Could affect regulation via vagal nerve self- stimulation be a maintaining factor in non-suicidal self-harm?

The Role of Pain and Blood Simulation of Nonsuicidal Self-Injury in Emotion Regulation Among Adolescents With Depression Based on the Principle of Harm Reduction: An Experimental Study

This study aims to explore the role of pain and blood in emotion regulation during nonsuicidal self-injury (NSSI) among adolescents with depression, which included 108 depressed adolescents with NSSI and 110 depressed adolescents without NSSI, to assess the impact of pain and blood on subjective emotional states, and pulse frequency (Pf), respiratory frequency (Rf), galvanic skin response (GSR), and electromyography (EMG). Significant condition×group×time interactions for positive emotions (β = -0.082, SE = 0.026, P = 0.002), Pf (β = -0.045, SE = 0.013, P = 0.001) and GSR (β = -0.041, SE = 0.018, P = 0.027) were found, indicating a significant increase in positive emotions and a significant decrease in Pf and GSR in the NSSI group post-pain/blood stimulus, especially within the first 10 seconds (for Pf, GSR)/3.5 minutes (for positive emotions) following stimulus. And Pf and GSR showed a more pronounced decrease over time in the NSSI group during the pain condition than in the blood condition. These findings highlight the significance of pain and blood in emotion regulation for adolescents with depression who engage in NSSI. Moreover, clinical healthcare professionals may be inspired by the pain and blood stimulus of NSSI based on the harm reduction principle, which provides new ideas for exploring potential interventions that can assist adolescents with depression regulate their emotions and reduce the occurrence of NSSI. And more relevant studies need to be carried out in this area.

The Feasibility of Ambulatory Heart Rate Variability Monitoring in Non-Suicidal Self-Injury

The polyvagal theory proposes that the autonomic nervous system influences affective systems and top-down emotional regulation. Vagal tone, as indexed by heart rate variability (HRV), is a measure of emotion regulation capacity. It is possible that non-suicidal self-injury (NSSI) occurs at times of low vagal tone and that NSSI may increase it. Little is known about the feasibility of collecting ambulatory HRV data in the context of NSSI. This prospective observational study examined the feasibility of ambulatory HRV monitoring during NSSI. Ten participants wore a chest-based heart rate monitor and used a diary app for 1 week. Baseline characteristics were collected. Heart rate monitoring duration, diary app entries, distress scores, and NSSI occurrences were recorded. Participant experience was assessed in a post-study questionnaire. At baseline, six had a history of NSSI, in two of whom it was current. Ten participants wore the monitor for an average of 137 h. Nine participants successfully used the diary app, making an average of 14 entries over a week. Although no NSSI occurred during the study, the overall experience of participation was positive. It is feasible to monitor HRV and collect app-based distress scores for a week, including in those with NSSI history.

Transcutaneous auricular vagus nerve stimulation to acutely reduce emotional vulnerability and improve emotional regulation in borderline personality disorder (tVNS-BPD): study protocol for a randomized, single-blind, sham-controlled trial

BACKGROUND

Borderline personality disorder (BPD) is considered a disorder of emotion regulation resulting from the expression of a biologically determined emotional vulnerability (that is, heightened sensitivity to emotion, increased emotional intensity/reactivity, and a slow return to emotional baseline) combined with exposure to invalidating environments. Vagal tone has been associated with activity in cortical regions involved in emotion regulation and a lower resting state of vagal tone has been observed in BPD patients relative to healthy controls. Non-invasive transcutaneous auricular vagus nerve stimulation (taVNS) has been shown to reduce temper outbursts in adults with Prader-Willi Syndrome, to enhance recognition of emotions in healthy students, and to improve depressive and anxiety symptoms. Furthermore, a single session of taVNS has been shown to acutely alter the recognition of facial expressions of negative valence in adolescents with MDD and increase emotion recognition in controls. However, the effect of taVNS on emotional vulnerability and regulation in individuals diagnosed with BPD has not been investigated. Our aims are to determine if taVNS is effective in acutely reducing emotional vulnerability and improve emotional regulation in BPD patients.

METHODS

Forty-two patients will be randomized to a single session of taVNS or sham-taVNS while going through an affect induction procedure. It will consist of the presentation of one neutral and three negative affect-evoking 4-min-long videos in sequence, each of which is followed by a 4-min post-induction period during which participants will rate the quality and intensity of their current self-reported emotions (post-induction ratings) and the perceived effectiveness in managing their emotions during the video presentation. The rating of the current self-reported emotions will be repeated after every post-induction period (recovery ratings). Mixed models with individuals as random effect will be used to investigate the ratings at each stage of the study, taking into account the repeated measures of the same individuals at baseline, pre-induction, post-induction, and recovery.

DISCUSSION

The study has potential to yield new insights into the role of vagal tone in emotion dysregulation in BPD and offer preliminary data on the effectiveness of taVNS as a possible non-invasive brain stimulation to treat a core symptom of BPD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05892900. Retrospectively registered on Jun 07, 2023.

Sexual Activity as Self-Injury: A Scoping Review

Suicide and other self-injurious behaviors (SIB) are significant causes of morbidity and mortality as well as healthcare costs. Sexual risk behaviors are associated with many SIB, and sexual activities may act as SIB as well. In this scoping review, we consider ways in which sexual activity has been conceptualized as SIB - types of sexual activities as a form of self-injury - and cases in which sexual activities as SIB have been classified as direct or indirect self-injury. We include English-language publications that discuss any aspect of sexual activity as SIB. Database, citation list, and gray literature searches yielded 33 publications. Sexual activities as a form of self-injury included exposure to HIV/AIDS and other sexually transmitted infections, sadomasochistic behaviors undertaken for punishment rather than pleasure, selling sex, injury to the genitals, and sexual encounters with undesired partners or consisting of undesired acts. Twenty-three publications did not categorize sexual activities to self-injure as either direct or indirect self-injury, three publications categorized them as indirect self-injury, and seven publications as direct self-injury. Sexual activity is used to self-injure in a variety of ways and its conceptualization as indirect or direct self-injury remains unclear.

Autonomic dysregulation and self-injurious thoughts and behaviours in children and young people: A systematic review and meta-analysis

Background

Self-injurious thoughts and behaviours (SITBs) have been associated with dysfunction of the Autonomic Nervous System (ANS) in children and young people, suggesting that objective ANS measures may aid assessment of suicide risk, but a systematic synthesis of this literature is currently lacking.

Methods

Following a pre-registered protocol (PROSPERO CRD42022327605), we conducted a systematic search of PubMed, Medline, Embase, PsycINFO, and Web of Science, for empirical studies published until 10th May 2022 that compared indices of ANS functioning in individuals aged 0-25 years with versus without SITBs, or reported continuous associations between ANS measures and SITBs. Study quality was assessed with the Newcastle-Ottawa Scales. Pooled effect sizes (Hedge's g) were estimated with random-effects meta-analytic models.

Results

Twenty studies (1979 participants) were included in our systematic review, with 16 included in meta-analyses. Results suggested that SITBs were associated with altered cardiac indices of arousal (g = -0.328, p < 0.001), which was driven by lower heart rate variability in individuals with SITBs (g = -0.375, p = 0.025). Overall results for electrodermal activity were not significant (g = 0.026, p = 0.857), but subgroup analyses showed increased activity in studies of individuals who engaged specifically in non-suicidal self-harm (g = 0.249, p = 0.014) but decreased activity in the remaining studies (g = -0.567, p = 0.004).

Conclusions

Our systematic review and meta-analysis found evidence of reduced parasympathetic regulation as well as more tentative evidence of altered electrodermal activity in children and young people displaying SITBs. Future longitudinal studies should test the clinical utility of these markers for detecting and monitoring suicide risk.