Treatments for NSSI

Treatment and recovery for self-injury can mean different things to different people. In general, "treatment" refers to physical and psychological interventions that help people who are self-injuring. 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)

DBT is a psychotherapeutic treatment designed to treat Borderline Personality Disorder (BPD), of which non-suicidal self-injury is a common behaviour. DBT is one of the most well-known treatments for people engaging in self-injury. It 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).

 

DBT treats self-injury in several ways:

  • Improving emotion regulation. DBT helps an individual better understand themselves and their emotions, including what might trigger emotional responses and how to notice emotions developing before they become overwhelming. DBT also teaches an individual strategies to cope with and control their emotions in such a way that self-injury is less and less needed to regulate emotions.

  • Increasing behavioral control.

  • Strengthening positive identity. 

  • Improving interpersonal skills.

 

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. It is important to note, however, that some research shows that DBT is not superior to other treatments in reducing self-injury. Further, DBT is designed to treat self-injury in the context of BPD; it is not clear how effective DBT may be for treating self-injury among individuals who do not have BPD.

Emotion Regulation Group Therapy (ERGT)

ERGT was developed as an alternative to DBT, offering a briefer treatment period including 14 weeks of group-based psychotherapy. Unlike DBT, which is intended to treat NSSI in combination with other challenges facing people living with BPD, ERGT focuses solely on NSSI. It integrates components of DBT and Acceptance and Commitment Therapy (ACT).

 

ERGT treats NSSI in several ways:

  • Increasing awareness, understanding, and acceptance of emotions. By learning more about emotions and how to recognise them, individuals are better equipped to cope with emotional experiences. ERGT also helps individuals develop greater tolerance of uncomfortable emotional experiences.

  • Improving emotional control. Individuals learn how to better control the intensity and duration of their emotions.

  • Facilitating behavioral control. Individuals learn how to enact goal-directed behaviors and inhibit impulsive behaviors in response to negative emotions.

 

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). Several well-designed studies have shown that ERGT is effective in reducing self-injury in adult women living with BPD. A recent feasibility study also suggests that ERGT may be effective in adolescent girls engaging in NSSI. 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)

T-SIB is a brief, nine-session intervention conducted weekly on an individual basis. Designed for young adults engaging in NSSI, T-SIB 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; 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.