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Cognitve Therapy Effective in Treatment of Self-Harming Behaviors

Posted Oct 03 2008 12:52pm

This is an interesting summary of a recent research study that found a 12-week course of cognitive-behavioral therapy (CBT) was effective in significantly reducing self-harming behaviors in individuals who engage in this type of behavior.  A couple of personal observations...

First, as the article notes, this type of behavior is on the rise, especially among teens.  The authors also note that the actual issues being addressed are depression and associated features.  These two aspects of the article, I imagine, are related - depression is on the rise, so it stands to reason that self-harm (a manifestation of depression), is on the rise.

Self-harming behaviors are not suicidal in nature, but very often people who engage in self-harming behaviors will end up with suicidal thinking at some point.  Self-harming behavior is actually a coping mechanism (albeit a very poor one), in which an individual is engaging in creating a sensation of pain in order to overcome a sense of "numbness."  This is a very difficult concept to understand in a "I get where you're coming from" way, as pain, for most of us, has a serious, built-in "avoid at all cost" response mechanism.  However, for individuals who are experiencing a certain combination of symptoms (to include depression, hopelessness, powerlessness, and a very low sense of self-efficacy, among other things), self-harm (such as cutting, burning, etc.) provides temporary relief.  However, the relief is often soon followed by even more depression, hopelessness, etc., as the relief is temporary, and the individual negatively judges them self for having engaged in the self-harming behavior (much like an alcoholic may drink to feel better, but feels worse the next day when they realize they got drunk again).

As a therapist, I can tell you that treating self-harming clients can be difficult.  As the article notes, it is important to acknowledge the individual's difficulties, without being judgmental, yet also promote the idea that there are better ways to handle their experiences.  Increased self-efficacy is crucial - basically, "Okay, you are feeling particularly bad right now - what can you do to provide relief that does not involve self-harm?"  As alternatives are developed, the individual improves their outlook and confidence in themselves, but it can take time, because the self-harm is quick and easy, while healthier solutions can take longer - not always an easy transition for an individual in crisis.

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