Thoughts and beliefs about nonsuicidal self-injury: An application of social cognitive theory

Measurement and stratification of nonsuicidal self-injury in adolescents

BACKGROUND

Nonsuicidal self-injury (NSSI) is highly prevalent in adolescents. In survey and interview studies assessing NSSI, methods of assessment have been shown to influence prevalence estimates. However, knowledge of which groups of adolescents that are identified with different measurement methods is lacking, and the characteristics of identified groups are yet to be investigated. Further, only a handful of studies have been carried out using exploratory methods to identify subgroups among adolescents with NSSI.

METHODS

The performance of two prevalence measures (single-item vs. behavioral checklist) in the same cross-sectional community sample (n = 266, age M = 14.21, 58.3% female) of adolescents was compared regarding prevalence estimates and also characterization of the identified groups with lifetime NSSI prevalence. A cluster analysis was carried out in the same sample. Identified clusters were compared to the two groups defined using the prevalence measures.

RESULTS

A total of 118 (44.4%) participants acknowledged having engaged in NSSI at least once. Of these, a group of 55 (20.7%) adolescents confirmed NSSI on a single item and 63 (23.7%) adolescents confirmed NSSI only on a behavioral checklist, while denying NSSI on the single item. Groups differed significantly, with the single-item group being more severely affected and having higher mean scores on difficulties in emotion regulation, self-criticism, number of methods, higher frequency of NSSI, higher rates of suicidal ideation and suicidal behavior and lower mean score on health-related quality of life. All cases with higher severity were not identified by the single-item question. Cluster analysis identified three clusters, two of which fit well with the groups identified by single-item and behavioral checklist measures.

CONCLUSIONS

When investigating NSSI prevalence in adolescents, findings are influenced by the researchers' choice of measures. The present study provides some directions toward what kind of influence to expect given the type of measure used, both with regards to the size of the identified group and its composition. Implications for future research as well as clinical and preventive work are discussed.

Factors influencing adolescent experimental and current smoking behaviors based on social cognitive theory: A cross-sectional study in Xiamen

Introduction

China has the largest youth population in the world. To better implement the Smoke-free School Initiative, this study aims to examine the protective and risk factors for different smoking behaviors (never smoked, experimental smoking, and current smoking) among school adolescents based on social cognitive theory.

Methods

This research was a secondary analysis of a cross-sectional survey of middle schools in Huli District of Xiamen, China. The final sample consisted of 1937 participants with an average age of 15.41 (SD = 1.64). Descriptive statistics were used to summarize the sociodemographic characteristics of the sample. Multivariate multinomial logistic regression analysis was performed using four models.

Results

Of the respondents, 1685 (86.99%) were never smokers, 210 (10.84%) were experimental smokers, and 42 (2.17%) were current smokers. Social norms, positive outcome expectations, anti-smoking self-efficacy, and attitudes toward control tobacco policies were associated with adolescents' smoking behaviors. The number of smoking family members, classmates smoking, the perception that smoking is cool and attractive, and attitudes toward control tobacco policies were the predictors of current smoking behavior (p < 0.05). In contrast, friends smoking and individual and social relationship motivation were associated with only experimental smoking (p < 0.05).

Discussion

The relationship of social norms, positive outcome expectations, anti-smoking self-efficacy, and attitudes toward control tobacco policies varied across smoking behaviors. Family, school, society and the government need to cooperate in prevention and intervention programs for adolescent smoking. The relationships between these factors and adolescents' different smoking behaviors needs to be further verified.

Pain analgesia or desensitization? A longitudinal lab-based study on the link between pain and nonsuicidal self-injury

Mounting evidence suggests that individuals who engage in nonsuicidal self-injury (NSSI) have lower pain sensitivity (e.g., pain thresholds and tolerances) than individuals without a history of NSSI. However, research has been largely cross-sectional, so it is unclear whether low pain sensitivity may increase risk for NSSI, or whether NSSI diminishes pain sensitivity over time. In the present study, the relations among NSSI frequency, versatility (number of NSSI methods), pain threshold, and pain tolerance were examined using a longitudinal research design. Participants included 156 undergraduate students at a large university (87% female; Mage = 19.79) with a recent history of NSSI. Participants reported on their NSSI engagement and completed a cold pressor task in a baseline session, as well as at one year follow-up. Eight regression models were run to examine the nature of the association between the two pain measures (i.e., pain threshold and tolerance) and the two NSSI measures (i.e., frequency and versatility). Pain tolerance and pain threshold predicted NSSI versatility over time, but NSSI frequency and versatility did not predict pain threshold or tolerance over time. Results suggest that low pain sensitivity may be a risk factor for severe NSSI engagement.

Relationships between Outcome Expectancies and Non-Suicidal Self-Injury: Moderating Roles of Emotion Regulation Difficulties and Self-Efficacy to Resist Self-Injury

BACKGROUND

Non-suicidal self-injury (NSSI) is the deliberate damage of one's own body tissue in the absence of suicidal intent. Research suggests that individuals engage in NSSI as a means of regulating their emotions and that NSSI is associated with emotion regulation difficulties. There is also evidence supporting the role of outcome expectancies and self-efficacy to resist NSSI. However, it is unclear how these factors work together to explain NSSI.

OBJECTIVE

To explore whether the relationships between five NSSI-specific outcome expectancies and NSSI history are moderated by emotion regulation difficulties and self-efficacy to resist NSSI.

METHOD

1002 participants (Mage = 20.51, 72.5% female, 39.7% lifetime history of NSSI) completed an online survey including measures of NSSI history, outcome expectancies, self-efficacy to resist NSSI, and emotion regulation difficulties.

RESULTS

Emotion regulation difficulties were associated with NSSI, as was expecting NSSI to regulate affect. Conversely, expectations of communication and/or pain, as well as self-efficacy to resist NSSI were negatively associated with NSSI. Expectancies also interacted with both difficulties in emotion regulation and self-efficacy to resist NSSI in predicting self-injury. For example, the association between expectations of affect regulation and self-injury was weaker when associated with greater self-efficacy to resist NSSI.

CONCLUSION

These findings provide support for considering NSSI-specific cognitions in concert with emotion regulation when understanding NSSI.HighlightsOutcome expectancies can differentiate people based on NSSI history.Emotion regulation difficulties and self-efficacy to resist NSSI moderate the relationships between outcome expectancies and NSSI history.Emotion regulation difficulties and low self-efficacy to resist NSSI work together to predict NSSI history.

Applying social cognitive theory to nonsuicidal self-injury: Interactions between expectancy beliefs

ObjectiveA measure was recently developed which assesses self-efficacy to resist NSSI across differing contexts. The aim of this study was to examine how self-efficacy to resist NSSI across contexts interacts with NSSI-related outcome expectancies when differentiating NSSI history. Participant: 501 Australian college students aged 17-40 years (M = 21.21, SD = 2.36). Method: Participants completed online questionnaires. Results: Self-efficacy to resist NSSI when in contexts considered to be protective or of high risk moderated the relationships between NSSI-related outcome expectancies and recent engagement in NSSI. Participants who expected NSSI to result in communication were more likely to have recently engaged in NSSI if they held weak self-efficacy to resist NSSI in protective contexts. Expecting NSSI to result in diminished self-worth was protective against weak self-efficacy to resist NSSI. Conclusion: Results support the application of Social Cognitive Theory to NSSI and provide future avenues for exploring NSSI-specific cognitions.

Support Seeking in the Context of Self-Injury Recovery: Perspectives From Individuals With Lived Experience

ABSTRACT

A sample of 229 university students responded to open-ended questions for the present study, which aimed to gain a deeper understanding of lived experiences of support seeking in the context of self-injury recovery. Inductive thematic analysis of the responses indicated themes from two domains: the benefits of support seeking and the barriers to support seeking. The first domain highlighted benefits from both professional sources (such as receiving diagnosis and referrals to therapy, learning emotion regulation strategies, and developing an improved understanding of self) and informal sources (such as receiving tangible aid, having a support system, and having a compassionate space). The second domain indicated that barriers could be both intrapersonal (such as desire to continue nonsuicidal self-injury, embarrassment and shame, establishing agency without others' support, and minimizing self-injury) and interpersonal (such as fear of being stigmatized, concern for others, and unhelpful prior experiences) in nature. Implications for future research, outreach efforts, and clinical practice are discussed.

Cognitive and emotional factors associated with the desire to cease non-suicidal self-injury

Background

Due to cognitive and emotional differences between individuals who have and have not stopped self‐injuring, we explored these in the context of desire to stop.

Method

Australian university students (n = 374) completed cognitive and emotional measures. Comparisons were made between those who had self‐injured in the past 12 months and those who had not, and between individuals who reported wanting to stop self‐injuring and those who did not.

Results

Approximately 20% of participants did not want to stop self‐injuring. Cognitive emotional factors (psychological distress, self‐efficacy to resist, difficulties regulating emotion, interpersonal functions, and outcome expectancies) differentiated individuals who had and had not stopped, but could not explain differences in desire to stop.

Conclusion

Factors associated with desire to stop are not the same as factors underlying behavioural cessation. Motivational approaches to changes in self‐injurious behaviour would be beneficial for clinicians and their clients.

A comparison of the associations between alexithymia and both non-suicidal self-injury and risky drinking: The roles of explicit outcome expectancies and refusal self-efficacy

Both non-suicidal self-injury (NSSI) and risky drinking are positively associated with alexithymia, a personality trait characterized by difficulties appraising feelings and an externally orientated thinking style. Although researchers have studied the associations between alexithymia and both NSSI and risky drinking, the underlying factors of both associations are rarely compared. Using path analysis, we compared the mediating effects of behaviour-specific outcome expectancies and self-efficacy beliefs on the associations between alexithymia and both NSSI and risky drinking. A sample of 627 university students (76.10% female, Mage = 20.75, SD = 1.88) completed a battery of questionnaires. Alexithymia exhibited indirect effects on NSSI via affect regulation expectancies, pain expectancies, communication expectancies, and low self-efficacy to resist NSSI. Alexithymia exhibited indirect effects on risky drinking via expectations of increased confidence and negative consequences. However, the indirect effects differed depending on the valance of the emotion the individual had difficulties appraising. Our findings indicate that the underlying factors in the associations between alexithymia and both NSSI and risky drinking could differ. Where individuals who have difficulties appraising negative emotions may engage in NSSI to help regulate negative feelings, they may consume alcohol to gain more confidence in expressing their feelings. Clinical implications are discussed.

The Co-occurrence of Self-Harm and Aggression: A Cognitive-Emotional Model of Dual-Harm

There is growing evidence that some individuals engage in both self-harm and aggression during the course of their lifetime. The co-occurrence of self-harm and aggression is termed dual-harm. Individuals who engage in dual-harm may represent a high-risk group with unique characteristics and pattern of harmful behaviours. Nevertheless, there is an absence of clinical guidelines for the treatment and prevention of dual-harm and a lack of agreed theoretical framework that accounts for why people may engage in this behaviour. The present work aimed to address this gap in the literature by providing a narrative review of previous research of self-harm, aggression and dual-harm, and through doing so, presenting an evidence-based theory of dual-harm – the cognitive-emotional model of dual-harm. This model draws from previous studies and theories, including the General Aggression Model, diathesis-stress models and emotional dysregulation theories. The cognitive-emotional model highlights the potential distal, proximal and feedback processes of dual-harm, the role of personality style and the possible emotional regulation and interpersonal functions of this behaviour. In line with our theory, various clinical and research implications for dual-harm are suggested, including hypotheses to be tested by future studies.