Self-injurious behavior : assessment and treatment

Abstract

This research explored the conceptualisation of self-injurious behavior (SIB) in terms of similarities and differences amongst the two types of this behavior. It further explored the efficacy of a brief psychological intervention for SIB as well as the effect of a brief training in the assessment and treatment of SIB on the attitudes psychiatric personnel hold towards people who engage in SIB. The participants in two of the three studies reported here were individuals who following a self-injury episode approached the accident and emergency unit at the Central Finland Community General Hospital. The participants in the third study were psychiatric personnel from the North Karelia Health District. The data in the first study consisted of 46 self-injurious acts committed by the study’s 16 participants. In the second study, the data pertained to the participants’ responses to multiple psychometrically sound instruments at baseline and at follow-up points. The third study consisted of participants’ pre and post training responses on a questionnaire measuring staff attitudes towards people who engage in SIB. The findings from the studies suggest the following: (i) non-suicidal self-injurious behavior (NSSI) and suicidal self-injurious behavior (SSI) co-occur and share certain similarities but also differ; (ii) SIB within individuals is changing with multiple different motivational factors at different time points; (iii) a comprehensive assessment of SIB using valid instruments is imperative; (iv) a brief 4-session psychological intervention is followed by a decrease in the frequency of SIB, with the decrease still present at 6-month follow-up; (v) a brief intervention can be taught to and implemented by the staff with no prior psychotherapeutic training; (vi) the attitudes of the psychiatric personnel towards individuals who engage in SIB are complex and ambivalent; (vii) a brief training in the assessment and treatment of SIB is followed by an improvement in personnel attitudes. This research contributed to the SIB field by illustrating how evidence-based assessment of SIB antecendents and consequences can result in treatment tailored to individuals’ specific needs. The research advocated that effective SIB intervention is grounded in evidence-based elements and cuts across different psychotherapeutic approaches. Because the implementation of evidence-based practices requires change at the level of policy making, this research explicates the need for the formation of Current Care Guidelines for SIB in Finland, with psychologists having a greater role in its assessment and treatment.