Background Programs for mental health promotion and prevention of nonsuicidal self-injury (NSSI) in schools have gained increased focus during the last decades, but less is known about adolescents’ experiences of such interventions.

Methods A whole-school preventive intervention targeting mental health and NSSI was delivered to six secondary schools. Adolescents participated in the Youth Aware of Mental Health program combined with an NSSI-focused psychoeducation module. Caregivers and teachers were given online psychoeducation on NSSI, and school health care staff were given a workshop on self-injury. Eleven group interviews (n = 65 participants) were conducted with adolescents (ages 13–15 years, 65% females) exploring participant experiences. Interviews were analyzed using thematic analysis and interpreted in light of a biopsychosocial understanding of adolescence.

Results The analysis generated two main themes. The first theme, Mental health in the context of adolescence, centered around adolescents’ conception of mental health, after having taken part in the intervention, framed in a context of coping with external stressors. The dilemma of autonomy versus help-seeking was also identified as part of the first main theme. The second theme, The who, when, what, and how of the intervention, described adolescents’ experiences of the intervention. This theme included increased awareness and knowledge of mental ill-health. The participants generally agreed that the topics included are important to adolescents and emphasized that the content needs to be relatable. Several factors that influence how a school-based program is received by adolescents were identified, such as who should be targeted and when. Adolescents also identified challenges and gave recommendations for future similar projects.

Conclusions Adolescents generally perceived addressing mental health and NSSI in schools as important. Help-seeking initiatives need to be balanced against adolescents’ need for autonomy when planning mental health prevention and intervention.

Introduction: Nonsuicidal self-injury (NSSI) is a common and concerning behavior in adolescents. However, most adolescents cease NSSI as they transition into adulthood. Increased knowledge of the cessation process is needed. This study aimed to qualitatively explore the factors contributing to NSSI cessation in individuals with lived experience of NSSI, providing valuable insights for treatment strategies. Methods: Twenty-six individuals assigned female sex at birth, between ages 20–22 years, from Sweden were interviewed between 2021 and 2023 in Linköping, Sweden. Of these, 21 individuals perceived themselves as having ceased NSSI and were included in the analysis. Thematic analysis and Hooley and Franklins' Benefits and Barriers Model of NSSI were used to analyze the transcripts. Results: Three overarching themes were generated: “Something inside me changed”, “Something in my close relationships changed”, and “Something in my life context changed”. The cessation of NSSI was associated with several key factors. Improved well-being and envisioning a different future were pivotal in initiating the cessation process. Additionally, interpersonal relationships and support from others were interpreted as powerful motivators for change. Transitioning to a new social context and leaving behind a destructive environment provided opportunities for personal growth and enhanced well-being, interpreted as initiators in the participants' broader life context. Conclusion: This study underscores the complexity of the NSSI cessation process and highlights the need for a comprehensive understanding of the underlying factors. Access to emotion regulation skills was perceived as a significant barrier to NSSI engagement. Clinical implications and different interventions to support NSSI cessation are discussed. © 2024 The Author(s). Journal of Adolescence published by John Wiley & Sons Ltd on behalf of Foundation for Professionals in Services to Adolescents.

BackgroundNonsuicidal 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.MethodsThe 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.ResultsA 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.ConclusionsWhen 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.

Social interactions are critical for the health and well-being of all group-living primates, including humans, across the lifespan. Social stressors, such as perceived criticism and rejection, are common triggers of nonsuicidal self-injury (NSSI). Social processes may thus have a central role in the etiology and maintenance of NSSI. Using the Research Domain Criteria (RDoC) framework for systems for social processes, the chapter presents recent findings on NSSI, mapping them onto the four constructs: affiliation and attachment, social communication, perception and understanding of self, and perception and understanding of others. The chapter also discusses available research related to NSSI for the respective units of analysis (genes and molecules, physiology, neurocircuitry, behavior, and self-report), focusing on the effects of social exclusion, rejection sensitivity, and negative social bias. The chapter also includes an overview of overlapping features related to social exclusion and rejection sensitivity between NSSI and borderline personality disorder, a condition characterized by interpersonal difficulties. This chapter provides an account of evidence-based assessment and intervention areas of social processes in NSSI together with recommendations and future directions. The chapter concludes that social processes are relevant to NSSI across the RDoC constructs and units of analyses. Social difficulties, social problem-solving, and experiences and interpretations of social situations need to be included in the conceptualization of how NSSI is developed and maintained and ultimately assessed and treated. In an effort to bring such conceptualization to life, a case example illustrates how an understanding of social processes may guide assessment and treatment of NSSI.

Background Emotion regulation difficulties appear to play a role in the development and maintenance of several eating disorders. This pilot study aimed at examining whether a short add-on group skills training in emotion regulation for young adults with different eating disorders was feasible in a psychiatric clinical setting. We also investigated if the treatment increased knowledge of emotions, and decreased self-reported difficulties with emotion regulation, alexithymia, symptoms of eating disorder, anxiety and depression, as well as clinical impairment. Methods Six skills training groups were piloted with a total of 29 participants (M = 21.41 years, SD = 1.92). The treatment consisted of five sessions dealing with psychoeducation about emotions and emotion regulation skills training. Paired samples t-test was used to compare differences between before-and-after measures. Results The primary outcomes measures difficulties in emotion regulation (p < 0.001) and alexithymia (p < 0.001) showed significant improvement after treatment. The total eating disorder score (p = 0.009) was also significantly reduced, as was clinical impairment (p < 0.001). Acceptance/valued direction, identifying primary emotions and learning about secondary emotions was rated as especially helpful. Conclusions This preliminary pilot study showed that group training targeting emotion regulation skills was feasible and appreciated by participants, as well as being potentially promising as an adjunctive treatment for different eating disorders. Further controlled studies are needed.

Difficulties with emotion regulation have been identified as an underlying mechanism in mental health. This pilot study aimed at examining whether group skills training in emotion regulation for adolescents and parents as an add-on intervention was feasible in an outpatient child and adolescent psychiatric clinic. We also investigated if the treatment increased knowledge and awareness of emotions and their functions, increased emotion regulation skills and decreased self-reported symptoms of anxiety and depression. Six skills training groups were piloted with a total of 20 adolescents and 21 adults. The treatment consisted of five sessions dealing with psychoeducation about emotions and emotion regulation skills training. Paired-samples t test was used to compare differences between before-and-after measures for adolescents and parents separately. The primary outcome measure, Difficulties in Emotion Regulation Scale, showed significant improvement after treatment for both adolescents and parents. For adolescents, measures of alexithymia were significantly reduced. Also, emotional awareness was significantly increased. Measures of depression and anxiety did not change. In conclusion, group skills training as an add-on treatment can be feasible and effective but further studies are needed.

Nonsuicidal self-injury disorder (NSSID) is a condition in need of further study, especially in adolescent and clinical populations where it is particularly prevalent and studies are limited. Twenty-nine clinical self-injuring adolescents were included in the study. The Clinical Assessment of Nonsuicidal Self-Injury Disorder Index (CANDI) was used to assess prevalence of NSSID. The NSSID diagnosis criteria were met by 62.1% of adolescents. The impairment or distress criterion was least often met. Criteria B and C (assessing reasons for NSSI and cognitions/emotions prior to NSSI) were confirmed by 96-100% of all participants. Adolescents with NSSI in this clinical sample had several comorbidities and high levels of psychopathology. NSSID occurred both in combination with and independently of borderline personality disorder traits as well as suicide plans and attempts. Those with NSSID had a significantly higher cutting frequency than those not meeting full NSSID criteria. Other NSSI characteristics, comorbidity, psychopathology, and trauma experiences did not differ between groups. CANDI was a feasible tool to assess NSSID in adolescents. It is important to use structured measures to assess the validity of the NSSID diagnosis across development in both community and clinical samples. The clinical utility of the NSSID diagnosis is discussed.

Background Increased awareness of anxiety in adolescents emphasises the need for effective interventions. Internet-based cognitive behavioural therapy (ICBT) could be a resource-effective and evidence-based treatment option, but little is known about how to optimize ICBT or which factors boost outcomes. Recently, the role of knowledge in psychotherapy has received increased focus. Further, chat-sessions are of interest when trying to optimize ICBT for youths. This study aimed to evaluate the role of learning support and chat-sessions during ICBT for adolescent anxiety, using a factorial design. Method A total of 120 adolescents were randomised to one of four treatment groups, in a 2x2 design with two factors: with or without learning support and/or chat-sessions. Results Anxiety and depressive symptoms were reduced (Beck Anxiety Inventory- BAI; Cohensd=0.72; Beck Depression Inventory- BDI;d=0.97). There was a main effect of learning support on BAI (d=0.38), and learning support increased knowledge gain (d =0.42). There were no main effects or interactions related to the chat-sessions. Treatment effects were maintained at 6-months, but the added effect of learning support had by then vanished. Conclusion ICBT can be an effective alternative when treating adolescents with anxiety. Learning support could be of importance to enhance short-term treatment effects, and should be investigated further.

Instruments for evaluating the progress and outcome of systemic therapeutic treatments in clinical practice need to be easily administered and have sound psychometric properties. The Systemic Clinical Outcome and Routine Evaluation, 15-item version (SCORE-15), is a self-report instrument that measures aspects of family functioning. This study investigates the psychometric qualities of a Swedish version of SCORE-15. Seventy Swedish families with healthy children and 159 families with children with psychiatric or behavioural problems were included in the study, resulting in a total of 397 individuals. Results showed that SCORE-15 differentiated clinical from non-clinical families with acceptable psychometric properties for test-retest, internal consistency, convergent and construct validity, as well as sensitivity to change for the clinical sample. The three-factor solution of strengths, difficulties and communication was tested. Results imply preliminary psychometric support for the use of the Swedish version of SCORE-15 to evaluate progress and outcome in clinical practice. Practitioner points SCORE-15 is an easily administered questionnaire suitable for use in clinical practice to evaluate systemic therapeutic progress and outcome The Swedish version of SCORE-15 has acceptable psychometric properties

Differences and similarities were studied in the functions of two different self-injurious behaviors (SIB): nonsuicidal self-injury (NSSI) and sex as self-injury (SASI). Based on type of SIB reported, adolescents were classified in one of three groups: NSSI only (n = 910), SASI only (n = 41), and both NSSI and SASI (n = 76). There was support for functional equivalence in the two forms of SIB, with automatic functions being most commonly endorsed in all three groups. There were also functional differences, with adolescents in the SASI only group reporting more social influence functions than those with NSSI only. Adolescents reporting both NSSI and SASI endorsed the highest number of functions for both behaviors. Clinical implications are discussed, emphasizing the need for emotion regulation skills.