Acute effects of inpatient brief cognitive-behavioral therapy for suicide prevention on non-suicidal self-injury: Exploring the association with improved distress tolerance

Abstract

Non-suicidal self-injury (NSSI) is common in individuals who attempt suicide and is a known risk factor for future suicide attempts. Thus, it is important to identify effective treatments for NSSI and related mechanisms when working with a suicidal population. Improving distress tolerance is a proposed mechanism of NSSI treatment. This post-hoc analysis of a randomized clinical trial determined the effect of adding inpatient Brief Cognitive-Behavioral Therapy for Suicide Prevention (BCBT-Inpatient) to treatment as usual (TAU) on the odds of NSSI occurring during the inpatient stay. Associations with improvements in distress tolerance were also explored. Two hundred participants with history of suicide attempt were enrolled with data on NSSI occurrence available from 188 (BCBT-Inpatient n = 90; TAU n = 98). A subset of these participants (BCBT-Inpatient n = 53, TAU n = 51) also completed the Distress Tolerance Scale (DTS) at pretreatment and discharge. A chi-square analysis indicated that significantly fewer BCBT-Inpatient (5.6%) than TAU (14.3%) participants engaged in NSSI during their inpatient stay [P = .047; OR = 0.35, 95% CI:(0.12, 1.02)]. DTS total scores demonstrated a statistically significant group by time interaction [P = .022], with larger improvements in distress tolerance occurring with BCBT-Inpatient added to TAU. Further, improvement in DTS scores was significantly associated with the absence of NSSI ( r = −0.344, P < .001). These results demonstrate acute treatment effects of BCBT-Inpatient to reduce self-harm behaviors during the inpatient stay and suggest improved distress tolerance as a potential treatment mechanism.

Publication Title

Journal of Affective Disorders

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