Self-harm – The solution not the problem: The Dialectical Behaviour Therapy Model

Utilization and Acceptability of Formal and Informal Support for Adolescents Following Self-Harm Before and During the First COVID-19 Lockdown: Results From a Large-Scale English Schools Survey

Background

Little is known about the perceived acceptability and usefulness of supports that adolescents have accessed following self-harm, especially since the onset of the COVID-19 pandemic.

Aims

To examine the utilization and acceptability of formal, informal, and online support accessed by adolescents following self-harm before and during the pandemic.

Method

Cross-sectional survey (OxWell) of 10,560 secondary school students aged 12-18 years in the south of England. Information on self-harm, support(s) accessed after self-harm, and satisfaction with support received were obtained via a structured, self-report questionnaire. No tests for significance were conducted.

Results

1,457 (12.5%) students reported having ever self-harmed and 789 (6.7%) reported self-harming during the first national lockdown. Informal sources of support were accessed by the greatest proportion of respondents (friends: 35.9%; parents: 25.0%). Formal sources of support were accessed by considerably fewer respondents (Child and Adolescent Mental Health Services: 12.1%; psychologist/ psychiatrist: 10.2%; general practitioner: 7.4%). Online support was accessed by 8.6% of respondents, and 38.3% reported accessing no support at all. Informal sources of support were rated as most helpful, followed by formal sources, and online support. Of the respondents who sought no support, 11.3% reported this as being helpful.

Conclusions

More than a third of secondary school students in this sample did not seek any help following self-harm. The majority of those not seeking help did not find this to be a helpful way of coping. Further work needs to determine effective ways of overcoming barriers to help-seeking among adolescents who self-harm and improving perceived helpfulness of the supports accessed.

Behavior change techniques in mobile apps targeting self-harm in young people: a systematic review

Despite the high prevalence of self-harm among young people, as well as their extensive use of mobile apps for seeking support with their mental healthcare, it is unclear whether the design of mobile apps aimed at targeting self-harm is underpinned by behavior change techniques (BCTs). To systematically analyze and identify (a) what BCTs and (b) what theories are present in self-harm apps for young people in an attempt to understand their active components. Systematic searches in Apple store, followed by thorough screening, were conducted to identify free mobile apps targeting self-harm in young people. Five apps met the inclusion criteria and were used by trained researchers, who coded identified features against the BCT Taxonomy V1. Despite the majority of apps being underpinned by principles of Dialectical Behavior Therapy (DBT), no other information is available about specific theories underpinning these apps. Nineteen of the 93 BCTs were identified across the five apps. The most frequently used BCT was "Distraction" (54.2%), offering ideas for activities to distract users from self-harming. Other techniques that were used often were "Social Support (unspecified)" (27.0%) and "Behavior Substitution" (10.6%). This study provides the first analysis of BCTs present in mental health apps which are designed to target the reduction of self-harm in young people. Future research is needed to evaluate the effectiveness of the apps, as well as assess the effectiveness of the BCTs present.

Harm minimisation for the management of self-harm: a mixed-methods analysis of electronic health records in secondary mental healthcare

BACKGROUND

Prevalence of self-harm in the UK was reported as 6.4% in 2014. Despite sparse evidence for effectiveness, guidelines recommend harm minimisation; a strategy in which people who self-harm are supported to do so safely.

AIMS

To determine the prevalence, sociodemographic and clinical characteristics of those who self-harm and practise harm minimisation within a London mental health trust.

METHOD

We included electronic health records for patients treated by South London and Maudsley NHS Trust. Using an iterative search strategy, we identified patients who practise harm minimisation, then classified the approaches using a content analysis. We compared the sociodemographic characteristics with that of a control group of patients who self-harm and do not use harm minimisation.

RESULTS

In total 22 736 patients reported self-harm, of these 693 (3%) had records reporting the use of harm-minimisation techniques. We coded the approaches into categories: (a) 'substitution' (>50% of those using harm minimisation), such as using rubber bands or using ice; (b) 'simulation' (9%) such as using red pens; (c) 'defer or avoid' (7%) such as an alternative self-injury location; (d) 'damage limitation' (9%) such as using antiseptic techniques; the remainder were unclassifiable (24%). The majority of people using harm minimisation described it as helpful (>90%). Those practising harm minimisation were younger, female, of White ethnicity, had previous admissions and were less likely to have self-harmed with suicidal intent.

CONCLUSIONS

A small minority of patients who self-harm report using harm minimisation, primarily substitution techniques, and the large majority find harm minimisation helpful. More research is required to determine the acceptability and effectiveness of harm-minimisation techniques and update national clinical guidelines.

Experiences of family members who have a relative diagnosed with borderline personality disorder

Background

While working in a psychiatric hospital, the researcher observed the beneficial effects of the mindfulness programme offered to patients diagnosed with borderline personality disorder (BPD). Little support was offered to family members who attempted to manage their relatives diagnosed with BPD. The family members often experienced stress, depression, grief and isolation.

Objectives

The purpose of this research was to explore and describe the experiences of family members who have a relative diagnosed with BPD.

Method

A qualitative, exploratory, descriptive and contextual study design was used. A purposive sample of family members aged between 24 and 74 years was made. Data were collected by conducting eight in-depth, phenomenological interviews, and field notes were taken. The interviews focused on the central question, ‘Tell me your experience of having a relative diagnosed with BPD’. Tesch’s method for data analysis was used, and an independent coder analysed the data and met with the researcher for a consensus discussion of the results. Measures to ensure trustworthiness were applied and ethical principles were adhered to.

Results

Four themes were identified. In theme one, family members described their relative diagnosed with BPD as experiencing emotional, behavioural, interpersonal and self-dysregulation. As a result, family members expressed negative feelings towards their relatives and experienced social humiliation, financial strain and marital discord. In theme two, they experienced a desire to move forward and improve their mental health. In theme three, family members experienced a challenging process of adaptation and coping. In theme four, family members experienced a quest for harmony and integration.

Conclusion

The results indicated that family members experienced disempowerment because they lacked knowledge about their relative’s BPD. More knowledge about BPD, the understanding and implication of the diagnosis, treatment and care are needed from mental health care professionals and service providers.

The Use of Dialectical Behavior Therapy (DBT) in Music Therapy: A Sequential Explanatory Study

BACKGROUND

There are published examples of how dialectical behavior therapy (DBT) and music therapy are effectively being used as separate therapies in the treatment of individuals with a variety of mental health disorders. However, research examining DBT-informed music therapy is limited.

OBJECTIVE

The purpose of this study was to determine whether music therapists working in mental health settings are implementing components of DBT in their work, and if so, how and why; and if not, why not and what is their level of interest in such work.

METHODS

We used a sequential explanatory mixed-methods research design implemented in two phases. Phase 1 was a quantitative survey of board-certified music therapists (n=260). Due to a low survey response rate (18%), and to enhance the validity of the findings, Phase 2, an embedded qualitative procedure in the form of interviews with clinicians experienced in the DBT approach, was added to the study. Both survey and interviews inquired about DBT training, use of DBT-informed music therapy, music therapy experiences used to address DBT skills, and experiences of implementing DBT-informed music therapy.

RESULTS

Respondents indicating they implement DBT-informed music therapy (38.3%) are using components and adaptations of the standard DBT protocol. Advantages of implementing DBT-informed music therapy were identified, and more than half of the respondents who do not implement DBT in their music therapy practice also perceived this work as at least somewhat important. Disadvantages were also identified and support the need for further research.

CONCLUSIONS

Components of DBT are used in music therapy and are valued, but there is a lack of empirical evidence to inform, refine, and guide practice.

It cuts both ways: an analysis of the psychological discourse on self-injury from a linguistic point of view

This article proposes an analysis of the phenomenon of self-injury through the prism of current linguistic theories. The author uses the clinical distinctions made by Roman Jakobson between metonymic and metaphoric aphasia to suggest that the psychological community and those who harm themselves are participating in separate "language games." While the clinical "language game" is characterized by the dominance of metaphor and a conception stressing the hierarchy between metaphor and metonymy, the "language game" of self-mutilators is dominated by metonymy. The author explores the clinical implications of understanding the language game of those who injure themselves as metonymic.