This site uses cookies for user authentication, optional permanent login and monitoring the number of page views (Google Analytics).
Do you agree with cookies being used in accordance with our Privacy policy? You can change your decision regarding the use of cookies on the Privacy page.

I want to know more

Horizons of Psychology :: Psihološka obzorja

Scientific and Professional Psychological Journal of the Slovenian Psychologists' Association

Indexed in:
Academic OneFile

Member of DOAJ and CrossRef



My Account

Most viewed articles


« Back to Volume 29 (2020)

flag Pojdi na slovensko stran članka / Go to the article page in Slovene

Cognitive-behavioural therapy of deliberate self-harm in adolescence

Barbara Dolenc

pdf Full text (pdf)  |  Views: 108  |  flagWritten in Slovene.  |  Published: March 27, 2020

pdf  |  Cited By: CrossRef (0)

Abstract: The purpose of this paper is to present cognitive-behavioural strategies for dealing with adolescents with deliberate self-harm. The presented interventions can be useful for anyone who is faced with that kind of problem in the clinical setting. Deliberate self-harm is defined as self-injury and self-poisoning. It usually occurs between the ages of 11 and 15 years. During adolescence, the prevalence of this type of behaviour is between 12 and 23%. The frequency of such behaviour is even greater among the clinical population. The most powerful risk factor for deliberate self-harm is the presence of mental disorder. Adolescents often report of chronic feelings of emptiness, alienation and isolation, of hopelessness, helplessness, of being unloved, of low self-esteem and a low tolerance for stress. The increased risk of deliberate self-harm is mainly related to emotional dysregulation and poor problem solving skills. If adolescents with deliberate self-harm do not seek help, self-inflicted behaviour may increase in its severity. It also represents a strong predictor of suicide; therefore, therapeutic intervention is of utmost importance. When dealing with deliberate self-harm, cognitive-behavioural therapy has proven to be one of the effective methods of treatment. Within therapy, the emphasis is on emotion regulation, dealing with dysfunctional thoughts and beliefs, reinforcing behavioural skills (such as problem solving skills) and improving interpersonal relationships. Moreover, much attention is paid to a mindful attitude towards oneself and one’s own past. Research shows that after completed treatment, adolescents reported less frequent self-harm behaviour and suicidal thoughts. At the same time, symptoms of depression and anxiety were reduced and adolescents reported of more positive self-image, better emotion regulation and better problem solving skills.

Keywords: deliberate self-harm, adolescence, cognitive-behavioural therapy, emotion regulation, problem solving

Dolenc, B. (2020). Kognitivno-vedenjska obravnava samopoškodbenega vedenja v mladostništvu [Cognitive-behavioural therapy of deliberate self-harm in adolescence]. Psihološka obzorja, 29, 21–31.

Reference list

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th ed. (DSM-5). Arlington: American Psychiatric Publishing. CrossRef

Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G., Wagner, K. D., ..., & Brent, D. (2011). Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: Findings from the TORDIA trial. Journal of the American Academy of Child and Adolescent Psychiatry, 50(8), 772–781. CrossRef

Berk, M. S., Henriques, G. R., Warman, D. M., Brown, G. K., & Beck, A. T. (2004). A cognitive therapy intervention for suicide attempters: An overview of the treatment and case examples. Cognitive and Behavioral Practice, 11(3), 265–277. CrossRef

Blakemore, S. J. (2008). The social brain in adolescence. Nature Reviews Neuroscience, 9(4), 267–277. CrossRef

Brown, G. K., Ten Have, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts. A randomized controlled trial. Journal of the American Medical Association, 294(5), 563–570. CrossRef

Brown, S. L., & Vinokur, A. D. (2003). The interplay among risk factors for suicidal ideation and suicide: the role of depression, poor health, and loved ones' messages of support and criticism. American Journal of Community Psychology, 32(1-2), 131–141. CrossRef

Cooper, J., Kapur, N., Webb, R., Lawlor, M., Guthrie, E., Mackway-Jones, K., Appleby, L. (2005). Suicide after deliberate self-harm: A 4-year cohort study. American Journal of Psychiatry, 162(2), 297–303. CrossRef

Evans, E., Hawton, K., & Rodham, K. (2005). Suicidal phenomena and abuse in adolescents: a review of epidemiological studies. Child Abuse and Neglect, 29(1), 45–58. CrossRef

Fleischhaker, C., Böhme, R., Sixt, B., Brück, C., Schneider, C., & Schulz, E. (2011). Dialectical Behavioral Therapy for Adolescents (DBT-A): a clinical trial for patients with suicidal and self-injurious behavior and borderline symptoms with a one-year follow-up. Child and Adolescent Psychiatry and Mental Health, 5(1), 3. CrossRef

Gonzales, A. H., & Bergstrom, L. (2013). Adolescent Non-Suicidal Self-Injury (NSSI) Interventions. Journal of Child and Adolescent Psychiatric Nursing, 26(2), 124–130. CrossRef

Gratz, K. L. (2001). Measurement of deliberate self-harm: preliminary data on the deliberate self-harm inventory. Journal of Psychopathology and Behavioral Assessment, 23(4), 253–263. CrossRef

Hankin, B. L., & Abela, J. R. (2011). Nonsuicidal self-injury in adolescence: prospective rates and risk factors in a 2(1/2) year longitudinal study. Psychiatry Research, 186(1), 65–70. CrossRef

Harrington, R., Pickles, A., Aglan, A., Harrington, V., Burroughs, H., & Kerfoot, M. (2005). Early adult outcomes of adolescents who deliberately poisoned themselves. Journal of the American Academy of Child and Adolescent Psychiatry, 45(3), 337–345. CrossRef

Hawton, K., & James, A. (2005). Suicide and deliberate selfharm in adolescents. British Medical Journal, 33, 891–894. CrossRef

Hawton, K., O'Connor, R. C., & Saunders, K. E. A. (2015). Suicidal behavior and self-harm. V A. Thapar, D. S. Pine, Lockman, J. F., Scott, S., Snowling, M. J. in Taylor, E. (ur.), Rutter's Child and Adolescent Psychiatry, 6th ed. (str. 893–912). Chichester: John Wiley and Sons Ltd. CrossRef

Hawton, K., Rodham, K., Evans, E., & Weatherall, R. (2002). Deliberate self-harm in adolescents: self report survey in schools in England. British Medical Journal, 325(7374), 1207–1211. CrossRef

Hawton, K., Zahl, D., & Weatherall, R. (2003). Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. British Journal of Psychiatry, 182, 537–542. CrossRef

Jacobson, C. M., & Gould, M. (2007). The epidemiology and phenomenology of nonsuicidal self-injurious behavior among adolescents: a critical review of the literature. Archives of Suicide Research, 11(2), 129–147. CrossRef

Kamphuis, J. H., Ruyling, S. B., & Reijntjes, A. H. (2007). Testing the emotion regulation hypothesis among self-injuring females: Evidence for differences across mood states. The Journal of Nervous and Mental Disease, 195(11), 912–918. CrossRef

King, R. A., Shwab-Stone, M., Flisher, A. J., Greenwald, S., Kramer, R. A., Goodman, S. H., ..., & Gould, M. S. (2001) Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation. Journal of the American Academy of Child and Adolescent Psychiatry, 40(7), 837–846. CrossRef

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: The Guilford Press.

Linehan, M. M., Comtois, K. A., Brown, M. Z., Heard, H. L., & Wagner, A. (2006). Suicide Attempt Self-Injury Interview (SASII): development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury. Psychological Assessment, 18(3), 303–312. CrossRef

Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., ..., & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766. CrossRef

Lloyd-Richardson, E. E., Perrine, N., Dierker, L., & Kelley, M. (2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine, 37(8), 1183–1192. CrossRef

Madge, N., Hawton, K., McMahon, E. M., Corcoran, P., De Leo, D., de Wilde, E. J., ..., & Arensman, E. (2011). Psychological characteristics, stressful life events and deliberate self-harm: findings from the Child & Adolescent Self-harm in Europe (CASE) Study. European Child and Adolescent Psychiatry, 20(19), 499–508. CrossRef

McAuliffe, C., Corcoran, P., Keeley, H. S., Arensman, E., Bille-Brahe, U., De Leo, D., ..., & Wasserman, D. (2006). Problem solving ability and repetition of deliberate self-harm: a multicentre study. Psychological Medicine, 36(1), 45–55. CrossRef

Muehlenkamp, J. J. (2006). Empirically supported treatments and general therapy guidelines for non-suicidal self-injury. Journal of Mental Health Counseling, 28(2), 166–185. CrossRef

National Institutte for Health and Care Excellence, NICE (2004). Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. Leucester (UK): The British Psychological Society.

Nixon, M. K., Levesque, C., Preye, M., Vanderkooy, J., & Clouties, P. F. (2015). The Ottawa Self-Injury Inventory: Evaluation of an assessment measure of nonsuicidal self-injury in an inpatient sample of adolescents. Child and Adolescent Psychiatry and Mental Health, 9, 26. CrossRef

Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-injurious thoughts and behaviors interview: development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309–317. CrossRef

O'Connor, R. C. (2003). Suicidal behavior as a cry of pain: Test of a psychological model. Archives of Suicide Research, 7(4), 297–308. CrossRef

Orbach, I., Mikulincer, M., Gilboa-Schechtman, E., & Sirota, P. (2003). Mental pain and its relationship to suicidality and life meaning. Suicide & Life-Threatening Behavior, 33(3), 231–241. CrossRef

Ougrin, D., Tranah, T., Leigh, E., Taylor, L., & Asarnow, J. R. (2012). Practitioner Review: Self-harm in adolescents. Journal of Child Psychology and Psychiatry, 53(4), 337–350. CrossRef

Ougrin, D., Tranah, T., Stahl, D., Moran, P., & Asarnow, J. R. (2015). Therapeutic Interventions for Suicide Attempts and Self-Harm in Adolescents: Systematic Review and Meta-Analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 54(2), 97–107. CrossRef

Perepletchikova, F., Axelrod, S. R., Kaufman, J., Rounsaville, B. J., Douglas-Palumberi, H., & Miller, A. L. (2011). Adapting dialectical behaviour therapy for children: towards a new research agenda for paediatric suicidal and non-suicidal self-injurious behaviours. Child and Adolescent Mental Health, 16(2), 116–121. CrossRef

Rodham, K., Hawton, K., & Evans, E. (2004). Reasons for deliberate self-harm: comparison of self-poisoners and self-cutters in a community sample of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 43(1), 80–87. CrossRef

Rudd, M. D. (2004). Cognitive therapy for suicidality: An integrative, comprehensive, and practical approach to conceptualization. Journal of Contemporary Psychotherapy, 34(1), 59–72. CrossRef

Rudd, M. D., Joiner, T., & Rajab, M. H. (2001). Treating suicidal behaviour. An effective, timelimited approach. New York: The Guilford Press.

Slee, N., Arensman, E., Garnefski, N., & Spinhoven, P. (2007). Cognitive-behavioral therapy for deliberate self-harm. Crisis, 28(4), 175–182. CrossRef

Slee, N., Garnefski, N., & Spinhoven, P. (2008). Treatment protocol for deliberate self-harm in adolescents and adults. V N. Slee (ur.), Cognitive-behavioural therapy for deliberate self-harm (str. 31-53). Enschede: PrintPartners Ipskamp.

Slee, N., Garnefski, N., Spinhoven, P., & Arensman, E. (2008). The influence of cognitive emotion regulation strategies and depression severity on deliberate self-harm. Suicide and Life-Threatening Behavior, 28(3), 274–286. CrossRef

Slee, N., Garnefski, N., van der Leeden, R., Arensman, E., & Spinhoven, P. (2008). Cognitive-behavioural intervention for self-harm: randomised controlled trial. The British Journal of Psychiatry, 192(3), 202–211. CrossRef

Slee, N., Spinhoven, P., Garnefski, N., & Arensman, E. (2008). Emotion regulation as mediator of treatment outcome in therapy for deliberate self-harm. Clinical Psychology and Psychotherapy, 15(4), 205–216. CrossRef

Townsend, E., Hawton, K., Altman, D. G., Arensman, E., Gunnell, D., Hazell, P., ..., & Van Heerugen, K. (2001). The efficacy of problem solving treatments after deliberate self-harm: metaanalysis of randomized controlled trials with respect to depression, hopelessness and improvement in problems. Psychological Medicine, 31(6), 979–988. CrossRef

Washburn, J. J., Juzwin, K. R., Styer, D. M., & Aldridge, D. (2010). Measuring the urge to self-injure: preliminary data from a clinical sample. Psychiatry Research, 178(3), 540–544. CrossRef

Washburn, J., Richardt, S. L., Styer, D. M., Gebhardt, M., Juzwin, K. R., Yourek, A., & Aldridge, D. (2012). Psychotherapeutic approaches to non-suicidal self-injury in adolescents. Child and Adolescent Psychiatry and Mental Health, 6, 14. CrossRef

Williams, J. M. G., Duggan, D. S., Crane, C., & Fennell, M. J. V. (2006). Mindfulness-based cognitive therapy for prevention of recurrence of suicidal behavior. Journal of Clinical Psychology, 62(2), 201–210. CrossRef

« Back to Volume 29 (2020)