The problem of self-harm is growing, especially among teens and young adults. People engage in self-harm — such as cutting, self-injury, or even self-poisoning — for a wide variety of reasons. But the real question is how to help a person who is self-harming.
Self-harm also hurts the family, friends, and other people around the person who is engaging in the behavior. Friends and loved ones don’t understand self-harm, and they don’t understand what they can do to help. People who self-harm are themselves sometimes unable to express their reasons, or the kind of relief it brings to their emotional hurt and pain.
Psychotherapy has long been used to help people with mental illness and mental health issues. Can it help a person who self-harms?
The most common type of self-harm appears to be cutting — intentional injury to one’s wrists, arms or legs, usually in a place that can be hidden by clothing. Many people who self-harm say it helps them focus their emotional pain onto physical pain, bringing an enormous sense of relief and well-being. Self-harm appears to be somewhat habit-forming, since engaging in the behavior makes a person feel better afterward.
Can Psychotherapy Help People Who Self-Harm?
Psychotherapy, specifically cognitive-behavioral therapy (CBT), has been used to combat all sorts of psychological problems, including serious mental illness. Research has shown it can help alter the brain’s neurochemical makeup and, when effective, can result in lasting emotional and behavioral changes. CBT focuses on how people’s internal beliefs and attitudes affect their feelings and behavior, and works to then help a person learn to recognize and change those beliefs.
Today, a new research study called a Cochrane Review, examined the efficacy of psychotherapy for helping people deal with self-harm. The Review does this by examining all of the published research and seeing what it says. “The Review includes 55 [research] trials, where a total of 17,699 participants were randomized to receive either a psychosocial intervention or the care they would normally have received.”
Cognitive-behavioral therapy was the most common psychotherapy intervention used in the review, showing up in 18 out of the 55 studies examined. The review found that CBT was typically conducted one-on-one with a single patient and a single therapy. The average length of time for this kind of psychotherapy to treat self-harm was fewer than ten sessions, which typically last about 45-to-50 minutes each. “Some of the other interventions were aimed at helping people who had a previous history of multiple episodes of self-harm,” according to the Review. “Other interventions were focused on helping people to maintain their treatment and contact with mental health services.”
The patients who self-harmed and received CBT were found less likely to self-harm after treatment ended. After CBT, 6 percent fewer people self-harmed when compared to those who didn’t receive treatment. However, the Cochrane researchers found that the quality of the 18 studies that used CBT was generally low.
Benefits of CBT-based psychological therapy were also found for depressed mood, hopelessness about the future, and suicidal thoughts. Some other interventions for people with a history of multiple episodes may help them self-harm less often; however, only a small number of trials evaluated these interventions.
“While most of the studies were small, taken together we found that CBT-based psychological therapy may have led to a small-to-modest reduction in the number of patients repeating self-harm behaviors,” noted Cochrane lead author, Keith Hawton, Professor of Psychiatry from the Centre for Suicide Research, Warneford Hospital, Oxford.
“[A] difficulty with [research] in this area is that patients will be aware that they received either the specific psychological therapy or the care they would normally have received, (unlike in placebo-controlled trials of medication). This expectation could have influenced the results.
“It is important to bear these points in mind when considering the implications of these findings. However there were indications that CBT-based psychological therapy also helped patients’ emotional well-being.”
The upshot appears to be that while cognitive behavioral therapy may be helpful for people who self-harm, it appears to be helpful only to a small number of people in actually reducing self-harm behaviors. The researchers also note that, “Dialectical behavior therapy for people with multiple episodes of self harm or probable personality disorder may lead to a reduction in frequency of self-harm, but this finding is based on low quality evidence. Case management and remote contact interventions did not appear to have any benefits in terms of reducing repetition of self-harm.”
More research is needed to better understand the most effective treatments for people who self-harm. Currently, CBT-based treatments seem to offer such people the best hope.
Hawton K, Witt KG, Taylor Salisbury TL, Arensman E, Gunnell D, Hazell P, Townsend E, van Heeringen K. (2016). Psychosocial interventions for self-harm in adults. Cochrane Database of Systematic Reviews 2016, DOI: 10.1002/14651858.CD012189