Group mindfulness based cognitive therapy vs group support for self-injury among young people: Study protocol for a randomised controlled trial

Background: Non-suicidal self-injury (NSSI) is a transdiagnostic behaviour that can be difficult to treat; to date no evidence based treatment for NSSI exists. Mindfulness Based Cognitive Therapy (MBCT) specifically targets the mechanisms thought to initiate and maintain NSSI, and thus appears a viable treatment option. The aims of the current study are to test the ability of MBCT to reduce the frequency and medical severity of NSSI, and explore the mechanisms by which MBCT exerts its effect. Methods/Design: We will conduct a parallel group randomised controlled trial of Mindfulness Based Cognitive Therapy (MBCT) versus Supportive Therapy (ST) in young people aged 18-25 years. Computerised block randomisation will be used to allocate participants to groups. All participants will meet the proposed DSM-5 criteria for NSSI (i.e. five episodes in the last twelve months). Participants will be excluded if they: 1) are currently receiving psychological treatment, 2) have attempted suicide in the previous 12 months, 3) exhibit acute psychosis, 4) have a diagnosis of borderline personality disorder, or 5) have prior experience of MBCT. Our primary outcome is the frequency and medical severity of NSSI. As secondary outcomes we will assess changes in rumination, mindfulness, emotion regulation, distress tolerance, stress, and attentional bias, and test these as mechanisms of change. Discussion: This is the first randomised controlled trial to test the efficacy of MBCT in reducing NSSI. Evidence of the efficacy of MBCT for self-injury will allow provision of a brief intervention for self-injury that can be implemented as a stand-alone treatment or integrated with existing treatments for psychiatric disorders

Adolescents at risk of self-harm in Ghana: a qualitative interview study exploring the views and experiences of key adult informants

Background In Ghana, rates of self-harm in young people are as high as they are in high income countries. Self-reported interpersonal, familial and societal stressors form the most important background, and self-harm is seen by young people as a way of responding to that stress. In the present study, we obtained the views of key adult informants about self-harm among adolescents in Ghana – what they thought as possible reasons for self-harm in young people and what actions might be needed at an individual or population level to respond to the problem. Methods We interviewed face-to-face 11 adults, using a semi-structured interview guide. We used an experiential thematic analysis technique to analyse the transcribed interviews. Results The analysis identified five themes: “underestimating the prevalence of self-harm in adolescents”, “life on the streets makes self-harm less likely”, “self-harm in adolescents is socially and psychologically understandable”, “ambivalence about responding to adolescent self-harm”, and “few immediate opportunities for self-harm prevention in Ghana”. Adolescent self-harm was acknowledged but its scale was underestimated. The participants offered explanations for adolescent self-harm in social and psychological terms that are recognisable from accounts in high income countries. Low rates among street-connected young people were explained by their overarching orientation for survival. Participants agreed that identification was important, but they expressed a sense of inadequacy in identifying and supporting adolescents at risk of self-harm. Again, the participants agreed that self-harm in adolescents should be prevented, but they recognised that relevant policies were not in place or if there were policies they were not implemented – mental health and self-harm were not high on public or political priorities. Conclusions The adults we interviewed about young people who self-harm see themselves as having a role in identifying adolescents at risk of self-harm and see the organisations in which they work as having a role in responding to individual young people in need. These are encouraging findings that point to at least one strand of a policy in Ghana for addressing the problem of self-harm in young people

International prevalence of adolescent non-suicidal self-injury and deliberate self-harm

<p>Abstract</p> <p>Background</p> <p>The behaviours of non-suicidal self-injury (NSSI) and deliberate self-harm (DSH) are prevalent among adolescents, and an increase of rates in recent years has been postulated. There is a lack of studies to support this postulation, and comparing prevalence across studies and nations is complicated due to substantial differences in the methodology and nomenclature of existing research.</p> <p>Methods</p> <p>We conducted a systematic review of current (2005 - 2011) empirical studies reporting on the prevalence of NSSI and DSH in adolescent samples across the globe.</p> <p>Results</p> <p>Fifty-two studies fulfilling the inclusion criteria were obtained for analysis. No statistically significant differences were found between NSSI (18.0% SD = 7.3) and DSH (16.1% SD = 11.6) studies. Assessment using single item questions led to lower prevalence rates than assessment with specific behaviour checklists. Mean prevalence rates have not increased in the past five years, suggesting stabilization.</p> <p>Conclusion</p> <p>NSSI and DSH have a comparable prevalence in studies with adolescents from different countries. The field would benefit from adopting a common approach to assessment to aide cross-cultural study and comparisons.</p

Differentiating Non-Suicidal Self-Injury and Risky Drinking: a Role for Outcome Expectancies and Self-Efficacy Beliefs

© 2017 Society for Prevention ResearchSocial cognitive theory articulates a role for two key thought processes in governing volitional behaviour: outcome expectancies and self-efficacy expectancies. These cognitions are behaviour-specific, and should thus differentiate people who engage in one behaviour over another. This paper presents the results of a study applying social cognitive theory to explore how outcome expectancies and self-efficacy expectancies differentially relate to non-suicidal self-injury (NSSI) and risky alcohol use amongst a sample of young adults. A sample of 389 undergraduate students completed self-report questionnaires assessing their engagement in NSSI, alcohol consumption, their beliefs about the anticipated consequences of self-injury and alcohol consumption (outcome expectancies), and their belief in their ability to resist self-injury or risky drinking (resistance self-efficacy). Generally, people who self-injure rather than drink are characterised by a belief in the ability to resist drinking, coupled with stronger positive, and weaker negative, NSSI expectancies. People who self-injure are less likely to think alcohol reduces tension than people who do not self-injure. People who engaged in both NSSI and risky drinking report more anxiety than participants who engaged only in risky drinking and lowered ability to resist self-injury. Overall, the findings suggest that a unique combination of beliefs differentially predict NSSI and drinking. The pattern of results suggests potential avenues for future research to delineate why people engage in one behaviour rather than another and to inform future prevention and early intervention initiatives

A Preliminary Application of Social Cognitive Theory to Nonsuicidal Self-Injury

Researchers have established a relationship between exposure to nonsuicidal self-injury (NSSI), and increased probability of engaging in the behavior, but few have endeavored to explain the mechanisms underlying the relationship. We drew on Social Cognitive Theory to argue that core cognitions, including NSSI outcome expectancies and self-efficacy expectancies, moderate this relationship. We also explored whether knowledge about NSSI and attitudes toward the behavior played a role in this relationship. A sample of 389 university students (73.1 % female, M age = 20.90, SD = 2.36), completed online questionnaires assessing the constructs of interest. Our findings support the application of Social Cognitive Theory to better understanding NSSI, with clear links between expectancies, self-efficacy and NSSI. Further, these cognitions moderated a number of exposure-NSSI relationships. Implications of these findings for theory, research and intervention are discussed

Non-suicidal Self-Injury and Firesetting: Shared and Unique Correlates Among School-Based Adolescents

Distinct behaviors such as non-suicidal self-injury (NSSI) and firesetting may represent functionally equivalent attempts to regulate difficult affective/cognitive or social experiences during adolescence. This study examined possible mechanisms leading to NSSI, as opposed to firesetting, as well as co-occurrence of these behaviors. Participants aged 12–18 years (N = 2,356; 67.5 % female) completed self-report questionnaires measuring NSSI and firesetting, as well as socio-demographic and psychosocial factors including personality traits related to impulsivity and anxiety, negative life events, emotion regulation, and coping. The findings indicated the presence of general risk factors (e.g., negative life events and poor coping) that increase the likelihood that adolescents will engage in any of a range of maladaptive behaviors. The probability of at-risk adolescents engaging in NSSI was increased by psychological states (i.e., rumination and poor self-esteem), whereas socio-demographic and personality traits were associated with firesetting. Implications for prevention and early intervention initiatives are discussed