
(23%), OR = 3.43, 95% CI [2.00, 5.89]. Only those with nonsuicidal self-harm had an improvement on Children's Global Assessment Scale score
following a brief therapeutic intervention, mean difference = 8.20, 95% CI [.97, 15.42]. However, there was no interaction between treatment and
suicidality. There are important differences between adolescents presenting with suicidal and nonsuicidal self-harm. Suicidal self-harm in
adolescence may be associated with a less favorable response to therapeutic assessment. (copyright) 2011 American Psychological Association.
Psychological Assessment, 24(1) : 11-
20
- Year: 2012
- 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
Pistorello, J., Fruzzetti, A. E., MacLane, C., Gallop, R., Iverson, K. M.
Objective: College counseling centers (CCCs) are increasingly being called upon to treat highly distressed students with
complex clinical presentations. This study compared the effectiveness of Dialectical Behavior Therapy (DBT) for suicidal college students with an
optimized control condition and analyzed baseline global functioning as a moderator. Method: The intent-to-treat (ITT) sample included 63 college
students between the ages of 18 and 25 years who were suicidal at baseline, reported at least 1 lifetime nonsuicidal self-injurious (NSSI) act or
suicide attempt, and met 3 or more borderline personality disorder (BPD) diagnostic criteria. Participants were randomly assigned to DBT (n = 31) or
an optimized treatment-as-usual (O-TAU) control condition (n = 32). Treatment was provided by trainees, supervised by experts in both treatments.
Both treatments lasted 7-12 months and included both individual and group components. Assessments were conducted at pretreatment, 3 months, 6 months,
9 months, 12 months, and 18 months (follow-up). Results: Mixed effects analyses (ITT sample) revealed that DBT, compared with the control condition,
showed significantly greater decreases in suicidality, depression, number of NSSI events (if participant had self-injured), BPD criteria, and
psychotropic medication use and significantly greater improvements in social adjustment. Most of these treatment effects were observed at follow-up.
No treatment differences were found for treatment dropout. Moderation analyses showed that DBT was particularly effective for suicidal students who
were lower functioning at pretreatment. Conclusions: DBT is an effective treatment for suicidal, multiproblem college students. Future research
should examine the implementation of DBT in CCCs in a stepped care approach. (copyright) 2012 American Psychological Association.
Journal of Consulting &
Clinical Psychology, 80(6) : 982-994
- Year: 2012
- 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), Dialectical behavioural therapy
(DBT)
Washburn, J. J., Richardt, S. L., Styer, D.
M., Gebhardt, M., Juzwin, K. R., Yourek, A., Aldridge, D.
Non-suicidal self-injury (NSSI) among adolescents
is gaining increasing attention in both clinical and scientific arenas. The lifetime prevalence of NSSI is estimated to vary between 7.5% to 8% for
preadolescents, increasing to between 12% and 23% for adolescents. Despite the prevalence and the increasing interest in NSSI, few psychotherapeutic
treatments have been designed specifically for NSSI, and no treatments have been evaluated specifically for the treatment of NSSI among adolescents.
Consequently, child and adolescent clinicians are left with little evidence-based guidance for treating this challenging population. To provide some
guidance, evaluations of treatments for adults with NSSI and for adolescents with related conditions, such as deliberate self-harm and borderline
personality disorder, are reviewed. Clinical guidelines and resources are also discussed to assist with the gaps in the knowledge base for treatment
of NSSI among adolescents. (copyright) 2012 Washburn et al.; licensee BioMed Central Ltd.
Child & Adolescent Psychiatry & Mental
Health, 6 :
- Year: 2012
- Problem: Non-suicidal self-harm behaviours
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Andion, O., Ferrer, M., Matali,
J., Gancedo, B., Calvo, N., Barral, C., Valero, S., Di Genova, A., Diener, M. J., Torrubia, R., Casas, M.
Dialectical behavior therapy (DBT) is an
effective therapy. However, treating borderline personality disorder (BPD) patients with standard DBT can be problematic in some institutions due to
logistical or cost limitations. The aim of this preliminary study is to examine the efficacy of Individual DBT in 37 BPD patients, compared with
Combined individual/Group DBT in 14 BPD patients. Outcome measures included suicide attempts, self-harm behaviors, and visits to emergency
departments. These variables were examined at pretreatment, 12 months/end of treatment, and at an 18-month follow-up. In addition, dropout rates were
examined. Significant improvements on the outcome measures were observed across both versions of DBT treatment, particularly at the 18-month follow-
up assessment. No significant differences were observed between Individual DBT and Combined individual/Group DBT on any of the posttreatment
evaluations. An individual version of DBT may be an effective and less costly option for BPD treatment. Larger controlled trials are needed to
confirm the results. PsycINFO Database Record (c) 2012 APA, all rights reserved.
Psychotherapy, 49(2) : 241-250
- Year: 2012
- Problem: Non-suicidal self-harm behaviours, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Dialectical behavioural therapy
(DBT)
Wilkinson, Beverly
The increasing prevalence of
self-injurious behavior (SIB) among mainstream adolescents has led to a growing body of research. This maladaptive behavior is used as a means of
regulating negative emotions. Best practices regarding therapy are unclear, with many types of intervention being tried. Analysis of 36 qualitative
and quantitative studies, reviews, and theory articles addressing adolescent SIB was conducted looking at aspects such as history, demographics,
motivators, risk factors, techniques, and treatment options. An explosion of research is surfacing to determine effective care through creative
approaches. Dialectical Behavior Therapy (DBT) shows great promise. The school setting is a natural environment for the identification and
intervention of SIB which requires knowledge of indicators and risk factors. Education of school staff will increase awareness and enhance
communication among disciplines. A circle of care can then surround the student to provide support and guidance while the proper interventions for
emotional regulation and individual health promotion are developed.
Journal of School Nursing, 27(2) : 120-
128
- Year: 2011
- Problem: Non-suicidal self-harm behaviours
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)