Self-Injury Workshop Summary
Part 2 – Treatment

By Lynn Mollick

Help patients develop replacement behaviors when they feel the urge to self-injure:

• Snapping a rubber band on the wrist
• Marking the body with a red marker instead of cutting
• Stroking the body with a feather or soft brush
• Holding an ice pack or frozen orange on the body. (Dr. Walsh advises against ice cubes because they cause burns.)

Help patients develop stress reduction behaviors to reduce urges to self-injure:

• Relaxation or mindfulness exercises of the patient’s choice
• Non-competitive physical exercise
• Journaling or creating artwork. The creation should be about emotions the patient wants to reduce, not the act of self-injury
• Music and sounds that reduce stress such as rainfall, ocean waver, or birdsongs.
• To help patients find replacement & stress reduction behaviors, ask “What do you do when self-injury is not possible, for example on a date or during a test?” For all replacement and distress reduction behaviors ask patients to rate their distress on a 1 – 10 scale before and after the replacement or stress reduction behavior.

Patients should develop a diverse list of replacement and stress reduction behaviors. Suggest that they carry the list with them at all times. Maintain your optimism because learning replacement & distress reduction behaviors can take time.

Treatment: Cognitive Behavior Therapy

1. Excessive self-blame is common in this group but identify all dysfunctional emotions that trigger the urge to self-injure – fear/anxiety, sadness/depression, guilt/shame, anger.
2. Identify the dysfunctional thoughts that trigger these emotions.
3. Teach functional thoughts that do not trigger these emotions.
4. Complete this analysis in writing at home and during therapy sessions. Begin with mundane situations.

Other Treatment Issues

Medication. Dr. Walsh expressed doubt about the helpfulness of medication. Plener & Schultze (2014) found anti-psychotics to be most effective, but receive a grade of only “C.” SSRI’s and anti-convulsant receive a D.

When the patient is an adolescent, Dr. Walsh recommended informing parents about self-injury with the adolescent present. Parents must understand that self-injury is about regulating psychological pain, not about suicide.

Therapy outcome research. In an analysis of 26 RCTs, Glenn et al. (2019) concluded that only DBT ranked as “efficacious.” Individual CBT combined with family therapy was “probably efficacious.”

Therapist Self-Care is essential. Find ways to reduce your own stress.