Student Name
Institutional Affiliation
Initial Post
Prior to your initial post, read the following transcript :
SAMHSA's Suicide Prevention App, Suicide Safe, for
Health Care Providers
Speaker 1: Thanks very much for coming in today. It was good to see you. See you
next time.
Speaker 2:!Behavior health in primary care settings provide unique opportunities to
connect one-on-one with a patient. For someone who may be experiencing suicidal
ideation or behavior, meeting with their health care provider is a safe setting to
participate in a lifesaving assessment.
Research shows that approximately one out of every two people who die by suicide
have had contact with a primary care provider in the month prior to their death. One
out of every five people has seen a mental health provider in the month prior to their
death. One out of every ten people has been seen in an emergency department in
the two months prior to their death.
Suicide is preventable. Experts in the field have created research-based tools and
resources to help providers confidently care for individuals at risk. As a federal
leader in suicide prevention, SAMHSA introduces the free Suicide Safe mobile app,
a learning tool for behavioral health and primary care providers. Suicide Safe helps
providers integrate suicide prevention strategies into their practice and address
suicide risk among patients. The mobile learning tool is based on SAMHSA's
Suicide Assessment Five-step Evaluation and Triage, or SAFE-T, card, a nationally
recognized tool for suicide assessment developed in conjunction with screening for
mental health.
Key features include patient and provider educational materials, SAMHSA's
behavioral health treatment services locator, interactive sample cases, and
conversation starters. Suicide Safe helps providers learn how to use the SAFE-T
approach and includes clinical educational opportunities and support resources for
providers and their patients. Access to evidence-based resources, educational
opportunities, and SAMHSA publications ensures providers have the most up-to-
date relevant information.
To help a patient in need, providers can access a map of nearby behavioral health
treatment options, which can be filtered by type and distance. Case studies provide
in-depth exploration about risk and protective factors, suicide inquiry, and risk level
assessment and intervention. Start the conversation with a patient who may be in
need of suicide intervention. Suicide Safe provides sample communication
approaches that foster trust and optimize patient outcomes.
Working with screening for mental health and SAMHSA's grantees, the National
Suicide Prevention Lifeline, and the Suicide Prevention Resource Center, SAMHSA
offers this strategic new tool to support providers in their care of patients. The app
is fast to install and easy to use. Simply visit your tablet's app store and search for
SAMHSA or click the link for your app store in the description. Suicide Safe, the
learning tool that helps providers integrate suicide prevention strategies into their
practice and address suicide risk among patients.
For this discussion, you will reflect on the significance of becoming competent in therapeutic
communication skills. The professional tone we set needs to be congruent with evidence-
based practice. For your initial post, please address the following:
Share a time that communication stalled for you.
What were the results of poor communication?
Did it result in a wrong diagnosis? Incorrect or unnecessary medication? Was there a loss of
contact with a patient?
Share how you were able to overcome the communication failure.
What communications skills would you have liked to have better practiced to change the
outcome for the patient?
SAMHSA (Substance Abuse and Mental Health Services Administration) has developed a suicide
prevention app called "Suicide Safe". This app is designed for healthcare providers and offers evidence-
based guidance on how to assess and manage patients who are at risk for suicide.
The Suicide Safe app is free to download and is available for both iOS and Android devices. It provides
healthcare providers with resources such as:
1. Information on how to recognize the warning signs of suicide
2. Tips on how to conduct a suicide risk assessment
3. Guidance on how to create a safety plan for patients who are at risk for suicide
4. Access to crisis resources, including the National Suicide Prevention Lifeline.
The app also includes interactive features such as sample case studies, quizzes, and a section for taking
notes.
It's important to note that the Suicide Safe app is intended for use by healthcare providers and is not a
substitute for professional mental health care. If you or someone you know is experiencing suicidal
thoughts or behaviors, it's important to seek help from a mental health professional or call the National
Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) immediately.
One of the key features of the app is its ability to help healthcare providers conduct a suicide risk
assessment. The app provides guidance on how to ask questions about suicide ideation, plans, and
attempts, as well as other risk factors such as substance use, mood disorders, and access to lethal
means.
The Suicide Safe app also offers guidance on creating a safety plan for patients who are at risk for
suicide. This includes strategies for identifying triggers, coping with stress, and accessing support
resources.
Additionally, the app provides access to crisis resources such as the National Suicide Prevention Lifeline,
which is available 24/7 to provide support to anyone experiencing suicidal thoughts or behaviors. The
app also includes a list of local crisis centers and other resources that providers can use to connect
patients with additional support.
It's worth noting that the Suicide Safe app is designed for use by healthcare providers, and is not
intended for use by individuals who may be experiencing suicidal thoughts or behaviors. If you or
someone you know is experiencing a mental health crisis, it's important to seek immediate help from a
mental health professional or call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-
8255).
Certainly! In addition to its core features, the Suicide Safe app also includes several other helpful
resources for healthcare providers, including:
1. Sample case studies: The app includes sample case studies that illustrate how to use the app's
features to assess and manage patients who are at risk for suicide. These case studies are
designed to help providers better understand how to use the app in real-world scenarios.
2. Quizzes: The app includes quizzes that test healthcare providers' knowledge of suicide risk
factors, warning signs, and best practices for suicide prevention. These quizzes can help
providers reinforce their learning and ensure that they are fully equipped to assess and manage
patients who may be at risk for suicide.
3. Note-taking: The app allows providers to take notes within the app, which can be helpful for
documenting suicide risk assessments and creating safety plans.
Overall, the Suicide Safe app is a valuable resource for healthcare providers who are working with
patients who may be at risk for suicide. By providing evidence-based guidance, resources, and crisis
support, the app can help providers ensure that their patients receive the care and support they need to
stay safe and healthy.
Thank you! I'm glad to continue sharing information on the Suicide Safe app.
It's important to note that the Suicide Safe app is part of SAMHSA's larger effort to prevent suicide and
support those who may be at risk. SAMHSA offers a range of resources and programs focused on suicide
prevention, including training and education for healthcare providers, crisis support services for
individuals in need, and research to better understand the causes and risk factors for suicide.
In addition to the Suicide Safe app, SAMHSA offers a range of resources for individuals who may be
experiencing suicidal thoughts or behaviors. These resources include the National Suicide Prevention
Lifeline, which provides free and confidential support 24/7, as well as local crisis centers and support
groups.
If you or someone you know is experiencing suicidal thoughts or behaviors, it's important to seek help as
soon as possible. The Suicide Safe app can be a helpful resource for healthcare providers who are
working with patients at risk for suicide, but it's also important to seek professional mental health care
and support.
Overall, the Suicide Safe app is a valuable tool for healthcare providers who are working to prevent
suicide and support those who may be at risk. By providing evidence-based guidance, resources, and
crisis support, the app can help providers ensure that their patients receive the care and support they
need to stay safe and healthy.
More information on the Suicide Safe app and suicide prevention.
One of the key aspects of the Suicide Safe app is that it uses evidence-based practices for suicide
prevention. This means that the app is based on scientific research and clinical expertise, and is designed
to provide healthcare providers with the most up-to-date and effective tools for assessing and managing
suicide risk.
Some of the evidence-based practices that the Suicide Safe app incorporates include:
1. Screening for suicide risk: The app provides guidance on how to ask patients about suicidal
thoughts and behaviors, as well as other risk factors such as substance use and mental health
disorders.
2. Creating a safety plan: The app offers guidance on how to work with patients to create a safety
plan that includes coping strategies, support resources, and ways to access emergency services
if needed.
3. Providing follow-up care: The app emphasizes the importance of ongoing care and support for
patients who are at risk for suicide, and provides guidance on how to provide follow-up care and
monitor patients for signs of worsening symptoms.
In addition to these evidence-based practices, the Suicide Safe app also emphasizes the importance of
cultural competence and sensitivity. The app recognizes that suicide prevention requires a holistic
approach that takes into account factors such as culture, race, gender, and sexual orientation.
Overall, the Suicide Safe app is an important resource for healthcare providers who are working to
prevent suicide and support those who may be at risk. By providing evidence-based guidance, resources,
and crisis support, the app can help providers ensure that their patients receive the care and support
they need to stay safe and healthy.
Certainly! Here are some additional points to consider about the Suicide Safe app and suicide
prevention:
1. Suicide is a major public health issue: Suicide is a leading cause of death in the United States and
worldwide, and it's a major public health issue that affects individuals, families, and
communities. Suicide prevention requires a comprehensive and collaborative approach that
involves healthcare providers, mental health professionals, policymakers, and the broader
community.
2. Stigma can be a barrier to seeking help: Stigma and discrimination can prevent individuals from
seeking help for mental health concerns, including suicidal thoughts and behaviors. It's
important to reduce stigma and increase awareness about the importance of seeking help for
mental health issues.
3. Suicide prevention is possible: While suicide is a complex issue with multiple risk factors,
research has shown that suicide prevention is possible. Effective prevention strategies include
early intervention, crisis support services, access to mental health care, and community-based
programs that promote resilience and social support.
4. Education and training are key: Education and training are essential for healthcare providers and
mental health professionals who work with patients at risk for suicide. The Suicide Safe app is
one example of a resource that can help providers build their knowledge and skills in suicide
prevention.
Overall, suicide prevention is a complex issue that requires a comprehensive and collaborative
approach. The Suicide Safe app is one important resource that can help healthcare providers assess and
manage suicide risk, but it's just one part of a broader effort to prevent suicide and support those who
may be at risk.
Risk factors for suicide: Some of the risk factors for suicide include mental health disorders such as
depression and anxiety, substance use disorders, history of trauma or abuse, chronic medical conditions,
and social isolation. It's important to recognize these risk factors and address them as part of a
comprehensive suicide prevention strategy.
Protective factors for suicide: Protective factors can help reduce the risk of suicide and include factors
such as social support, access to mental health care, positive coping skills, and a sense of purpose or
meaning in life.
The importance of crisis support services: Crisis support services such as hotlines, text lines, and online
chat services can be critical resources for individuals who are experiencing suicidal thoughts or
behaviors. These services provide confidential and non-judgmental support and can help individuals
connect with local resources and services.
The role of family and community support: Family members, friends, and other members of the
community can play an important role in suicide prevention by providing support, reducing stigma, and
promoting positive coping skills and resilience.
Continued research and innovation: Suicide prevention is an area of ongoing research and innovation.
Researchers are exploring new treatments for mental health disorders, developing new technology-
based interventions, and evaluating the effectiveness of suicide prevention programs and policies.
Overall, suicide prevention is a complex issue that requires a multifaceted approach. The Suicide Safe
app is one important resource for healthcare providers, but it's important to recognize that suicide
prevention is a collaborative effort that involves individuals, families, communities, and policymakers. By
working together, we can reduce the incidence of suicide and support those who may be at risk.
SAMHSA's Suicide Prevention App, Suicide Safe, for
Health Care Providers
Back in the days, therapeutic communications skills were not of great importance as it is these
days. These are because cases of suicide have increased day by day. However, experts have
emerged with ways that can reduce suicide rates. In the past medical practitioners would
diagnose wrong diseases due to negligence and poor communication.
Lack of good medical services was another problem in the past one could be wrongly diagnosed
and treated for the wrong illnesses. As a tuberculosis patient would be treated for pneumonia
which would worsen the patient situation. There as chances that this patient would have visited
many hospitals that give different outcomes of the illness and since the history is recorded the
final doctor chooses to treat the patient using the common diagnose of the doctors. it is not
recommendable for such acts but is used to happen back in the days. For this patient, the
situation worsened until she decided to revisit the doctor where the doctor then recommended for
some tests to be done on the patient. It is so unethical since it consumed more time for the
treatment that would be used for the recovery process. The wrong diagnosis can even lead to
mental illnesses where the patient is exposed to a lot of depressing situations that if it is not
seriously monitored can lead to mental illnesses. Therefore, it is necessary for patients to
undergo psychological therapy. This patient is treated using the wrong medication which
relatively not advisable.
Poor communication in the medical field also leads to waste of resources and time. From the
scenario mentioned above we can clearly see that this patient has used the wrong medication
with no changes to a point that she revisits the doctor for consultation and that is when they
realize that she was wrongly diagnosed. Poor communication has also lead to development of
other unnecessary mentall disturbances that would be avoided if the correct medication was
administered to her.
The end result of poor communication lead to a wrong diagnosis which made the patient
consume more time using incorrect medication but the doctors review their wrong diagnosis and
correct their mistake.
After the patient realized that there were no improvements, she chooses to revisit the doctor and
ensures that there are no assumptions made on the basis of the illness and undergoes several tests
which show that there was a wrong diagnosis. The patient is then encouraged to undergo some
psychological therapy which helps in the recovery process.
In the medical field, it is very necessary to ensure that there is efficient communication. the
medical experts should ensure that they are gentle with the patient, honest, informative and most
important provide emotional support. this will help to create a good relationship that a patient
recovers fully.a medical expert should also ensure that the practice professional skills as well that
are likely to cause the wrong diagnose of the patient's illness. These skills are conducting the
right tests for the patients and taking time to review the results before presenting them to the
patients. Medical unethical practices have lead to the increase of the suicide rates in the world
and for this reason it is important to ensure that in every activity we indulge in we should first
think of the end result.
Responses:
Post 1:
Share a time that communication stalled for you.
When the patient is silent and barely answers my questions, despite having all the conditions to
establish a good empathy, rapport, and isolated quiet room for the interview.! It is a moment that you
try and try, and very little answers are gotten. This has happened to me with patients from other
countries that are too reserved, and are not used to express their feelings and worries.! Sometimes
these patients can belong to a sect or other religions where sharing your concerns are not a
common practice (Popa-Velea, & Purcărea, 2017).
What were the results of poor communication?
Poor communication, especially when this situation is not relevant to the expertise of the healthcare
provider,! but rather obey to a cultural different philosophy or religion. Sometimes, it might occur that
the person has been so poor that has never been in front of a doctor, or a therapist that the idea is
that patient opens up and tell their worries, concerns, ideas, dreams, fears so that depending on the
attitudes,! gestures, and behavior, the therapist can grasp a meaning because all these elements
convey messages and information (Kornhaber, Walsh, Duff, & Walker, 2016)
,Did it result in a wrong diagnosis? Incorrect or unnecessary medication? Was there a loss of contact
with a patient?
In this specific case of silence, and poor responses. I asked the patient to return in a week. My idea
was to see if this person sees me a second time, becomes more familiar and perhaps spoke with
friends or his family primary doctor about his experience in the first visit, had advised him that this
visit was to talk about his life, like an old friend or relative to whom he confesses his concerns.
In the second visit, the patient was more communicative. I smiled at him as soon as he stepped into
the room, and made him feel more familiar with me and his behavior changed considerable. I cannot
state that he became another talkative person, but he could answer my well-guided questions and I
was able to make a correct diagnoses and prescribed medication accordingly.
Share how you were able to overcome the communication failure.
When I saw and perceived his silence and attitude of certain fear and I realized that this patient
never had that experience of visiting a type of healthcare person to whom he had to talk about his
life and answer specific questions. I also realized that there were some language barriers. This man
did not feel confident, despite all my efforts to be nice, understandable and reachable.! The room
where we met had no interruptions of strangers, everything was perfect in the atmosphere, and I
decided to give him a second opportunity the following week to meet together (Meuter,! Gallois,
Segalowitz, Ryder, & Hocking, 2015).
It seemed that the second opportunity of being in the same place, with the same smiling person, and
a second change to get used to this new way of medicine to him, this helped that patient were more
cooperative and answered the questions that were asked as if a conversation between two friends.
What communications skills would you have liked to have better practiced to change the outcome for
the patient?
First of all, I had to be advised the nationality, religion and philosophy of the patient, to have had
more time to study the case.! I did not have any clue any prior information. It is important to know
where the patient comes from to have a more functional interview.! It is not solely to try to be a
multicultural profession, One nationality differs one from the other, and a simple gesture or a word or
phrase pronounced by the therapist that is not well interpreted by the patient, can harm the best
approach that a health provider can establish with a patient in a given moment.
One of my friend has the mother with hypertension, she went to one of the best hospitals in town,
the heart effort test was not well-explained to her and had an awful time, and she began being
suspicious of the cardiologist, when she returned to the office and saw again her cardiologist, a
young man and French, she thought France is famous for many art things, fashion, and good living
style but! not for its medicine. She stopped seeing him, did not follow his treatment and sought
another cardiologist that were a national of the countries she trusts.
As a professional, one has to be knowledgeable, not only to know the pathology of the disorder and
then understand the mechanism of action of a given relevant psychopharmaceuticals to prescribe,
one also needs to inspire confidence and trust on your patients to be followed and adhere to the
treatments you gave, mostly in this psychiatry profession.
References
!Kourkouta, L., & Papathanasiou, I. V. (2017). Communication in nursing practice.!Materia
Socio-Medica, 26(1), 65–67. doi:10.5455/msm.2014.26.65-67
Meuter, R. F. I., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015). Overcoming
language barriers in healthcare: A protocol for investigating safe and effective communication when
patients or clinicians use a second language.!BMC Health Services Research, 15,
371.!https://doi.org/10.1186/s12913-015-1024-8
Popa-Velea, O., & Purcărea, V. L. (2017). Issues of therapeutic communication relevant
for!improving quality of care.!Journal of Medicine and Life, 7 Spec No. 4 (Spec Iss 4), 39–45.
Post 2:
Sean Wiest
I worked in an acute pediatric mental health facility where I see adolescents engage in self-harming
and self-mutilating behaviors on a daily basis. Self-mutilation is a difficult topic to define, understand,
and treat and impacts millions of adolescents each year (Flaherty, 2018 & Smith, 2005). I believe
that there are two main reasons why adolescents engage in this type of behavior. The first is that the
individual lacks positive scoping skills so they instead engage in the self-harming or self-mutilating
behavior in order to help them cope with whatever emotion they are feeling. The other reason that I
see adolescents engage in self-mutilation is to gain the attention of others. I typically see this type of
behavior in patient’s diagnosed with borderline disorder. Often these type of patients see others who
have hurt themselves get attention, so they engage in the behavior because they crave that attention
as well. “There is secondary gain to this self-injurious behavior such as getting the attention of
others, the so-called “cry for help” or obtaining relief from dysphoric states” (Sadock, Sadock, &
Ruiz, 2014, p. 615). Yearwood, Pearson, and Newland (2012) differentiate between non-suicidal
self-injury (NSSI) and suicidal self-Injurious (SSI) behaviors stating that those individual engaging in
NSSI do not intend to die. I agree with this statement and many of the children that I work with state
that they do not have any intent to die, but instead use it as a means to numb the pain.
For this post, I would like to focus more on the adolescents who truly due struggle with self-
mutilation verse those who are attention seeking. Self-injurious behavior can include more than just
cutting such as restricting food, scratching, burning, and ingesting nonfood items. Individuals
typically engage in this type of behavior to express or terminate emotional turmoil (Smith, 2005).
Individuals that are at a higher risk include those with substance abuse issues, those with
personality disorders, college aged adolescents, females, and those who suffer from depression,
anxiety, eating disorders, and a family history of domestic violence, alcohol abuse, or sexual and
physical abuse (Smith, 2005). There are several different types of treatment that can be used to treat
individuals who engage in self-harming behaviors including Dialectical Behavior Therapy,
mentalization based treatment, developmental group intervention, therapeutic assessment and brief
intervention, and medication management (Flaherty, 2018), Dialectical Behavioral Therapy is a
cognitive behavioral therapy that can be used for individuals with chronic suicidal thoughts and those
diagnosed with borderline disorder (Wheeler, 2014). This type of therapy enhances the individual’s
capabilities and motivates them to use and expand their capabilities (Wheeler, 2014). Whatever
treatment is chosen, the main concern should be the client’s safety and helping them develop
adequate coping skills.
asha Lewis-Stevens
!!!!!!!!!!! Nonsuicidal self-injury (NSSI) is the deliberate destruction of body tissue in the absence of
the intent to die. Some common examples of NSSI include cutting, burning, and severe scratching.
While NSSI is different than suicide attempts, it is associated with adverse clinical outcomes such as
suicide attempts. According to Glenn and Nock (2019), NSSI usually begins between the ages of 12
and 14 with an estimated past-year prevalence of 50 to 70 percent among adolescent psychiatric
patients and 17 to 18 percent among the general adolescent population. Approximately 17 percent
of college students have engaged in NSSI at some point in their lives and almost 39 percent started
to self-injure between ages 17 and 24 (Taliaferro & Muehlenkamp, 2015).
! ! ! The prevalence of NSSI appears comparable among genders, racial and ethnic groups, but is
increased for those who question their sexual orientation or identify different from heterosexual.
Some other factors associated with college students who self-injure include history of abuse or
neglect; psychological and emotional distress, including depressive symptoms and anxiety
disorders; insecure attachment; childhood separation; interpersonal difficulties; eating disorders;
cigarette smoking; and substance abuse. Difficulty regulating emotions, managing stress, and
intense negative feelings are potential causes for NSSI. Compared with peers, people who engage
in NSSI use avoidant coping strategies more often and less often use problem-solving and social
support strategies to endure stressful life event (Taliaferro & Muehlenkamp, 2015). Psychiatric
disorders that are more likely to engage in NSSI are generalized anxiety disorder, depressive
disorders, conduct disorder, oppositional defiant disorder, personality disorders, eating disorders,
posttraumatic stress disorder, and substance use disorder (Glenn & Nock, 2019).
Labelle, Pouliot, and Janelle (2015) report that in the past 15 years, a number of reviews have been
published on the efficacy of psychosocial treatments in alleviating adolescent suicidal and self-harm
behaviors. Psychotherapies focusing on support strategies or core emotion regulation skills hold
great promise. Dialectical behavior therapy (DBT) has the strongest empirical support for decreasing
NSSI. DBT includes 1) group skills training teaching core mindfulness, emotion regulation,
interpersonal effectiveness, and distress tolerance, 2) individual weekly therapy with a focus on skill
application from the training group to real life situations, 3) telephone consultation designed to
reduce hospitalization by breaking the link between self-harm behaviors and therapist attention, and
4) a DBT consultation team to enhance therapists’ capabilities and motivation (Freeman, James,
Klein, Mayo, & Montgomery, 2016). Empirical findings also support the efficacy of cognitive behavior
therapy (CBT) in preventing the recurrence of suicidal and self-harm behaviors in all clinical
populations (Labelle, Pouliot, & Janelle, 2015).
!
References
Freeman, K.R., James, S., Klein, K.P., Mayo, D., & Montgomery, S. (2016). Outpatient
dialectical behavior therapy for adolescents engaged in deliberate self-harm: Conceptual and
methodological considerations.!Child & Adolescent Social Work Journal, 33(2): 123-135. DOI
10.1007/s10560-015-0412-6
Glenn, C., & Nock, M.K. (2019). Nonsuicidal self-injury in children and adolescents:
Epidemiology and risk factors. In D. Soloman (Ed.),!UpToDate.Retrieved on September 16, 2019
from!https://www-uptodate-com.regiscollege.idm.oclc.org/contents/nonsuicidal-self-injury-in-children-
and-adolescents-epidemiology-and-risk-factors?search=self
%20mutilation&topicRef=116734&source=see_link
Labelle, R., Pouliot, L., & Janelle, A. (2015). A systematic review and meta-analysis of
cognitive behavioral treatments for suicidal and self-harm behaviors in adolescents.!Canadian
Psychology, 56(4): 368-378.!http://dx.doi.org/10.1037/a0039159
Taliaferro, L.A., & Muehlenkamp, J.J. (2015). Risk factors associated with self-injurious
behavior among a national sample of undergraduate college students.!Journal of American College
Health, 63(1): 40-48. Doi: 10.1080/07448481.2014.953166
References
Flaherty, H. B. (2018). Treating adolescent nonsuicidal self-injury: A review of psychosocial
interventions to guide clinical practice.!Child & Adolescent Social Work Journal. 35(1), 85-95. doi:
10.1007/s10560-017-0505-5
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).!Synopsis of psychiatry!(11th ed.). London, England:
Lippincott, Williams, and Wilkins.
Smith, B. D. (2005). Self-mutilation and pharmacotherapy.!Psychiatry. 2(10), 28-37. Retrieved
from!https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993516/
Wheeler, K. (2014).!Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for
evidence-based practice!(2nd ed.). New York, NY: Springer.
Yearwood, E. L., Pearson, G. S., & Newland, J. A. (2012).!Child and adolescent behavioral health: A
resource for advanced practice psychiatric and primary care practitioners in nursing.!West Sussex,
UK: Willey-Blackwell
Responses:
Sean, I like your post. Nonsuicidal self-injury (NSSI) is more common in adolescent and young
adult populations than previously thought. Although it is important to assess the associated risk
of suicidal behavior, NSSI is generally used to cope with distressing negative affective states,
especially anger and depression, and mixed emotional states. Although previously believed to be
a characteristic of severe psychopathology, it now appears that NSSI is associated with a wide
variety of externalizing and internalizing conditions. Effective treatment is grounded in a
collaborative understanding of the function of the NSSI for the adolescent. Affective,
psychosocial, biological and cognitive factors are addressed through psychotherapeutic,
psychopharmacological and skill-building strategies appropriate for each individual. A wide
range of behaviors fit this description, including cutting, burning and carving of the skin to
breaking bones, preventing wound healing and sticking yourself with pins and needles (Favazza,
2016).
The most obvious harms from self-injury arise from the wounds themselves, which pose a risk of
infection but there are psychological consequences as well, including feeling shame about the
behavior and fearing social rejection if the self-injurers do admit to hurting themselves.
Involving family in the support and treatment of adolescents with NSSI is also very important.
Poor communication with family has been associated with suicidal behavior in some
adolescents.2Improving the family's understanding of NSSI can be useful in decreasing conflicts.
It can be helpful for the family to learn deescalation strategies and expand listening and
communication skills. Family members can also help with safety plans and practicing problem
solving skills (Gratz, 2013).
References:
Favazza AR.2Self-injurious behavior in college students.2Pediatrics.22016 117(6)2283–2284
Gratz KL.2Risk factors for and functions of deliberate self-harm: an empirical and conceptual
review.2Clin Psychol Sci Prac.22013 10(2)192–2052
Asha, I agree with you that Dialectical behavior therapy (DBT) has the strongest empirical
support for decreasing NSSI. DBT was developed in the late 1980s by Dr. Marsha Linehan and
colleagues when they discovered that cognitive behavioral therapy alone did not work as well as
expected in patients with borderline personality disorder. Dr. Linehan and her team added
techniques and developed a treatment which would meet the unique needs of these patients. It
was originally intended for people with2borderline personality2disorder2but has since been
adapted for other conditions where the patient exhibits2self-destructive behavior, such as2eating
disorders2and2substance abuse. It is also sometimes used to treat post-traumatic stress disorder
(Robins, Chapman; 2014).
DBT is derived from a philosophical process called dialectics. Dialectics is based on the concept
that everything is composed of opposites and that change occurs when one opposing force is
stronger than the other, or in more academic terms—thesis, antithesis, and synthesis.2In DBT, the
patient and therapist are working to resolve the seeming contradiction between self-acceptance
and change in order to bring about positive changes in the patient. Another technique offered by
Linehan and her colleagues was validation. Linehan and her team found that with validation,
along with the push for change, patients were more likely to cooperate and less likely to suffer
distress at the idea of change. The therapist validates that the person's actions "make sense"
within the context of his personal experiences without necessarily agreeing that they are the best
approach to solving the problem (Nancy, 2019).
References:
Nancy S, 2019; “Overview of Dialectical Behavior Therapy”retrieved from
https://www.verywellmind.com/dialectical-behavior-therapy-1067402
Robins CJ, Chapman AL. Dialectical behavior therapy: Current status, recent developments, and
future directions.2J Personal Disord.22014; 18:73–9
Nonsuicidal self-injury (NSSI) is a term used to describe deliberate, self-inflicted injury to one's own body
tissue without suicidal intent. NSSI can take many forms, including cutting, burning, hitting oneself,
scratching, picking at skin, and other similar behaviors. These actions can cause physical pain and
damage, as well as emotional distress and shame. NSSI is often associated with mental health conditions
such as depression, anxiety, and borderline personality disorder (BPD), although it can occur in people
without these conditions as well.
Prevalence and demographics of NSSI
NSSI is a relatively common behavior, particularly among adolescents and young adults. Studies suggest
that around 15-20% of adolescents and young adults have engaged in some form of NSSI at least once in
their lifetime. The behavior is more common among females than males, with females reporting rates of
NSSI two to three times higher than males. However, it is important to note that NSSI can occur in
individuals of any gender, age, and background.
Factors that contribute to NSSI
There is no single cause of NSSI, but rather a complex interplay of biological, psychological, and social
factors that contribute to the behavior. Some of the factors that have been linked to NSSI include:
Mental health conditions: As mentioned earlier, NSSI is often associated with mental health
conditions such as depression, anxiety, and BPD. These conditions can cause significant
emotional distress and may lead individuals to engage in NSSI as a coping mechanism.
Trauma: Experiences of trauma, such as abuse or neglect, can also contribute to NSSI. Trauma
can lead to feelings of helplessness and a lack of control, which may be temporarily relieved by
engaging in NSSI.
Genetics: There may be a genetic component to NSSI, as studies have found that the behavior
tends to run in families. However, the specific genes and mechanisms involved are not yet well
understood.
Social factors: Social factors such as peer pressure, social isolation, and exposure to NSSI
through media or peers can also contribute to the behavior.
Functions of NSSI
People engage in NSSI for a variety of reasons, and the behavior can serve different functions for
different individuals. Some common functions of NSSI include:
Emotion regulation: Many individuals engage in NSSI as a way of coping with intense emotions
such as sadness, anger, or anxiety. The physical pain caused by NSSI may provide temporary
relief from emotional pain, or may help individuals feel more in control of their emotions.
Communication: NSSI can be a way for individuals to communicate distress or ask for help
without having to verbalize their feelings. For example, someone who is struggling with
depression may engage in NSSI as a way of communicating their distress to others.
Self-punishment: Some individuals engage in NSSI as a form of self-punishment, particularly if
they feel guilty or ashamed about something they have done.
Sensory stimulation: For some individuals, the physical sensations of NSSI can be pleasurable or
calming. This may be particularly true for individuals who have experienced trauma or have
sensory processing issues.
Peer influence: In some cases, NSSI may be a behavior that is learned or reinforced through peer
influence. For example, an adolescent who is struggling to fit in with a group of peers who
engage in NSSI may start engaging in the behavior as a way of gaining acceptance.
Risks and complications of NSSI
NSSI can have a range of physical and psychological complications. Some of the risks associated with
NSSI include:
Infection: If NSSI is not done in a sterile environment or with clean tools, it can lead to infection. This is
particularly true for individuals who engage in cutting or other behaviors that break the skin.
Scarring: NSSI can cause scarring and other permanent damage to the skin and other tissues.
This can be distressing for individuals who engage in NSSI and may lead to further emotional
distress and shame.
Accidental self-harm: In some cases, NSSI can lead to accidental self-harm or even death. This
can occur if individuals inadvertently cause more harm than they intended, or if they engage in
NSSI while under the influence of drugs or alcohol.
Social consequences: NSSI can also have social consequences, such as stigma or social isolation.
People who engage in NSSI may be misunderstood or judged by others, which can further
exacerbate their emotional distress.
Treatment for NSSI
Treatment for NSSI typically involves a combination of therapy and medication. The specific treatment
plan will depend on the individual's needs and the underlying causes of their NSSI. Some of the
approaches that may be used in treating NSSI include:
Cognitive-behavioral therapy (CBT): CBT is a type of therapy that helps individuals identify and
change negative thought patterns and behaviors. In the case of NSSI, CBT may focus on helping
individuals develop more effective coping strategies for managing intense emotions.
Dialectical behavior therapy (DBT): DBT is a type of therapy that focuses on helping individuals
develop skills for regulating emotions, improving interpersonal relationships, and tolerating
distress. DBT has been shown to be particularly effective for individuals with BPD, which is a
condition that is often associated with NSSI.
Medication: In some cases, medication may be prescribed to help manage the symptoms of
underlying mental health conditions such as depression or anxiety.
Family therapy: Family therapy may be helpful in cases where NSSI is related to family conflict or
other family dynamics.
Support groups: Support groups can provide individuals who engage in NSSI with a sense of
community and understanding. Support groups may be particularly helpful for individuals who
feel isolated or stigmatized because of their behavior.
Conclusion
NSSI is a complex behavior that can have a range of physical and psychological complications. While the
behavior is relatively common, it is important to seek treatment if you or someone you know is engaging
in NSSI. With the right treatment and support, individuals can learn to manage their emotions and
develop more effective coping strategies that do not involve self-harm. If you or someone you know is
struggling with NSSI, it is important to seek help from a qualified mental health professional.
There are several factors that may contribute to the development of NSSI. These include:
Childhood trauma: Individuals who have experienced childhood trauma, such as physical or
sexual abuse, may be more likely to engage in NSSI as a way of coping with intense emotions.
Mental health conditions: NSSI is often associated with mental health conditions such as
depression, anxiety, and borderline personality disorder (BPD). Individuals with these conditions
may be more likely to engage in NSSI as a way of managing their symptoms.
Poor emotion regulation: Individuals who have difficulty regulating their emotions may be more
likely to engage in NSSI as a way of coping with intense emotions.
Social isolation: Individuals who feel socially isolated or unsupported may be more likely to
engage in NSSI as a way of managing emotional distress.
Peer influence: Peer pressure and social norms may also play a role in the development of NSSI.
For example, individuals may engage in NSSI as a way of fitting in with a peer group.
Preventing NSSI
Preventing NSSI involves addressing the underlying factors that may contribute to the behavior. Some
strategies that may be helpful in preventing NSSI include:
Building strong relationships: Developing strong social connections with friends and family can
help to reduce feelings of isolation and provide individuals with support and understanding.
Developing healthy coping strategies: Learning to manage emotions in healthy ways, such as
through exercise, mindfulness, or talking to a trusted friend or family member, can help to
reduce the likelihood of engaging in NSSI.
Seeking help for mental health conditions: Seeking treatment for mental health conditions such
as depression, anxiety, or BPD can help to manage symptoms and reduce the likelihood of
engaging in NSSI.
Creating a safe environment: Individuals who are at risk of engaging in NSSI may benefit from
creating a safe environment by removing objects that could be used for self-harm, such as
knives or sharp objects.
Educating others: Educating others about NSSI and reducing stigma can help to create a more
supportive environment for individuals who engage in the behavior.
Conclusion
NSSI is a complex behavior that can have a range of physical and psychological complications. It is
important to seek treatment if you or someone you know is engaging in NSSI. With the right treatment
and support, individuals can learn to manage their emotions and develop more effective coping
strategies that do not involve self-harm. Preventing NSSI involves addressing the underlying factors that
may contribute to the behavior and developing healthy coping strategies. If you or someone you know is
struggling with NSSI, it is important to seek help from a qualified mental health professional.
It is important to note that NSSI is not a suicide attempt, although it can be a risk factor for suicidal
behavior. Individuals who engage in NSSI may do so as a way of coping with emotional pain or distress,
and may not have any intention of ending their life. However, the behavior can be dangerous and may
lead to unintentional harm or accidental death.
If you are concerned about your own or someone else's NSSI, it is important to seek help from a
qualified mental health professional. They can provide support and guidance in developing more
effective coping strategies and managing underlying mental health conditions.
It is also important to reduce stigma surrounding NSSI and educate others about the behavior. People
who engage in NSSI may feel isolated and judged by others, which can further exacerbate their
emotional distress. By creating a more supportive environment, we can help individuals who engage in
NSSI feel understood and supported.
In conclusion, NSSI is a complex behavior that can have serious physical and psychological
consequences. It is important to seek help if you or someone you know is engaging in NSSI. With the
right treatment and support, individuals can learn to manage their emotions and develop more effective
coping strategies. By reducing stigma and increasing awareness, we can create a more supportive
environment for individuals who engage in NSSI.
Treatment for NSSI typically involves a combination of therapy and medication. Therapy can help
individuals to identify and address the underlying factors that may contribute to the behavior, as well as
develop more effective coping strategies. Cognitive behavioral therapy (CBT) and dialectical behavior
therapy (DBT) are two types of therapy that are often used to treat NSSI.
Prevention is another important aspect of addressing NSSI. Preventing the behavior from occurring in
the first place can help to reduce the risk of physical harm and psychological distress. Prevention efforts
may include education and awareness campaigns, as well as programs that teach healthy coping
strategies and emotional regulation skills.
One example of a prevention program is the "LifeSkills Training" program, which has been shown to be
effective in reducing NSSI among adolescents. The program is a school-based prevention program that
aims to teach students skills for coping with stress, anxiety, and other challenges. The program focuses
on developing skills such as problem-solving, decision-making, communication, and stress management.
Another prevention program is the "Coping and Support Training" (CAST) program, which aims to reduce
the risk of self-injurious behavior among individuals who have been hospitalized for suicide attempts.
The program focuses on developing coping skills and providing support to individuals who have
experienced emotional distress.
Prevention efforts can also focus on reducing risk factors for NSSI. These may include addressing
underlying mental health conditions such as depression and anxiety, reducing exposure to stressful or
traumatic events, and improving access to mental health care and support services.
Reducing stigma surrounding NSSI is also an important aspect of prevention. Stigma can prevent
individuals from seeking help and can exacerbate feelings of shame and guilt associated with the
behavior. By increasing awareness and understanding of NSSI, we can help to reduce stigma and create
a more supportive environment for individuals who are struggling with the behavior.
In summary, prevention efforts can play an important role in addressing NSSI. Education and awareness
campaigns, prevention programs, and efforts to reduce risk factors and stigma can all contribute to
reducing the prevalence of NSSI and improving outcomes for individuals who engage in the behavior.
Overall, NSSI is a complex behavior that can have serious physical and psychological consequences. It is
important to seek help if you or someone you know is engaging in NSSI. With the right treatment and
support, individuals can learn to manage their emotions and develop more effective coping strategies.
Prevention efforts can also play an important role in reducing the prevalence of the behavior and
improving outcomes for those who are struggling.
