1
|
Ip JWY, McMain SF, Chapman AL, Kuo JR. The role of emotion dysregulation and interpersonal dysfunction in nonsuicidal self-injury during dialectical behavior therapy for borderline personality disorder. Behav Res Ther 2024; 180:104594. [PMID: 38945041 DOI: 10.1016/j.brat.2024.104594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 05/29/2024] [Accepted: 06/11/2024] [Indexed: 07/02/2024]
Abstract
Dialectical Behaviour Therapy (DBT) is an evidence-based treatment for borderline personality disorder (BPD), with findings demonstrating improvements in various BPD features and related behaviours, such as nonsuicidal self-injury (NSSI). Theory and research suggest that reductions in emotion dysregulation and interpersonal dysfunction could account for at least some of the reduction in NSSI observed during the course of DBT. The current research investigated: 1) the trajectory of changes in emotion dysregulation, interpersonal dysfunction, and NSSI over the course of DBT, and 2) whether changes in emotion dysregulation mediate the relationship between changes in interpersonal dysfunction and changes in NSSI over treatment. One hundred and twenty individuals with BPD enrolled in a multi-site randomized-clinical trial were assessed at five timepoints over 12 months of standard DBT. Results indicated that interpersonal dysfunction and NSSI decreased over the course of DBT. Emotion dysregulation decreased in a quadratic manner such that most of the gains in emotion dysregulation occurred in earlier phases of DBT. Although changes in interpersonal dysfunction predicted changes in emotion dysregulation, changes in emotion dysregulation did not mediate the relationship between changes in interpersonal dysfunction and changes in NSSI.
Collapse
Affiliation(s)
- Jennifer W Y Ip
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada.
| | - Shelley F McMain
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | | | - Janice R Kuo
- Department of Psychology, Palo Alto University, California, USA
| |
Collapse
|
2
|
Cheung JC, Sorgi-Wilson KM, Ciesinski NK, McCloskey MS. Examining the relationship between subtypes of rumination and non-suicidal self-injury: A meta-analytic review. Suicide Life Threat Behav 2024; 54:528-555. [PMID: 38411021 DOI: 10.1111/sltb.13051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 10/24/2023] [Accepted: 01/09/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Non-suicidal self-injury (NSSI) is a highly prevalent maladaptive behavior, often used to cope with intense negative affect. Rumination is an emotion regulation strategy that leads to fixation on and exacerbation of (typically) negative affective states. However, studies examining the relationship between rumination and NSSI have yielded mixed results, showing high degrees of heterogeneity. METHODS The present study conducted meta-analyses (k = 50) of the association between overall rumination and NSSI, and independent meta-analyses for each of four subtypes of rumination (general, depressive, brooding, reflection rumination). Potential moderators that may influence the magnitude of these relationships were also examined. RESULTS A small-to-moderate positive association between rumination and NSSI was found independent of rumination subtype. Moderating effects included NSSI outcome measure and study design for overall rumination and general rumination, respectively. Race was found to moderate the relationships between both brooding and depressive rumination and NSSI, though in inverse directions. An analysis of effect heterogeneity across studies suggested that undetected moderators may be present. CONCLUSION Results of this study support the relationships between rumination subtypes and NSSI and identify factors that may impact these relationships. Continued research is needed to understand this association, particularly in more varied subtypes of rumination and cognitive-affective moderators.
Collapse
Affiliation(s)
- Joey C Cheung
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | | | - Nicole K Ciesinski
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Michael S McCloskey
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Babaeifard M, Akbari M, Mohammadkhani S, Hasani J, Shahbazian R, Selby EA. Early maladaptive schemas, distress tolerance and self-injury in Iranian adolescents: serial mediation model of transdiagnostic factors. BJPsych Open 2024; 10:e116. [PMID: 38770605 DOI: 10.1192/bjo.2024.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is prevalent behaviour among adolescents. Although there are different etiological models of NSSI, there is a general lack of evidence-based, comprehensive and transdiagnostic models of NSSI in adolescents. AIMS The aim of this study was to investigate a model of transdiagnostic factors of NSSI in adolescents, testing a serial mediation model of the relationship between early maladaptive schemas (EMS), distress tolerance and NSSI through experiential avoidance and rumination. METHOD A community sample was identified of 1014 adolescents aged 13-17, of whom 425 had a history of NSSI. A serial mediation path analytic method was utilised to examine the relationships between NSSI and its associated functions as criterion variables, EMS and distress tolerance as predictors, experiential avoidance as the first mediator and rumination as the second mediator. RESULTS The path analytic model fit indices were good (X2/d.f. = 2.25, goodness of fit index = 0.98, normed fit index = 0.97, comparative fit index = 0.98, root mean square error of approximation = 0.054, standardised root mean squared residual = 0.028). Rumination significantly mediated the relationship between schemas of 'vulnerability to harm', 'emotional deprivation', 'social isolation', 'insufficient self-control', and NSSI frequency and intrapersonal functions. In serial fashion, experiential avoidance mediated the role of rumination in the relationship between social isolation, and insufficient self-control and NSSI frequency and intrapersonal functions. All indirect effects were significant. CONCLUSIONS Key indirect effects were found linking maladaptive schemas and distress tolerance to NSSI frequency, and NSSI intrapersonal functions via experiential avoidance and rumination. Thus, it is important to address these transdiagnostic factors with particular emphasis on the sequential mediating role of experiential avoidance and rumination in conceptualisation and therapeutic interventions for NSSI.
Collapse
Affiliation(s)
- Maryam Babaeifard
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, No. 43, South Mofatteh Ave., Tehran, Iran
| | - Shahram Mohammadkhani
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Jafar Hasani
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Reza Shahbazian
- Department of Computer Engineering, Modelling, Electronics and Systems Engineering, University of Calabria, Rende, Italy
| | - Edward A Selby
- Department of Psychology, Rutgers University, New Brunswick, New Jersey, USA
| |
Collapse
|
4
|
Oh Y, Shin C, Lee J, Oh K, Seo H, Chung S, Lee JJ. Comparing Ruminative and Distracting Responses and Emotion Regulation Difficulties in Early Community Adolescents With and Without Self-Harm. Soa Chongsonyon Chongsin Uihak 2024; 35:127-135. [PMID: 38601104 PMCID: PMC11001500 DOI: 10.5765/jkacap.230068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 04/12/2024] Open
Abstract
Objectives This study aimed to compare the demographic characteristics, responses to negative emotions, and difficulties in emotion regulation between self-harming adolescents and control individuals aged 12-14 years from the community. Methods Data were collected from adolescents in Chungcheong Province, South Korea, between September 2021 and November 2022. Demographic characteristics and responses to the Depressed Mood Questionnaire and Difficulties in Emotion Regulation Scale-16 (DERS-16) were compared between the self-harm and control groups. Results The self-harm group exhibited a higher prevalence of child abuse (odds ratio [OR]=4.787, 95% confidence interval [CI]=1.591-14.409, p=0.005) and school bullying victimization (OR=4.495, 95% CI=2.353-8.588, p<0.001) than those in the control group. The selfharm group displayed higher levels of rumination (t=7.88, p<0.001) and reduced distraction responses (reverse score t=2.25, p=0.025) than those of the control group. Additionally, the self-harm group scored higher on all subscales and the total DERS-16 score (t=7.61, p<0.001). Conclusion Interventions for self-harming adolescents should address child abuse and bullying victimization. Prevention programs for self-harming adolescents should focus on reducing rumination responses, increasing distractive responses, and addressing difficulties in emotion regulation using dialectical behavior therapy-skill training.
Collapse
Affiliation(s)
- Yeontaek Oh
- Department of Psychiatry, Gongju National Hospital, Gongju, Korea
| | - Cheolgyu Shin
- Department of Child and Adolescent Psychiatry, Gongju National Hospital, Gongju, Korea
| | - Jonggook Lee
- Department of Psychiatry, Gongju National Hospital, Gongju, Korea
| | - Keun Oh
- Department of Psychiatry, Gongju National Hospital, Gongju, Korea
| | - Heeyoung Seo
- Department of Psychiatry, Gongju National Hospital, Gongju, Korea
| | - Seungwon Chung
- Department of Psychiatry, Chungbuk National University Hospital, Cheongju, Korea
| | - Je Jung Lee
- Department of Psychiatry, Gongju National Hospital, Gongju, Korea
- Department of Child and Adolescent Psychiatry, Gongju National Hospital, Gongju, Korea
| |
Collapse
|
5
|
Akbari M, Seydavi M, Firoozabadi MA, Babaeifard M. Distress tolerance and lifetime frequency of non-suicidal self-injury (NSSI): A systematic review and meta-analysis. Clin Psychol Psychother 2024; 31:e2957. [PMID: 38343352 DOI: 10.1002/cpp.2957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Abstract
NSSI has recently been recognized as a significant health issue given its documented association with psychopathology and across a broad spectrum of psychiatric disorders. It has been found that individuals experiencing heightened emotions, which is referred to as an emotional cascade, are more likely to engage in self-injury behaviour due to low levels of distress tolerance (DT). The current meta-analysis using PRISMA guidelines sought to quantify the strength of the association between DT and lifetime frequency of NSSI using 22 eligible studies (N = 14,588; F = 60.7%; age = 23.35 ± 7.30), mainly from the United States. The correlation between emotional DT and NSSI was a small negative correlation (r = -.14), and it was non-significant for behavioural DT and NSSI (r = .02). Also, the effect-size was significant for studies that used interview-based measure of NSSI (r = -.24), and it was non-significant when self-report measures of NSSI (r = -.11) utilized. The association between DT and NSSI was significant and negative across the general population (r = -.47), university students (r = -.17), and inpatients (r = -.27); surprisingly, it was significant and positive among adolescents or high school students (r = .17). The observed effect-sizes were independent of publication year, mean age and its standard deviation, study quality, female proportion, DT, NSSI measures reliability, and clinical status. Future studies on NSSI should consider DT as a spectrum from distress intolerance to distress over-tolerance, given that it seems it has different functions when different samples (e.g., adolescents) are studied.
Collapse
Affiliation(s)
- Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Mohammad Seydavi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Mahsa Akbarian Firoozabadi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Maryam Babaeifard
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| |
Collapse
|
6
|
Yang Y. Modeling state- and trait-level associations between aggression, somatic symptoms, substance use, and distress tolerance. Aggress Behav 2023; 49:580-594. [PMID: 37390384 DOI: 10.1002/ab.22096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/23/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
The current study examined the state- and trait-level associations of psychological and physical aggression to somatic symptoms, and alcohol and drug use and tested the influence of distress tolerance on these associations, while controlling for stress, sex, and minority status. A naturalistic observation was used to collect data with a sample of 245 college students at three time points with 2 weeks apart. Random-intercept cross-lagged panel models were used to disaggregate within-person effects (autoregressive and cross-lagged effects) from the between-person (latent trait-level) associations. The findings revealed that there were autoregressive effects of psychological aggression between Time 1 (T1) and Time 2 (T2) and of physical aggression between T1 and T2. There was a bidirectional association between psychological aggression and somatic symptoms at T2 and Time 3 (T3), in which T2 psychological aggression predicted T3 somatic symptoms and verse vera. T1 drug use predicted T2 physical aggression, which in turn predicted T3 somatic symptoms, indicating physical aggression being a mediator between earlier drug use and later somatic symptoms. Distress tolerance was negatively associated with psychological aggression and somatic symptoms, respectively, and such an influence did not differ across time occasions. The findings indicated the importance of incorporating physical health in the prevention and intervention of psychological aggression. Clinicians may also consider including psychological aggression in the screening of somatic symptoms or physical health. Empirical-supported therapy components for enhancing distress tolerance may help mitigate psychological aggression and somatic symptoms.
Collapse
Affiliation(s)
- Yang Yang
- Institute of Behavioral Research, Texas Christian University, Fort Worth, Texas, USA
| |
Collapse
|
7
|
Wang Y, Liu Y, Zhou J. Cyberbullying Victimization and Nonsuicidal Self-Injury in Early Adolescents: A Moderated Mediation Model of Social Anxiety and Emotion Reactivity. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2023. [PMID: 37140449 DOI: 10.1089/cyber.2022.0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This study examined the mediating role of social anxiety in the relation between cyberbullying victimization and nonsuicidal self-injury (NSSI), as well as the moderating role of emotion reactivity in those associations. Participants included 2,864 adolescents (Mage = 12.46, SD = 1.36, 47.1 percent girls). Results of path analysis showed that cyberbullying victimization was significantly related to NSSI, and social anxiety plays a mediating role in the relation between them. Emotion reactivity strengthened the effect of cyberbullying victimization on NSSI and of social anxiety on NSSI. The results further showed that the mediating effect of social anxiety was more prominent for youths who have higher levels of emotion reactivity. Interventions to reduce adolescent social anxiety and emotion reactivity may interrupt the pathway from cyberbullying victimization to NSSI.
Collapse
Affiliation(s)
- Yuan Wang
- School of Psychology, Northwest Normal University, Lanzhou, China
| | - Yanyan Liu
- School of Psychology, Northwest Normal University, Lanzhou, China
| | - Jianhua Zhou
- School of Psychology, Northwest Normal University, Lanzhou, China
| |
Collapse
|
8
|
Nagy LM, Shanahan ML, Seaford SP. Nonsuicidal self-injury and rumination: A meta-analysis. J Clin Psychol 2023; 79:7-27. [PMID: 35639994 PMCID: PMC10084048 DOI: 10.1002/jclp.23394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/06/2022] [Accepted: 05/07/2022] [Indexed: 12/14/2022]
Abstract
Trait rumination is the tendency to overthink and focus on negative emotions and events and is related to a number of psychological disorders and maladaptive behaviors including nonsuicidal self-injury (NSSI). The purpose of this study was to conduct a meta-analysis of the relationship between trait rumination and NSSI behaviors. Results from 60 samples showed small effect sizes between trait rumination and NSSI engagement, NSSI frequency, and the number of methods used to self-injure in cross-sectional samples. Results from 13 samples showed small effect sizes between trait rumination and NSSI engagement and NSSI frequency in longitudinal samples. Moderator analyses indicated that this relationship is similar whether the type of rumination is depressive or not and is generally consistent across different ages, genders, and ethnicities. These results help clarify the role of trait rumination as a risk factor for NSSI.
Collapse
Affiliation(s)
- Laura M Nagy
- Department of Psychology, High Point University, High Point, North Carolina, USA
| | - Mackenzie L Shanahan
- Department of Psychology, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Sara P Seaford
- Department of Psychology, High Point University, High Point, North Carolina, USA
| |
Collapse
|
9
|
Slabbert A, Hasking P, Notebaert L, Boyes M. The Role of Distress Tolerance in the Relationship Between Affect and NSSI. Arch Suicide Res 2022; 26:761-775. [PMID: 33084535 DOI: 10.1080/13811118.2020.1833797] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI), the deliberate and self-inflicted damage of body tissue, typically serves an emotion regulation function. Both negative and positive affectivity have been associated with NSSI, as has low distress tolerance. In the current study, we tested whether relationships between both negative and positive affectivity and NSSI are moderated by the four facets of distress tolerance (tolerance, absorption, appraisal, regulation) captured by the Distress Tolerance Scale. METHODS A sample of 531 university students completed well-validated measures of NSSI, negative affectivity, positive affectivity, and distress tolerance. RESULTS Findings indicate that negative and positive affectivity, as well as the appraisal (i.e. negative perceptions of distress) and absorption (i.e. allocation of attention to distress) facets of distress tolerance, were directly associated with NSSI. Positive affectivity and appraisal also interacted in differentiating participants with recent, lifetime and no history of NSSI. Specifically, the association between negative perceptions of distress and self-injury was weaker at high levels of positive affectivity. Positive affectivity and absorption also interacted to differentiate between individuals with no history of NSSI and individuals who recently engaged in NSSI. Specifically, positive affectivity was negatively associated with self-injury, but only among individuals who allocate less attention to their distress. CONCLUSIONS Considering the independent roles of negative and positive affectivity alongside specific facets of distress tolerance and their interactions with emotional experience, may enhance understanding of NSSI. Prevention and intervention initiatives that assist regulation of negative affectivity, increase positive affectivity, and improve distress tolerance, may reduce the likelihood of engaging in self-injury.HighlightsNegative and positive affectivity are independently associated with NSSIAppraisal and absorption facets of distress tolerance are associated with NSSIPositive affectivity moderates associations between appraisal and absorption and NSSI.
Collapse
|
10
|
We have so much in common: Does shared variance between emotion-related constructs account for relationships with self-injury? JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
11
|
Gao Q, Guo J, Wu H, Huang J, Wu N, You J. Different profiles with multiple risk factors of nonsuicidal self-injury and their transitions during adolescence: A person-centered analysis. J Affect Disord 2021; 295:63-71. [PMID: 34416619 DOI: 10.1016/j.jad.2021.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is a serious public health concern among adolescents. However, adolescents with different combinations of NSSI risk factors may constitute different subgroups that vary in subsequent risks of NSSI engagement, and the membership in these subgroups may change during early adolescence. Gender differences related to risk profiles and transition patterns may also exist. This study thus aimed to address these three questions. METHODS A total of 2,942 participants ranging from 12 to 17 years old (55.2% females; Mage = 14.60, SD = 1.21) completed a series of questionnaires about NSSI and its risk factors on three occasions, every six months. Latent profile and latent transition analyses were used to examine NSSI risk profiles (subgroups), their transition patterns, and gender differences. RESULTS Three distinct risk profiles were identified: Low-risk profile, Medium-risk profile, and High-risk profile. The profile membership was fairly stable over one year, and the shift across profiles represented a "resilient" pattern. Regarding gender differences, boys were less likely to be in either the Medium- or the High-risk groups, but more likely to transition from the Medium- to the Low-risk group, relative to girls. LIMITATIONS This study relied upon self-report measures. Additional research is needed to investigate the generalizability of the results to other populations, and to examine more predictors of class membership and transitions. CONCLUSIONS The results highlight the importance of considering subgroup differences in understanding NSSI risks. Differentiated interventions with multi-pronged approaches tailoring to different risk classes and gender groups may therefore prove more efficient and effective.
Collapse
Affiliation(s)
- Qianqian Gao
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, & School of Psychology, South China Normal University, Guangzhou, 510631, PR China.
| | - Jiaqi Guo
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, & School of Psychology, South China Normal University, Guangzhou, 510631, PR China.
| | - Huijiao Wu
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, & School of Psychology, South China Normal University, Guangzhou, 510631, PR China.
| | - Jialing Huang
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, & School of Psychology, South China Normal University, Guangzhou, 510631, PR China.
| | - Nini Wu
- Department of Psychology, School of Education, Guangdong University of Education, No.351 XinGangZhong Road, 510303 Guangzhou, PR China.
| | - Jianing You
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, & School of Psychology, South China Normal University, Guangzhou, 510631, PR China.
| |
Collapse
|
12
|
Coleman SE, Dunlop BJ, Hartley S, Taylor PJ. The relationship between rumination and NSSI: A systematic review and meta-analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:405-443. [PMID: 34806214 DOI: 10.1111/bjc.12350] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/13/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Rumination is a cognitive process that has been implicated in the onset and maintenance of a variety of psychological difficulties. The purpose of this review and meta-analysis was to examine the nature and strength of the relationship between rumination and non-suicidal self-injury (NSSI). METHODS The protocol for this review was pre-registered (CRD42019148186). A literature search of electronic databases PsycINFO, CINAHL, MEDLINE, and Web of Science was performed from the earliest date available to March 2020. Thirty-nine eligible papers were identified. An additional seven papers were identified from a search conducted in September 2021, resulting in a total of 46 papers. Separate meta-analyses were undertaken for NSSI frequency and NSSI history, with studies grouped by rumination type (depressive, transdiagnostic, anger, brooding, reflection, catastrophising, overall). Moderator analyses were also conducted along with a narrative synthesis of adjusted associations and longitudinal studies. RESULTS Rumination had a positive small association with NSSI frequency and a positive moderate association with NSSI history. The adjusted associations yielded mixed findings and most longitudinal research found rumination to be associated with prospective NSSI. LIMITATIONS Most included studies had a moderate risk of bias and used a student sample. A limitation of this review was that only English language papers were included. CONCLUSIONS Findings indicate that rumination is associated with NSSI, but more so the likelihood of engaging in NSSI overall than the frequency. Rumination-focused techniques for NSSI may therefore be of benefit. Further research is needed to understand this association, particularly with longitudinal studies that focus on state rumination rather than stable trait rumination. PRACTITIONER POINTS Rumination was found to have a small to moderate association with NSSI. Some individuals who engage in NSSI may benefit from psychological techniques that target rumination. Most of the studies included had a moderate risk of bias.
Collapse
Affiliation(s)
- Sophie E Coleman
- Division of Psychology & Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, UK.,Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Brendan J Dunlop
- Division of Psychology & Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - Samantha Hartley
- Division of Psychology & Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, UK.,Pennine Care NHS Foundation Trust, Greater Manchester, UK
| | - Peter J Taylor
- Division of Psychology & Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, UK
| |
Collapse
|
13
|
Hatzopoulos K, Boyes M, Hasking P. Relationships between dimensions of emotional experience, rumination, and nonsuicidal self-injury: An application of the Emotional Cascade Model. J Clin Psychol 2021; 78:692-709. [PMID: 34529842 DOI: 10.1002/jclp.23247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/01/2021] [Accepted: 09/05/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The Emotional Cascade Model posits that nonsuicidal self-injury (NSSI) functions to distract from cascades of intense negative emotion and rumination. We investigated the moderating role of rumination in the relationships between reactivity, intensity, and perseveration of emotion and NSSI. METHOD University students (N = 992) completed self-report measures of self-injury, emotional reactivity, intensity and perseveration, and rumination. RESULTS Together, the dimensions of negative emotion were associated with NSSI, but none contributed unique variance. For positive emotion, reactivity was negatively associated with history of self-injury and perseveration was negatively associated with frequency of the behaviour. Rumination was associated with NSSI, but did not moderate associations between the dimensions of negative emotion and self-injury. Rumination moderated the relationship between perseveration of positive emotion and history of NSSI, such that it was only significant at high levels of rumination. CONCLUSION Findings highlight the importance of dimensions of positive emotion in understanding self-injury.
Collapse
Affiliation(s)
- Katerina Hatzopoulos
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Mark Boyes
- School of Population Health, Curtin University, Perth, Western Australia, Australia.,Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Penelope Hasking
- School of Population Health, Curtin University, Perth, Western Australia, Australia.,Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
14
|
Emotional Schemas Contribute to Suicide Behavior and Self-Harm: Toward Finding Suicidal Emotional Schemas (SESs). Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00115-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
15
|
Tonta KE, Hasking P, Boyes M, Howell J, McEvoy P, Kiekens G. Measurement Invariance of Three Brief Measures of Rumination in Young Adults With and Without a History of Self-Injury. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2021. [DOI: 10.1027/1015-5759/a000605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract. Rumination is central to understanding the onset and maintenance of non-suicidal self-injury. Yet, no study has evaluated whether reported differences in rumination between people with and without a history of self-injury represent genuine group differences. The present study reports an investigation into the measurement invariance of three common measures of rumination in university students with and without a history of self-injury (total N = 1,519). Results revealed configural invariance for the Ruminative Responses Scale (RRS), the Ruminative Thought Style Questionnaire (RTSQ), and the Repetitive Thinking Questionnaire (RTQ). Additionally, the RTSQ and RTQ supported metric invariance, while the RRS supported partial metric invariance. Further, the RTQ demonstrated partial scalar invariance while the RTSQ demonstrated full scalar invariance. The current findings suggest that observed differences using the RTSQ and RTQ reflect genuine differences in rumination between people with and without a history of self-injury, while researchers using the RRS are advised to account for differential item functioning.
Collapse
Affiliation(s)
- Kate E. Tonta
- School of Psychology, Curtin University, Bentley, Australia
| | | | - Mark Boyes
- School of Psychology, Curtin University, Bentley, Australia
| | - Joel Howell
- School of Psychology, Curtin University, Bentley, Australia
| | - Peter McEvoy
- School of Psychology, Curtin University, Bentley, Australia
- Centre for Clinical Interventions, Perth, WA, Australia
| | - Glenn Kiekens
- School of Psychology, Curtin University, Bentley, Australia
- Department of Neurosciences, Center for Public Health Psychiatry, KU Leuven, Belgium
| |
Collapse
|
16
|
Sloan E, Moulding R, Weiner C, Dowling RM, Hall K. A qualitative examination of the relationship between rumination, distress, and dysregulated behaviours in vulnerable young people. Psychol Psychother 2021; 94:322-340. [PMID: 32716586 DOI: 10.1111/papt.12297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 06/03/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Young people accessing mental health treatment in Australia frequently engage in dysregulated behaviours, such as substance misuse, deliberate self-harm (DSH), and binge eating and purging. Rumination has been identified as a correlate of behavioural dysregulation; however, a qualitative examination of the functional relationship between ruminative processes and distress and subsequent engagement in dysregulated behaviours has not yet been conducted. This study aimed to explore the characteristics of rumination in young people and examine how this process relates to engagement in DSH, binge eating and purging, and substance misuse in a sample of treatment-seeking young people. DESIGN A qualitative research methodology was used gain an in-depth understanding of participants' experience of rumination as it relates to their engagement in dysregulated behaviours. METHODS Twelve treatment-seeking young people were interviewed about their experience of rumination in the context of a recently recalled situation where they engaged in a dysregulated behaviour. Interview data were analysed using thematic analysis. RESULTS Themes included the following: (1) triggers to behavioural dysregulation; (2) characteristics and content of rumination; (3) key precipitants to dysregulated behaviours (rumination, distress, and prior ineffective were at managing rumination); and (4) distraction from rumination and regulation of distress as short term, positively reinforcing consequences of dysregulated behaviours, while ongoing cycles of rumination and psychological distress were identified as long-term consequences. CONCLUSIONS DSH, binge/purge behaviours, and substance misuse represent maladaptive ways to distract from intense and pervasive rumination in this cohort of young people. Theoretical and treatment implications pertaining to these findings are discussed. PRACTITIONER POINTS Rumination is a common experience in young people who engage in dysregulated behaviours including deliberate self-harm, binging and purging, and substance misuse Engagement in behavioural dysregulation functions to distract from rumination, which negatively reinforces further engagement in dysregulated behaviours. Interventions in this population should focus on the development of adaptive skills that provide the same level of distraction provided by the physical sensations associated with engaging in a dysregulated behaviour.
Collapse
Affiliation(s)
- Elise Sloan
- School of Psychology, Deakin University, Geelong, Victoria, Australia.,Deakin University Centre for Drug Use, Addictive and Anti-social Behaviour Research, Burwood, Victoria, Australia
| | - Richard Moulding
- School of Psychology, Deakin University, Geelong, Victoria, Australia.,Deakin University Centre for Drug Use, Addictive and Anti-social Behaviour Research, Burwood, Victoria, Australia
| | - Carlye Weiner
- Youth Support and Advocacy Service (YSAS), Fitzroy, Victoria, Australia
| | - Rose-Mary Dowling
- Youth Support and Advocacy Service (YSAS), Fitzroy, Victoria, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, Victoria, Australia.,Deakin University Centre for Drug Use, Addictive and Anti-social Behaviour Research, Burwood, Victoria, Australia
| |
Collapse
|
17
|
Slabbert A, Hasking P, Greene D, Boyes M. Measurement invariance of the distress tolerance scale among university students with and without a history of non-suicidal self-injury. PeerJ 2021; 9:e10915. [PMID: 33777518 PMCID: PMC7971082 DOI: 10.7717/peerj.10915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/18/2021] [Indexed: 11/20/2022] Open
Abstract
Non-suicidal self-injury (NSSI) is the intentional damage to one's body tissue in the absence of suicidal intent. NSSI primarily serves an emotion regulation function, with individuals engaging in self-injury to escape intense or unwanted emotion. Low distress tolerance has been identified as a mechanism that underlies self-injury, and is commonly assessed using the self-report Distress Tolerance Scale. There are mixed findings regarding the factor structure of the Distress Tolerance Scale, with some researchers utilising a higher-order distress tolerance score (derived from the scores on the four lower-order subscales) and other researchers using the four subscales as unique predictors of psychological outcomes. Neither of these factor structures have been assessed among individuals with a history of self-injury. Of note, an inability to tolerate distress (thought to underlie NSSI) may limit an individual's capacity to accurately observe and report specific thoughts and emotions experienced in a state of heightened distress, which may impact the validity of scores on the Distress Tolerance Scale. Therefore, measurement invariance should be established before attributing NSSI-related differences on the scale to true differences in distress tolerance. We compared the Distress Tolerance Scale higher-order model with the lower-order four factor model among university students with and without a history of NSSI. Our results indicated that the lower-order four factor model was a significantly better fit to the data than the higher-order model. We then tested the measurement invariance of this lower-order factor model among individuals with and without a history of NSSI, and established configural and full metric invariance, followed by partial scalar and full residual error invariance. These results suggest the four subscales of the Distress Tolerance Scale can be used to confidently discern NSSI-related differences in distress tolerance.
Collapse
Affiliation(s)
- Ashley Slabbert
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Penelope Hasking
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Danyelle Greene
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Mark Boyes
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
18
|
Boyes ME, Wilmot A, Hasking PA. Nonsuicidal Self-Injury-Related Differences in the Experience of Negative and Positive Emotion. Suicide Life Threat Behav 2020; 50:437-448. [PMID: 31682015 DOI: 10.1111/sltb.12599] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Emotional experience is argued to contribute to the initiation and maintenance of nonsuicidal self-injury (NSSI). We investigated whether individuals with/without a history of NSSI differed in their dispositional experience of negative and positive emotion, as well as their state responses to negatively and positively valenced movie clips. METHOD Undergraduates (n = 214, Mage = 21.33, 73.8% female, 35.5% reporting NSSI) completed measures of NSSI and dispositional emotional experience. Participants also viewed a sad and amusing movie clip and provided sadness/amusement ratings at seven time-points. RESULTS Relative to participants with no history of self-injury, participants reporting NSSI indicated more reactivity, intensity, and perseveration of dispositional negative emotion; however, differences were negated after adjusting for mental illness. Unexpectedly, individuals with a history of NSSI responded less intensely to the sad clip, although they demonstrated perseveration of sadness over time. Participants reporting NSSI also indicated less reactivity, intensity, and perseveration of dispositional positive emotion and, in response to the amusing film, reported less amusement at all time-points. CONCLUSIONS Considering different dimensions of negative and positive emotion may enhance understanding of NSSI. Future research should disentangle which dimensions of emotional experience are unique to NSSI and which are shared with mental illness more generally.
Collapse
Affiliation(s)
- Mark E Boyes
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Adrienne Wilmot
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Penelope A Hasking
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| |
Collapse
|
19
|
Yardley P, McCall A, Savage A, Newton R. Effectiveness of a brief intervention aimed at increasing distress tolerance for individuals in crisis or at risk of self-harm. Australas Psychiatry 2019; 27:565-568. [PMID: 31090433 DOI: 10.1177/1039856219848835] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study evaluated a brief psychological intervention aimed at improving distress tolerance and decreasing future admissions for individuals presenting to a mental health service in the context of crisis or self-harm. METHODS Eighty-five participants completed The Crisis Intervention Package at the point of contact with the mental health service. The outcome of the intervention was evaluated through pre- and post-scores on the Distress Tolerance Scale and future hospital admissions. RESULTS Participants showed a significant improvement in Distress Tolerance Scale scores (P < 0.001) indicating an increase in ability to tolerate distressing emotions. Additionally, there was a significant decrease in hospital admissions 6 months pre-test to 6 months post-test. CONCLUSIONS The results demonstrate the potential effectiveness of structured, brief interventions aimed at increasing distress tolerance and self-management skills for individuals presenting to a mental health service in crisis.
Collapse
Affiliation(s)
- Priscilla Yardley
- Senior Lecturer, Department of Psychiatry, University of Melbourne, VIC, Australia
| | - Allira McCall
- Occupational Therapist, Peninsula Mental Health Service, Melbourne, VIC, Australia
| | - Alexandra Savage
- Occupational Therapist, Peninsula Mental Health Service, Melbourne, VIC, Australia
| | - Richard Newton
- Clinical Director and Adjunct Professor, Peninsula Mental Health Service, Monash University, Melbourne, VIC, Australia
| |
Collapse
|