Targeting self-criticism in the treatment of nonsuicidal self-injury in dialectical behavior therapy for adolescents: a randomized clinical trial


Background: The Benefits and Barriers Model proposes both benefits and barriers associated with nonsuicidal self-injury (NSSI) and that a negative association with the self plays a key role in the initial selection of and acute motivation for NSSI. The current investigation builds upon previous findings by assessing the added benefit of targeting self-criticism in the treatment of NSSI. Methods: Sample included 40 participants (30 females; Mage = 14.92) enrolled in dialectical behavior therapy for adolescents within a partial hospitalization program. All study participants received dialectical behavior therapy for adolescents, and those randomized to the experimental condition received an additional brief cognitive intervention developed to decrease self-criticism. Results: There was no evidence of an indirect effect of targeting self-criticism upon NSSI at post-treatment via post-treatment self-criticism (b = −0.98, p =.543); however, there was evidence of a significant interaction between treatment condition and self-criticism at pretreatment in the prediction of NSSI at post-treatment (b = 0.33, p =.030). Analyses of simple slopes indicated the conditional direct effect of targeting self-criticism varied as a function of patient’s level of self-criticism at the onset of treatment, such that individuals −1 SD below the mean (b = −5.76, p =.037) and at average pretreatment levels of self-criticism (b = −4.09, p =.042), but not + 1 SD above the mean (b = −2.42, p =.056), experienced fewer incidents of NSSI at post-treatment. Conclusions: The results of this investigation support the added benefit of targeting self-criticism in the treatment of NSSI for adolescents.

Publication Title

Child and Adolescent Mental Health