Case Series on Effectiveness of Cutting-Down Program for Managing Non-Suicidal Self-Injury Among Adolescents

Abstract

Background: Non-suicidal self-injury (NSSI) is an emerging issue among adolescents with a growing prevalence in clinical settings. It is a multi-faceted condition in terms of psychiatric comorbidities, variation in the form and method of self-harm, body area, the pattern of the wound and the function served, and therefore, understanding and managing it adequately in routine clinical practice is a challenge. There is a need for research to focus on in-depth understanding of the effectiveness of and process issues for existing interventions for NSSI in adolescents. Aim: The present research is a case series aimed at examining the effectiveness of the cutting-down programme (CDP), a manualized cognitive behaviour therapy programme, in reducing the frequency and intensity of NSSI acts and urges in two adolescents. The objectives of the study were to examine the effect of the CDP on depressive symptoms, dysfunctional attitudes, emotion regulation, experiential avoidance and global functioning in adolescents with NSSI, and to explore the association of patient motivation and patient perception of therapy with therapy outcome in adolescents with NSSI. Method: For the study, two adolescents with NSSI who presented to the Department of Child and Adolescent Psychiatry, NIMHANS, Bangalore, were recruited using purposive sampling. They were assessed using the MINI-International Neuropsychiatric Interview for Children and Adolescents (MINI Kid Screen 7.0.2). In addition, standardized were used to assess the severity and functions of NSSI, borderline personality disorder, depression, emotion regulation skills, dysfunctional attitudes, psychological flexibility and global functioning. The participants were also assessed on a semi-structured interview to assess NSSI every week during the intervention. Baseline measures were repeated when the CDP was completed. Further, the non-specific factors such as patient’s perceptions of therapy and patient motivation were assessed using the standardized scales. Results: The CDP was found to be effective in reducing the NSSI among the two adolescents. It also improved their depressive symptoms, dysfunctional attitudes, emotion regulation, experiential avoidance and global functioning. The therapy outcome was related to the participants’ motivations and perceptions of therapy. Conclusion: The CDP is an effective intervention for reducing NSSI acts. However, client characteristics such as perception and motivation for therapy will play a role in therapy outcome.