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\"Treating Self-Destructive Behaviors in Trauma Survivors, 2nd ed, can be used on its own or in conjunction with the accompanying client-focused workbook, Letting Go of Self-Destructive Behaviors\"--Provided by publisher.

AbstractObjectiveTo evaluate the clinical effectiveness of the YCMAP intervention (Youth Culturally Adapted Manual Assisted Problem Solving) for adolescents after self-harm in Pakistan.DesignMulticentre, randomised controlled trial that compared YCMAP with enhanced treatment as usual.SettingsGeneral practices, emergency departments, medical wards of participating hospitals, and community centres across Karachi, Hyderabad, Lahore, Multan, and Rawalpindi.ParticipantsAdolescents with a recent history of self-harm identified at participating health centres by treating physicians between 5 November 2019 and 31 August 2021.InterventionThe YCMAP group received up to 10 treatment sessions over three months; the intervention was based on the principles of cognitive behaviour therapy.Main outcome measureThe primary outcome was the repetition of self-harm at 12 months after randomisation. Secondary outcomes were distress, hopelessness, suicidal ideation, and health related quality of life at three, six, nine, and 12 months after randomisation. Participants’ satisfaction with the services was assessed at three and 12 months after randomisation.ResultsThis trial was conducted between November 2019 and February 2023 and included 684 adolescents randomised to YCMAP (n=342) or enhanced treatment as usual (n=342). The YCMAP group had a significantly lower risk of self-harm repetition than the enhanced treatment as usual group at 12 months after randomisation (odds ratio 0.20, 95% confidence interval 0.06 to 0.70, P=0.006). YCMAP participants showed a statistically significant reduction in distress, hopelessness, and suicidal ideation at three months, but these differences were not statistically significant at 12 months. YCMAP participants also reported significantly better quality of life and satisfaction with services at three months, with these effects sustained at all follow-up points.ConclusionThe YCMAP intervention was shown to be beneficial in self-harm prevention among adolescents. Further research and replication of findings in diverse settings are recommended to strengthen the evidence base for this public health intervention.Trial registrationClinicalTrials.gov NCT04131179 and ISRCTN registry ISRCTN57325925.

\"Parents who discover a teen's self-injurious behavior are gripped by uncertainty and flooded with questions - Why is my child doing this? Is this a suicide attempt? What did I do wrong? What can I do to stop it? And yet basic educational resources for parents with self-injuring children are sorely lacking. Healing after Self-Injury provides desperately-needed guidance to parents and others who love a young person struggling with self-injury\"-- Provided by publisher.

Dialectical behaviour therapy (DBT) and mentalisation-based therapy (MBT) are both widely used evidence-based treatments for borderline personality disorder (BPD), yet a head-to-head comparison of outcomes has never been conducted. The present study therefore aimed to compare the clinical outcomes of DBT v. MBT in patients with BPD. A non-randomised comparison of clinical outcomes in N = 90 patients with BPD receiving either DBT or MBT over a 12-month period. After adjusting for potentially confounding differences between participants, participants receiving DBT reported a significantly steeper decline over time in incidents of self-harm (adjusted IRR = 0.93, 95% CI 0.87-0.99, p = 0.02) and in emotional dysregulation (adjusted β = -1.94, 95% CI -3.37 to -0.51, p < 0.01) than participants receiving MBT. Differences in treatment dropout and use of crisis services were no longer significant after adjusting for confounding, and there were no significant differences in BPD symptoms or interpersonal problems. Within this sample of people using specialist personality disorder treatment services, reductions in self-harm and improvements in emotional regulation at 12 months were greater amongst those receiving DBT than amongst those receiving MBT. Experimental studies assessing outcomes beyond 12 months are needed to examine whether these findings represent differences in the clinical effectiveness of these therapies.

Although nonsuicidal self-injury (NSSI) is a clinically significant behavior, evidence-based, specific, time-, and cost-effective treatment approaches are lacking. The aim of this study was to compare the efficacies of a brief cognitive-behavioral psychotherapy manual, the Cutting Down Programme (CDP), and treatment as usual (TAU) in the treatment of adolescent NSSI. We conducted a single-centre randomised controlled trial (RCT). Eligible participants were aged 12–17 years engaging in repetitive NSSI (at least 5 times within the past 6 months). We randomly allocated 74 participants to CDP (n = 37) or TAU (n = 37; in a 1:1 ratio). Outcome measures were administered before treatment (T0), directly after CDP or 4 months after baseline evaluation in the TAU group (T1), and another 6 months later (T2; primary endpoint). Primary outcome was a 50% reduction in NSSI frequency within the past 6 months at 10-month follow-up (T2). Regarding the primary outcome, there were no significant differences between the CDP (n = 26; 70.3%) and TAU group [n = 27; 73.0%; χ2(1) = 0.07; p = 0.797]; NSSI frequency within the past 6 months was significantly reduced at T2 [χ2(1) = 12.45; p < 0.001] with no between-group difference [χ2(1) = 0.14; p = 0.704]. However, we found a significant group x point of measurement interaction [χ2(2) = 7.78; p = 0.021] regarding NSSI within the last month indicating at T1. CDP was equally effective and achieved faster recovery compared to a significantly more intensive TAU in treating adolescent NSSI. The CDP could provide a brief and pragmatic first treatment within a stepped-care model for NSSI in routine clinical care.Clinical Trial Registration The trial was prospectively registered in the German Registry of Clinical Trials (https://www.drks.de; DRKS00003605) and is now complete.

Despite the clinical importance of deliberate self-harm (DSH; also referred to as non-suicidal self-injury) within borderline personality disorder (BPD), empirically supported treatments for this behavior among individuals with BPD are difficult to implement in many clinical settings. To address this limitation, a 14-week, adjunctive emotion regulation group therapy (ERGT) for DSH among women with BPD was developed. The current study examined the efficacy of this ERGT in a randomized controlled trial (RCT) and the durability of treatment gains over a 9-month uncontrolled follow-up period. Female out-patients with BPD and recent recurrent DSH were randomly assigned to receive this ERGT in addition to their ongoing out-patient therapy immediately (n = 31) or after 14 weeks (n = 30). Measures of DSH and other self-destructive behaviors, psychiatric symptoms, adaptive functioning and the proposed mechanisms of change (emotion dysregulation/avoidance) were administered pre- and post-treatment or -waitlist (to assess treatment efficacy), and 3 and 9 months post-treatment (to assess durability of treatment gains). Intent-to-treat (ITT) analyses (n = 61) revealed significant effects of this ERGT on DSH and other self-destructive behaviors, emotion dysregulation, BPD symptoms, depression and stress symptoms, and quality of life. Analyses of all participants who began ERGT (across treatment and waitlist conditions; n = 51) revealed significant improvements from pre- to post-treatment on all outcomes, additional significant improvements from post-treatment to 9-month follow-up for DSH, emotion dysregulation/avoidance, BPD symptoms and quality of life, and no significant changes from post-treatment to 9-month follow-up on the other measures. The results support the efficacy of this ERGT and the durability of treatment gains.

Background Non-suicidal self-injury (NSSI) in adolescents is a significant public health issue worldwide. Dialectical Behavior Therapy (DBT) is an evidence-based intervention for treating NSSI. However, there are currently few independent studies on DBT interventions specifically targeting NSSI, particularly in Shantou city, within the Chaoshan area of southeast China. This study aimed to evaluate the effectiveness of DBT in reducing NSSI among secondary school students. Methods A total of 220 7th-grade students from four classes in two schools in Shantou City were selected using randomized cluster sampling. Two classes from one school were assigned to the DBT-based intervention group, while two classes from the other school were assigned to the control group, which received general education intervention. Comparative analyses of quantitative and categorical data were conducted using Student’s t-test and chi-square tests. Results The occurrence of NSSI in DBT group and control group was 23.60% and 24.50%, respectively. Most students who engaged in NSSI sustained mild injuries (71.43%). The occurrence of NSSI in the DBT group decreased from 23.60% to 10.91% after the DBT-based interventions ( χ 2  = 6.23, P  < 0.05). The frequency of NSSI in the DBT group was also reduced (from 1.57 ± 4.411 to 0.54 ± 1.895) after the intervention( t  = 3.628, P <0.001). In the DBT group, depression scores significantly decreased from 9.59 ± 11.15 to 6.51 ± 3.08 ( t  = 2.217, P  < 0.05). The total Sub-Optimal Health Status (SHS) score was also significantly reduced, from 16.43 ± 12.74 to 12.04 ± 7.80 ( t  = 3.083, P  < 0.05). Among its subdimensions, the psychological state score declined from 5.37 ± 4.78 to 3.70 ± 4.08 ( t  = 2.792, P  < 0.05), while the fatigue score dropped from 7.06 ± 5.28 to 5.06 ± 3.92 ( t  = 3.186, P  < 0.05). However, the control group did not show significant differences in the above aspects after the conventional interventions. Conclusions The six-month DBT-based intervention markedly reduced NSSI and improved mental-health indicators, suggesting that DBT offers an effective, scalable framework for school-based prevention in culturally diverse Chinese settings.

Recent findings suggest that brief dialectical behavior therapy (DBT) for borderline personality disorder is effective for reducing self-harm, but it remains unknown which patients are likely to improve in brief 12 months of DBT. Research is needed to identify patient characteristics that moderate outcomes. Here, we characterized changes in cognition across brief DBT (DBT-6) a standard 12-month course (DBT-12) and examined whether cognition predicted self-harm outcomes in each arm. In this secondary analysis of 240 participants in the FASTER study (NCT02387736), cognitive measures were administered at pre-treatment, after 6 months, and at 12 months. Self-harm was assessed from pre-treatment to 2-year follow-up. Multilevel models characterized changes in cognition across treatment. Generalized estimating equations examined whether pre-treatment cognitive performance predicted self-harm outcomes in each arm. Cognitive performance improved in both arms after 6 months of treatment, with no between-arm differences at 12-months. Pre-treatment inhibitory control was associated with different self-harm outcomes in DBT-6 DBT-12. For participants with average inhibitory control, self-harm outcomes were significantly better when assigned to DBT-12, relative to DBT-6, at 9-18 months after initiating treatment. In contrast, participants with poor inhibitory control showed better self-harm outcomes when assigned to brief DBT-6 DBT-12, at 12-24 months after initiating treatment. This work represents an initial step toward an improved understanding of patient profiles that are best suited to briefer standard 12 months of DBT, but observed effects should be replicated in a waitlist-controlled study to confirm that they were treatment-specific.

Background Mentalization Based Therapy (MBT) has yielded promising outcomes for reducing self-harm, although to date only one study has reported MBT’s effectiveness for adolescents (Rossouw and Fonagy, J Am Acad Child Adolesc Psychiatry 51:1304–1313, 2012) wherein the treatment protocol consisted of an intensive programme of individual and family therapy. We sought to investigate an adaptation of the adult MBT introductory manual in a group format for adolescents. Methods The present study is a randomised controlled single blind feasibility trial that aims to (1) adapt the original explicit MBT introductory group manual for an adolescent population (MBT-Ai) and to (2) assess the feasibility of a trial of MBT-Ai through examination of consent rates, attendance, attrition and self-harm. Repeated measures ANOVAs were conducted to examine change over time in independent and dependent variables between groups, and multi level models (MLM) were conducted to examine key predictors in relation to change over time with self-report self-harm and emergency department presentation for harm as the primary outcome variables. Results Fifty-three young people consented to participate and were randomised to MBT-Ai + TAU or TAU alone. Five participants withdrew from the trial. Trial procedures seemed appropriate and safe, with acceptable group attendance. Self-reported self-harm and emergency department presentation for self-harm significantly decreased over time in both groups, though there were no between group differences. Social anxiety, emotion regulation, and borderline traits also significantly decreased over time in both groups. Mentalization emerged as a significant predictor of change over time in self reported self harm and hospital presentation for self-harm. Conclusions It was feasible to carry out an RCT of MBT-Ai for adolescents already attending NHS CAMHS who have recently self-harmed. Our data gave signals that suggested a relatively brief group-based MBT-Ai intervention may be a promising intervention with potential for service implementation. Future research should consider the appropriate format, dosage and intensity of MBT for the adolescent population. Trial registration NCT02771691 ; Trial Registration Date: 25/04/2016.

Mindfulness-based programming (MBP) is increasingly being implemented within university settings to support students' mental health, and it typically includes the instruction of formal mindfulness (FM) and informal mindfulness (IM) activities. However, recent evidence suggests that university students with a history of nonsuicidal self-injury (NSSI) may experience challenges in response to FM (eg, physical or psychological discomfort), whereas the flexibility and brevity inherent in IM may be better tolerated. This randomized controlled trial compared web-based FM and IM programs to each other and to an inactive control condition in terms of (1) effectiveness and (2) acceptability as a function of NSSI history (NSSI or no NSSI) and time (1 week after the program or 1 month after the program). Indices of effectiveness included dispositional mindfulness, well-being, perceived stress, psychological need satisfaction, emotion regulation styles, and academic engagement. Participants were university students with (n=127) and those without (n=100) past-year NSSI engagement. All procedures were conducted online. Once informed consent was obtained and eligibility was confirmed, participants were randomly assigned to 1 of 3 conditions: FM program, IM program, or inactive control condition. One week before the FM and IM programs commenced, all participants completed a baseline survey assessing all indices of effectiveness. Participants assigned to the FM and IM conditions then attended hour-long mindfulness program group sessions once per week over 4 consecutive weeks, while those assigned to the inactive control condition did not complete any study tasks during this time. Mindfulness program sessions were hosted on the videoconference platform Webex. The same survey completed at baseline was completed again 1 week and 1 month following the intervention period, with added acceptability measures for those who took part in the FM and IM programs. Overall, the results did not differ as a function of NSSI history. A series of 3-way analyses of covariance revealed that both the FM and IM programs were effective at improving dispositional mindfulness (P<.001; ηp2=0.07), nonjudging (P=.03; ηp2=0.04), describing (P=.007; ηp2=0.05), well-being (P=.04; ηp2=0.03), and psychological need satisfaction (P=.005; ηp2=0.05) immediately after the program, with these improvements sustained 1 month later. Neither program resulted in improved awareness, nonreacting, observing, stress, emotion regulation styles, or academic engagement (all P>.05). Moreover, 3-way ANOVAs revealed high acceptability of both the FM and IM programs, with a preference for IM immediately after the program (P=.03; ηp2=0.03). The findings of this study underscore the effectiveness and acceptability of the FM and IM programs to MBP in the university context, as well as the potential value of explicitly teaching and similarly emphasizing both FM and IM, an approach that may be optimally responsive to diverse needs and preferences among students.