Self-harm and self-injury come when an individual harms themselves physically. Nonsuicidal self-injury is not intended to lead to suicide, but it can lead to death. So then why do people do it when it is so risky? And how do therapists use their resources to help?
It is often hard to know whether a client reporting for therapy engages in self-harm behaviors. There are many possible reasons. This warrants a thorough assessment to further understand the individual’s intent. Were they trying to end their life or was there something else motivating them to initiate that behavior? If they were attempting suicide, there are approaches and therapist resources to help.
Nonsuicidal self-injurious behavior, on the other hand, usually occurs for other reasons. In our recent article on eating disorder behavior, we wrote about the “function” of a behavior. That is, what a behavior provides for an individual is a form of short-term psychological or emotion “pay off”. Such immediate payoff reinforces such harmful behaviors even when those behaviors contribute to large scale or long-term problems for the individual. This is also common for jumping into rumination in general and/or hyper-preparedness behaviors in generalized anxiety disorder (GAD).
There can be many functions in the case of nonsuicidal self-harm or self-injury (e.g., cutting or burning behaviors). Research finds a few common reasons individuals engage in nonsuicidal self-injury, including self-punishment and self-injury. The most common function, however, is emotion regulation. This is especially the case when occurring along with borderline personality disorder symptoms.
Self-injurious behaviors often helps neutralize overwhelming negative emotions in the moment. Those who self-harm often report feeling emotionally numb following extreme emotions like anger, fear, or panic. Additionally, they report self-injury is the only behavior they have found to suddenly “neutralize” such difficult emotions. This is why this apparently harmful behavior can be so reinforcing.
So how do therapists help combat such a powerful and strongly appealing behavior? In a nut shell, the solution is to help clients learn other forms of regulating strong emotions.
Dialectical behavior therapy (DBT) provides a number of effective methods for self harm. Multiple forms of mindfulness, acceptance, social strategies, and tasks like holding on to ice cubes are just a few.
Psychotherapy Academy has a course that provides a toolbox of multiple DBT strategies for emotion regulation. PsychWire has a whole suite of DBT trainings sponsored by Marsha Linehan herself, for those looking to get full-on DBT training.
And what’dya know, CBT also shows efficacy for reducing self-harm behaviors. A few studies also find that a form of ACT may also be efficacious.
Providing alternatives in the face of such powerfully-reinforcing maladaptive behaviors is among the greatest challenges therapists face. Luckily, continued research and developed therapy approaches provide understanding and effective methods. These help mitigate risk of long-term harm and help clients find ways to more effectively manage difficult experiences.
