Research from the University of Washington Medical School suggests how to improve treatments for college students struggling with non-suicidal self-injury (NSSI). Treatments which develop people’s practical skill in managing emotions may be more effective than the current therapies that increase people’s confidence in their ability to cope with events.

The study involved 187 students with a history of self-injury. The students provided information about their experiences with NSSI, including the age at which they first self-injured and the reasons behind their self-injury.

Students also answered questions about their level of emotional dysregulation (EDR). Emotion regulation skills include how well someone can understand and accept uncomfortable emotions, and whether they can deal with strong emotions appropriately without acting impulsively. EDR measures how much a person struggles to use emotion regulation skills. High EDR is associated with unhealthy coping mechanisms such as alcohol misuse and aggression.

Finally, students were asked about their coping self-efficacy (CSE). CSE describes how strongly someone believes that they are capable of coping with difficult situations and of finding solutions to problems. High CSE is associated with success and with experiencing fewer psychological consequences from traumatic events.

The study found that emotional dysregulation and low CSE were strongly associated with each other, and both were linked with self-injury. Students who found regulating their emotions harder were likely to have self-injured more often.

However, differences in CSE between students did not independently affect differences in NSSI. So although the students who believed they were unable to cope with problems were more likely to have self-injured, their CSE score could not directly predict how often they self-injured.

Some current treatments such as Motivational Interviewing centre on strengthening a client’s CSE. Based on existing psychological research, these approaches assume that clients need to believe appropriate coping strategies are possible for them before they can move towards using those strategies. This study suggests that focusing on building a client’s emotional regulation skills will more directly reduce their tendency to self-injure while also increasing their CSE as a result.

Younger adults (aged >30) are the most likely people to self-injure; while approximately 1 in 20 (5.5%) people in the US have ever self-injured, this rises to 1 in 7 (13.4%) for young adults. Although long-term or repeated NSSI is much rarer, the lifestyle changes involved in attending college can lead to individuals starting or increasing NSSI. As such, college mental health services need to understand the risks of NSSI.

As increasing emotion regulation ability, and therefore decreasing EDR, is associated with reduced self-injury, the authors conclude that developing emotion regulation skills seems to be the most important part of treatment for NSSI. Existing therapy methods which focus on emotional regulation, such as dialectical behaviour therapy, could be adapted into workshops taught within colleges.

The authors conclude that further research should focus more specifically on students who are seeking medical treatment for current self-injury, as their experiences and needs may be different compared to students who used NSSI and then stopped.

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Study Evaluation

This decently-sized study uses sensible questionnaires to assess the three factors of self-injury, CSE, and emotional regulation. The methods used to develop the results also seem appropriate for the study.

Overall, the study suggests that treatments which focus on increasing CSE will be less effective than treatments which focus on directly increasing practical emotion regulation skills. This seems to go against a previous study which found that CSE could directly modify the link between a person’s level of mindfulness and their level of self-injury. However, the authors point out that CSE, mindfulness, emotion regulation and related concepts contain many overlapping elements and can be defined using very similar words. As such, the broken link between CSE and emotion regulation might not be a sign of them being different… instead, it may be a statistical complication caused by them being too similar.

Another thing I noticed is that the authors don’t mention whether they asked any questions about mental health conditions. This is important here because people with mental health conditions, especially depression, may have unrealistically poor ratings of their CSE and emotion regulation ability. As mental health conditions are already associated with self-injury prevalence, they may interfere with how CSE and emotion regulation are measured and how they connect to NSSI.

The source article can be read for free at https://www.cogentoa.com/article/10.1080/23311908.2018.1520437.pdf

Featured illustration by Rowena Sheehan – www.rowenasheehan.com