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Rising cases of self-injury treated with new therapy

An estimated 13 percent to 26 percent of high school students engage in non-suicidal self-injury
Psychologists from Ardsley Union Free School District in New York use behavioral therapy for students who injure themselves.
Psychologists from Ardsley Union Free School District in New York use behavioral therapy for students who injure themselves.

Emergency room visits for self-inflicted injuries in adolescents have risen significantly since 2009, according to a study in July Pediatrics. Schools looking to curb this behavior have turned to new mental health programs that focus on navigating stress and emotional regulation.

An estimated 13 percent to 26 percent of high school students engage in non-suicidal self-injury, says Alec Miller, clinical professor in the department of psychiatry and behavioral science at Albert Einstein College of Medicine in New York. Cutting is the most common method, but teens also burn and punch themselves.

“It’s a silent epidemic, when you think of the number of kids engaging in this behavior, and that it’s still going under the radar,” says Miller, who is also the clinical director of Cognitive & Behavioral Consultants LLP.

Mental health workers are now better at evaluating the behavior—in previous years, risk assessments would include only suicidal attempts, not non-suicidal self-injury.

Students harm themselves mainly to regulate emotions, particularly anger, fear and loneliness. The physical pain temporarily distracts the student from emotional distress, Miller says.

A new treatment

To reach more students, Cognitive & Behavioral Consultants developed a school-based curriculum to teach dialectical behavior therapy (DBT), the leading treatment for self-injury. Lessons include self-soothing and regulating emotions.

The core focus is mindfulness—the intentional, non-judgemental focus of one’s attention on the emotions, thoughts and sensations occurring at the present moment. The therapy also teaches students alternative actions to take when they feel an urge to hurt themselves.

A student might learn to notice anxiety by sensations in their stomach and practice deep breathing or muscle relaxation techniques to cope.

“It’s about slowing down so that you can begin to catch these feelings at the nascent stage before it’s too late and you have a razor blade out,” Miller says.

Schools use the curriculum either in health class as a prevention method for all students, or in small groups of at-risk students. The therapy is now used in 25 schools in New York, and in several others nationwide, Miller says.

The therapy, compared to other common treatments, significantly lowered the frequency of self-injury in 77 teenagers, according to a study published in the October 2014 Journal of the American Academy of Child & Adolescent Psychiatry.

‘A beautiful shift’

Ardsley Union Free School District in 2008 was the first to implement the therapy in a high school setting. The district’s middle and elementary school followed.

The district provides the treatment to students who self-injure, struggle behaviorally, have difficulty maintaining relationships, or have trouble at home. Most are suffering from depression, says district psychologist Dawn Catucci.

The treatment at Ardsley is completely voluntary, and takes place during lunch or after school. Forty K12 students participated in 2014-15, taking lessons on distress tolerance, interpersonal communications and other skills.

School staff training is extensive, and costs the district about $11,000 for the first year. By the second year, costs were about $5,000. The treatment saves money in the end, as it keeps students out of the hospital or specialized programs.

It also prevents students who may have been classified as having emotional disabilities from entering special education unnecessarily, Catucci says

“It changes their mental health trajectory—we see them become more skillful instead of continuing on in the same patterns,” Catucci says. “It’s a beautiful shift.”