Academic journal article Journal of Cognitive Psychotherapy

Ecological Momentary Assessment and Intervention in Nonsuicidal Self-Injury: A Novel Approach to Treatment

Academic journal article Journal of Cognitive Psychotherapy

Ecological Momentary Assessment and Intervention in Nonsuicidal Self-Injury: A Novel Approach to Treatment

Article excerpt

This study provides an introduction to ecological momentary assessment (EMA) methods and the potential use of ecological momentary intervention (EMI) for nonsuicidal self-injury (NSSI). The novel use of EMA and EMI are discussed within the context of the emotion regulation function of NSSI, the ability of these approaches to complement established treatments (i.e., cognitive behavior therapy & dialectical behavior therapy), and the specific areas in which an EMI treatment approach can augment traditional treatment. Based on established EMA findings in general and specific applications of EMA to the NSSI, a model EMI for NSSI is proposed.

Keywords: non-suicidal self-injury; ecological momentary intervention; self-injury; emotion regulation

Nonsuicidal self-injury (NSSI) is defined as the deliberate damage or alteration of body tissue without conscious suicidal intent but not including tattooing, body piercing, or other culturally sanctioned methods of body modification (Favazza & Favazza, 1987). NSSI represents a significant and growing public health concern, particularly among adolescents and young adults (Olfson, Gameroff, Marcus, Greenberg, & Shaffer, 2005; Rodham & Hawton, 2009; Sansone & Levitt, 2002) and has recently been proposed for inclusion as a Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) diagnosis (Shaffer & Jacobson, 2009). Although long-term outcome research in the area of NSSI is limited, those who engage in NSSI appear to be at increased risk for lasting physical injury (Briere & Gil, 1998; Stanley, Gameroff, Michalsen, & Mann, 2001; Stellrecht et al., 2006), increased emergency room use (Olfson et al., 2005), and suicide (Brown, Comtois, & Linehan, 2002; Dulit, Ryer, Leon, & Brodsky, 1994; Joiner, 2005; Nock, Joiner, Gordon, Lloyd-Richardson, & Prinstein, 2006).

These risks clearly highlight the importance of better understanding the phenomenology of NSSI behavior and the processes through which distal risk factors (e.g., trauma experiences or self-reported emotion regulation deficits) contribute to actual episodes of self-harm. In this article, I discuss ecological momentary assessment (EMA), or the use of handheld computers to collect data regarding daily thoughts, behaviors, and emotions, as both a research strategy permitting a better understanding of NSSI phenomenology and a potentially efficacious and novel intervention. Because EMA permits the examination of dynamic processes, such as the affective instability central to NSSI (Connors, 1996; Favazza & Conterio, 1988; Favazza, DeRosear, & Conterio, 1989), the use of EMA methods permits a unique opportunity to explore the causal factors that influence NSSI episodes. Moreover, because NSSI is a behavior that frequently occurs in secret, when clients are isolated and alone, the use of EMA may permit the deployment of an intervention within contexts and at times in which clients might not otherwise have access to treatment.

As an introduction to EMA methods as an intervention for NSSI, I first review the most commonly investigated functions of NSSI. I then review the most commonly used interventions for NSSI and describe how EMA can build on established treatments. Next, I review the most central characteristics of EMA methods and the implications of those characteristics on the assessment and treatment of NSSI. Then, I discuss three areas in which EMA has already clarified our understanding of NSSI behavior and introduce some never before reported data to support these findings. Finally, I propose a model of an EMA-based treatment for NSSI.

Functions oF nssi: Probable targets For treatment

Multiple functions have been proposed for NSSI (e.g., Gratz, 2003; Suyemoto, 1998), some of which have shown greater empirical support than others. Significantly, over the past decade or so, it has become clear that affect, affect variability, and affect regulation strategies influence the occurrence of NSSI behavior. …

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