Anxious and Overwhelming Affects and Repetitive Negative Thinking as Ecological Predictors of Self-Injurious Thoughts and Behaviors

  • Christopher D. Hughes
  • Alexandra M. King
  • Amy Kranzler
  • Kara Fehling
  • Alec Miller
  • Janne Lindqvist
  • Edward A. SelbyEmail author
Original Article


Nonsuicidal self-injury (NSSI) refers to purposely injuring one’s body without suicidal intent via methods such as cutting or hitting oneself, and is a serious health concern that has been linked to detrimental behavioral and physical health consequences. One of the primary reasons that people report engaging in NSSI is that it appears to help them cope with intense affective states and upsetting thoughts, both of which they perceive as unbearable at the time. However, empirical investigation into the affective and cognitive states preceding NSSI has been limited, especially during daily life. The current study utilized ecological momentary assessment to measure multiple daily recordings of negative affect, repetitive negative thinking (RNT), and NSSI thoughts and behaviors among a community sample of adolescents and young adults (N = 47). Findings indicated that anxiety and feeling overwhelmed predicted NSSI most strongly when RNT was elevated, suggesting that these three factors may interact in a process creating an aversive affective state that self-injurers attempt to “escape” by engaging in NSSI.


Nonsuicidal self-injury Repetitive negative thinking Ecological momentary Assessment Negative affect Anxiety 



This study was funded by NSF Grant #1211079.

Compliance with Ethical Standards

Conflict of interest

Christopher Hughes, Alexandra King, Amy Kranzler, Kara Fehling, Alec Miller, Janne Lindqvist, Edward Selby declares that they have no conflicts of interest.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments.

Informed Consent

Informed consent was obtained from all participants in this study or their legal guardians, and all participants under the age of 18 provided assent to the study.

Supplementary material

10608_2019_9996_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 KB)


  1. Ambwani, S., Roche, M. J., Minnick, A. M., & Pincus, A. L. (2015). Negative affect, interpersonal perception, and binge eating behavior: An experience sampling study. International Journal of Eating Disorders, 48(6), 715–726.CrossRefGoogle Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington: American Psychiatric Association.CrossRefGoogle Scholar
  3. Andrewes, H. E., Hulbert, C., Cotton, S. M., Betts, J., & Chanen, A. M. (2016). Ecological momentary assessment of nonsuicidal self-injury in youth with borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 8(4), 357.CrossRefGoogle Scholar
  4. Armey, M. F., Crowther, J. H., & Miller, I. W. (2011). Changes in ecological momentary assessment reported affect associated with episodes of nonsuicidal self-injury. Behavior Therapy, 42(4), 579–588.CrossRefGoogle Scholar
  5. Beck, A. T., & Steer, R. A. (1990). Manual for the beck anxiety inventory. San Antonio, TX: Psychological Corporation.Google Scholar
  6. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory-II. San Antonio, 78(2), 490–498.Google Scholar
  7. Bentley, K. H. (2017). Applying the unified protocol transdiagnostic treatment to nonsuicidal self-injury and co-occurring emotional disorders: A case illustration. Journal of Clinical Psychology, 73(5), 547–558.CrossRefGoogle Scholar
  8. Bentley, K. H., Nock, M. K., & Barlow, D. H. (2014). The four-function model of nonsuicidal self-injury: Key directions for future research. Clinical Psychological Science, 2(5), 638–656.CrossRefGoogle Scholar
  9. Bryk, A. S., & Raudenbush, S. W. (1992). Hierarchical linear models newbury park. Calif: Sage Publications.Google Scholar
  10. Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44(3), 371–394.CrossRefGoogle Scholar
  11. Chapman, A. L., Specht, M. W., & Cellucci, T. (2005). Borderline personality disorder and deliberate self-harm: Does experiential avoidance play a role? Suicide and Life-Threatening Behavior, 35(4), 388–399.CrossRefGoogle Scholar
  12. Cipriano, A., De Maio, S., Cella, S., & Cotrufo, P. (2017). Nonsuicidal self-injury: A systematic review. Frontiers in Psychology, 8, 1946.CrossRefGoogle Scholar
  13. Claes, L., Vandereycken, W., & Vertommen, H. (2005). Self-care versus self-harm: Piercing, tattooing, and self-injuring in eating disorders. European Eating Disorders Review, 13(1), 11–18.CrossRefGoogle Scholar
  14. Cohen, J. N., Stange, J. P., Hamilton, J. L., Burke, T. A., Jenkins, A., Ong, M. L., Heimberg, R. G., Abramson, L. Y., & Alloy, L. B. (2015). The interaction of affective states and cognitive vulnerabilities in the prediction of non-suicidal self-injury. Cognition and Emotion, 29(3), 539–547.CrossRefGoogle Scholar
  15. De Giorgi, A., Fabbian, F., Piazza, G., Faccini, A., Menegatti, A. M., Storari, A., Grassi, L., & Manfredini, R. (2013). Acute renal failure secondary to suicidal behavior: A systematic minireview of case reports referred to the ED. The American Journal of Emergency Medicine, 31(8), 1283–1284.CrossRefGoogle Scholar
  16. Doshi, A., Boudreaux, E. D., Wang, N., Pelletier, A. J., & Camargo, C. A. (2005). National study of US emergency department visits for attempted suicide and self-inflicted injury, 1997–2001. Annals of Emergency Medicine, 46(4), 369–375.CrossRefGoogle Scholar
  17. Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205.CrossRefGoogle Scholar
  18. Fox, K. R., Franklin, J. C., Ribeiro, J. D., Kleiman, E. M., Bentley, K. H., & Nock, M. K. (2015). Meta-analysis of risk factors for nonsuicidal self-injury. Clinical Psychology Review, 42, 156–167.CrossRefGoogle Scholar
  19. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54.CrossRefGoogle Scholar
  20. Hamza, C. A., Stewart, S. L., & Willoughby, T. (2012). Examining the link between nonsuicidal self-injury and suicidal behavior: A review of the literature and an integrated model. Clinical Psychology Review, 32(6), 482–495.CrossRefGoogle Scholar
  21. Hilt, L. M., Cha, C. B., & Nolen-Hoeksema, S. (2008). Nonsuicidal self-injury in young adolescent girls: Moderators of the distress-function relationship. Journal of Consulting and Clinical Psychology, 76(1), 63.CrossRefGoogle Scholar
  22. Hoff, E. R., & Muehlenkamp, J. J. (2009). Nonsuicidal self-injury in college students: The role of perfectionism and rumination. Suicide and Life-Threatening Behavior, 39(6), 576–587.CrossRefGoogle Scholar
  23. Keough, M. E., Riccardi, C. J., Timpano, K. R., Mitchell, M. A., & Schmidt, N. B. (2010). Anxiety symptomatology: The association with distress tolerance and anxiety sensitivity. Behavior Therapy, 41(4), 567–574.CrossRefGoogle Scholar
  24. Klonsky, E. D. (2011). Non-suicidal self-injury in United States adults: Prevalence, sociodemographics, topography and functions. Psychological Medicine, 41(9), 1981–1986.CrossRefGoogle Scholar
  25. Klonsky, E. D., & Glenn, C. R. (2009). Assessing the functions of non-suicidal self-injury: Psychometric properties of the inventory of statements about self-injury (ISAS). Journal of Psychopathology and Behavioral Assessment, 31(3), 215–219.CrossRefGoogle Scholar
  26. Kranzler, A., Fehling, K. B., Lindqvist, J., Brillante, J., Yuan, F., Gao, X., et al. (2018). An ecological investigation of the emotional context surrounding nonsuicidal self-injurious thoughts and behaviors in adolescents and young adults. Suicide and Life-Threatening Behavior, 48(2), 149–159.CrossRefGoogle Scholar
  27. Laye-Gindhu, A., & Schonert-Reichl, K. A. (2005). Nonsuicidal self-harm among community adolescents: Understanding the “whats” and “whys” of self-harm. Journal of Youth and Adolescence, 34(5), 447–457.CrossRefGoogle Scholar
  28. Lee, C. H., Cha, S. M., & Shin, H. D. (2016). Injury patterns and the role of tendons in protecting neurovascular structures in wrist injuries. Injury, 47(6), 1264–1269.CrossRefGoogle Scholar
  29. Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford press.Google Scholar
  30. Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the penn state worry questionnaire. Behaviour Research and Therapy, 28(6), 487–495.CrossRefGoogle Scholar
  31. Michl, L. C., McLaughlin, K. A., Shepherd, K., & Nolen-Hoeksema, S. (2013). Rumination as a mechanism linking stressful life events to symptoms of depression and anxiety: Longitudinal evidence in early adolescents and adults. Journal of Abnormal Psychology, 122(2), 339.CrossRefGoogle Scholar
  32. Muehlenkamp, J. J., Claes, L., Havertape, L., & Plener, P. L. (2012). International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child and Adolescent Psychiatry and Mental Health, 6(1), 10.CrossRefGoogle Scholar
  33. Muehlenkamp, J. J., Engel, S. G., Wadeson, A., Crosby, R. D., Wonderlich, S. A., Simonich, H., & Mitchell, J. E. (2009). Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients. Behaviour Research and Therapy, 47(1), 83–87.CrossRefGoogle Scholar
  34. Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72(5), 885.CrossRefGoogle Scholar
  35. Nock, M. K., Prinstein, M. J., & Sterba, S. K. (2009). Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults. Journal of Abnormal Psychology, 118(4), 816.CrossRefGoogle Scholar
  36. Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta Earthquake. Journal of Personality and Social Psychology, 61(1), 115.CrossRefGoogle Scholar
  37. Raes, F., Hermans, D., Williams, J. M. G., Demyttenaere, K., Sabbe, B., Pieters, G., & Eelen, P. (2005). Reduced specificity of autobiographical memory: A mediator between rumination and ineffective social problem-solving in major depression? Journal of Affective Disorders, 87(2), 331–335.CrossRefGoogle Scholar
  38. Schimmenti, A., & Caretti, V. (2016). Linking the overwhelming with the unbearable: Developmental trauma, dissociation, and the disconnected self. Psychoanalytic Psychology, 33(1), 106.CrossRefGoogle Scholar
  39. Selby, E. A., Anestis, M. D., & Joiner, T. E. (2008). Understanding the relationship between emotional and behavioral dysregulation: Emotional cascades. Behaviour Research and Therapy, 46(5), 593–611.CrossRefGoogle Scholar
  40. Selby, E. A., Franklin, J., Carson-Wong, A., & Rizvi, S. L. (2013). Emotional cascades and self-injury: Investigating instability of rumination and negative emotion. Journal of Clinical Psychology, 69(12), 1213–1227.CrossRefGoogle Scholar
  41. Selby, E. A., Kranzler, A., Panza, E., & Fehling, K. B. (2016). Bidirectional-compounding effects of rumination and negative emotion in predicting impulsive behavior: Implications for emotional cascades. Journal of Personality, 84(2), 139–153.CrossRefGoogle Scholar
  42. Selby, E. A., & Joiner, T. E. Jr. (2013). Emotional cascades as prospective predictors of dysregulated behaviors in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 4(2), 168.CrossRefGoogle Scholar
  43. Starr, L. R., Stroud, C. B., & Li, Y. I. (2016). Predicting the transition from anxiety to depressive symptoms in early adolescence: Negative anxiety response style as a moderator of sequential comorbidity. Journal of Affective Disorders, 190, 757–763.CrossRefGoogle Scholar
  44. Swannell, S. V., Martin, G. E., Page, A., Hasking, P., & St John, N. J. (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta-regression. Suicide and Life-Threatening Behavior, 44(3), 273–303.CrossRefGoogle Scholar
  45. Tull, M. T., & Gratz, K. L. (2008). Further examination of the relationship between anxiety sensitivity and depression: The mediating role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed. Journal of Anxiety Disorders, 22(2), 199–210.CrossRefGoogle Scholar
  46. Victor, S. E., & Klonsky, E. D. (2014). Daily emotion in non-suicidal self-injury. Journal of Clinical Psychology, 70(4), 364–375.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Christopher D. Hughes
    • 1
  • Alexandra M. King
    • 1
  • Amy Kranzler
    • 2
  • Kara Fehling
    • 1
  • Alec Miller
    • 2
    • 3
  • Janne Lindqvist
    • 1
  • Edward A. Selby
    • 1
    Email author
  1. 1.Rutgers, The State University of New JerseyPiscatawayUSA
  2. 2.Montefiore Medical Center, Albert Einstein College of MedicineNew YorkUSA
  3. 3.Cognitive and Behavioral Consultants, LLPNew YorkUSA

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