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Pilot Study: Cut the Cut—A Treatment Program for Adolescent Inpatients with Nonsuicidal Self-Injury

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Abstract

Non-suicidal-self-injury (NSSI) in adolescents needing inpatient treatment is a serious health risk behaviour. NSSI-specific treatment programs for inpatients hardly exist. “Cut the Cut” (CTC) is a new treatment program in intervals, addressing this problem. Aim of this pilot-study was to evaluate acceptability and feasibility of CTC. 23 female inpatients (12 CTC, 11 control, aged 15–17; mean = 16.80, SD.70) engaging in NSSI were evaluated for service user satisfaction, frequency, and severity of NSSI at T1 (admission), T2 (discharge after interval 1, CTC-group) and T3 (discharge). A qualitative interview was performed at T3. Significant improvement in NSSI-frequency was given (T1–T3: CTC p = 0.010; control p = 0.038). Severity of NSSI reduced slightly (mild NSSI: CTC p = 0.022, control p = 0.087; severe NSSI: CTC p = 0.111, control p = 0.066). Satisfaction of parents (T3 mean 28.38) and adolescents (T3 mean 26.11) in CTC was rated high. CTC is a feasible treatment option for inpatients engaging in NSSI. Further studies over time are needed.

Trial registration Number DRKS00016762, 05.03.2019, retrospectively registered

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References

  1. Lloyd-Richardson EE, Perrine N, Dierker L, Kelley ML (2007) Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychol Med 37(8):1183–1192

    Article  PubMed  PubMed Central  Google Scholar 

  2. Zetterqvist M (2015) The DSM-5 diagnosis of nonsuicidal self-injury disorder: a review of the empirical literature. Child Adolesc Psychiatry Ment Health 9:31

    Article  PubMed  PubMed Central  Google Scholar 

  3. Plener PL, Allroggen M, Kapusta ND, Brähler E, Fegert JM, Groschwitz RC (2016) The prevalence of Nonsuicidal Self-Injury (NSSI) in a representative sample of the German population. BMC Psychiatry 16(1):353

    Article  PubMed  PubMed Central  Google Scholar 

  4. Plener PL, Schumacher T, Munz L, Groschwitz R (2015) The longitudinal course of non-suicidal self-injury and deliberate self-harm: a systematic review of the literature. Borderline Personal Disorder Emotion Dysregul 2(1):2

    Article  Google Scholar 

  5. Brunner R, Kaess M, Parzer P, Fischer G, Carli V, Hoven CW et al (2014) Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: a comparative study of findings in 11 European countries. J Child Psychol Psychiatry 55:337–348

    Article  PubMed  Google Scholar 

  6. Swannell SV, Martin GE, Page A, Hasking P, St John NJ (2014) Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide Life Threat Behav 44(3):273–303

    Article  PubMed  Google Scholar 

  7. Seveke K, Bock A, Fenzel L, Gander M, Fuchs M (2017) Nonsuicidal self-injury in a naturalistic sample of adolescents undergoing inpatient psychiatric treatment: prevalence, gender distribution and comorbidities. Psychiatrica Danubina 29(4):522–528

    Article  Google Scholar 

  8. Kaess M, Parzer P, Mattern M, Plener PL, Bifulco A, Resch F et al (2013) Adverse childhood experiences and their impact on frequency, severity, and the individual function of nonsuicidal self-injury in youth. Psychiatry Res 206:265–272

    Article  PubMed  Google Scholar 

  9. Andover MS, Morris BW, Wren A, Bruzzese ME (2012) The co-occurrence of non-suicidal self-injury and attempted suicide among adolescents: distinguishing risk factors and psychosocial correlates. Child Adolesc Psychiatry Ment Health 6:11

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hawton K, Bergen H, Cooper J, Turnbull P, Waters K, Ness J et al (2015) Suicide following self-harm: findings from the multicentre study of self-harm in England, 2000–2012. J Affect Disord 175:147–151

    Article  PubMed  Google Scholar 

  11. Nakar O, Brunner R, Schilling O, Chanen A, Fischer G, Parzer P et al (2016) Developmental trajectories of self-injurious behavior, suicidal behavior and substance misuse and their association with adolescent borderline personality pathology. J Affect Disord 197:231–238

    Article  PubMed  Google Scholar 

  12. Groschwitz RC, Kaess M, Fischer G, Ameis N, Schulze UM, Brunner R et al (2015) The association of non-suicidal self-injury and suicidal behavior according to DSM-5 in adolescent psychiatric inpatients. Psychiatry Res 228:454–461

    Article  PubMed  Google Scholar 

  13. Mehlum L, Ramberg M, Tørmoen AJ, Haga E, Diep LM, Stanley BH et al (2016) Dialectical behavior therapy compared with enhanced usual care for adolescents with repeated suicidal and self-harming behavior: outcomes over a 1-year follow-up. J Am Acad Child Adolesc Psychiatry 55:295–300

    Article  PubMed  Google Scholar 

  14. Tørmoen AJ, Groholt B, Haga E, Brager-Larsen A, Miller A et al (2014) Feasibility of dialectical behavior therapy with suicidal and self-harming adolescents with multi-problems: training, adherence, and retention. Arch Suicide Res 18:432–444

    Article  PubMed  Google Scholar 

  15. Taylor LMW, Oldershaw A, Richards C, Davidson K, Schmidt U et al (2011) Development and pilot evaluation of a manualized cognitive-behavioural treatment package for adolescent self-harm. Behav Cogn Psychother 39:619–625

    Article  PubMed  Google Scholar 

  16. Fischer G, Brunner R, Parzer P, Resch F, Kaess M (2013) Short-term psychotherapeutic treatment in adolescents engaging in nonsuicidal self-injury: a randomized controlled trial. Trials 14:294

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chanen AM, Jackson HJ, McCutcheon LK (2008) Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: a randomised controlled trial. Br J Psychiatry 193:477–484

    Article  PubMed  Google Scholar 

  18. Rossouw TI, Fonagy P (2012) Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 51:1304–1313

    Article  PubMed  Google Scholar 

  19. Campbell-Sills L, Ellard KK, Barlow DH (2012) Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. In: Gross JJ (ed) Handbook of emotion regulation. Guilford Press, New York

    Google Scholar 

  20. Ougrin D, Tranah T, Stahl D, Moran P (2015) Therapeutic interventions for suicide attempts and self-harm in adolescents: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 54(2):97

    Article  PubMed  Google Scholar 

  21. Glenn CR, Franklin JC, Nock MK (2015) Evidence-based psychosocial treatments for self-injurious thoughts and behaviors in youth. J Clin Child Adolesc Psychiatry 44(1):1–29

    Article  Google Scholar 

  22. Slesinger NC, Hayes NA, Washburn JJ (2020) Understanding predictors of change in a day treatment setting for non-suicidal self-injury. Psychol Psychother. https://doi.org/10.1111/papt.12295

    Article  PubMed  Google Scholar 

  23. Selby EA, Franklin J, Carson-Wong A, Rizvi SL (2013) Emotional cascades and self-injury: investigating instability of rumination and negative emotion. J Clin Psychol 69:1213–1227

    Article  PubMed  Google Scholar 

  24. Bresin K (2014) Five indices of emotion regulation in participants with a history of nonsuicidal self-injury: a daily diary study. Behav Ther 45:56–66

    Article  PubMed  Google Scholar 

  25. Vansteelandt K, Claes L, Muehlenkamp J, De Cuyper K, Lemmens J, Probst M et al (2013) Variability in affective activation predicts non-suicidal self-injury in eating disorders. Eur Eat Disord Rev 21:143–147

    Article  PubMed  Google Scholar 

  26. Reitz S, Kluetsch R, Niedtfeld I, Knorz T, Lis S, Paret C, Kirsch P, Meyer-Lindenberg A, Treede RD, Baumgärtner U, Bohus M (2015) Incision and stress regulation in borderline personality disorder: neurobiological mechanisms of self-injurious behaviour. Br J Psychiatry 207(2):165–172

    Article  PubMed  Google Scholar 

  27. Paris J (2004) Is hospitalization useful for suicidal patients with borderline personality disorder? J Pers Disord 18:240–247

    Article  PubMed  Google Scholar 

  28. Linehan MM (l993) Cognitive behavioral therapy of borderline personality disorder. Guilford, New York

  29. Fowler CJ, Clann JD, Madan A, Allan JG, Frueh BC, Fonagy P, Oldham JM (2018) A naturalistic longitudional study of extended inpatient treatment for adults with borderline personality disorder: an examination of treatment response. J Affect Disorders 235:323–331

    Article  PubMed  Google Scholar 

  30. Garland AF, Aarons G, Saltzman M, Kruse M (2000) Correlates of adolescents’ satisfaction with mental health services. Ment Health Serv Res 2:127–139

    Article  PubMed  Google Scholar 

  31. Ross S, Heath NL (2002) A study of the frequency of self-mutilation in a community sample of adolescents. J Youth Adolesc 31(1):67–77

    Article  Google Scholar 

  32. Bonnenberger M, Plener PL, Kirchner I, Keller F (2013) Wie ich mit Stress umgehe. Nervenheilkunde 1–2:11–16

    Google Scholar 

  33. Toste JR, Christie M & Heath NL (2011) How do I deal with stress (HIDS): evidence for the use of an NSSI screening questionnaire among young adults. Poster session presented at the annual meeting of the International Society for the Study of Self-Injury, New York, NY

  34. Lloyd EE, Kelley ML, Hope T (1997) Self-mutilation in a community sample of adolescents: descriptive characteristics and provisional prevalence rates. Poster session at the annual meeting of the Society for Behavioral Medicine; New Orleans, LA

  35. Attkisson CC, Zwick RJ (1982) The Client Satisfaction Questionnaire: psychometric properties and correlations with service utilization and psychotherapy outcome. Eval Program Plann 5(3):233–237

    Article  PubMed  Google Scholar 

  36. Schmidt J, Lamprecht F, Wittmann WW (1989) Zufriedenheit mit der stationären Versorgung. Entwicklung eines Fragebogens und erste Validitätsuntersuchungen. Psychother Psychosom Med Psychol 39:248–255

    PubMed  Google Scholar 

  37. Kriz D, Nübling R, Steffanowski A, Rieger J, Schmidt J (2008) Patientenzufriedenheit: Psychometrische Reanalyse des ZUF-8. 2008. DRV-Schriften 77:84–85

    Google Scholar 

  38. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  PubMed  Google Scholar 

  39. Mayring P (2000) Qualitative content analysis. In Forum qualitative sozialforschung / forum: qualitative social research

  40. McHugh ML (2012) Interrater reliability: the kappa statistic. Biochemica Medica 22(3):276–282

    Article  Google Scholar 

  41. Arland AF, Haine RA, LewczykBoxmeyer C (2007) Determinates of youth and parent satisfaction in usual care psychotherapy. Eval Progr Plan 30(1):45–54

    Article  Google Scholar 

  42. Evans E, Hawton K, Rodham K (2005) In what ways are adolescents who engage in self-harm or experience thoughts of self-harm different in terms of help-seeking, communication and coping strategies? J Adolesc 28(4):573–587

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department for Child and Adolescent Psychiatry, ZfP Suedwuerttemberg, CAP, Weingartshoferstrasse 2, 88214, Ravensburg, Germany

    Isabel Boege & Nina Scheider

  2. University of Ulm, CAP, Steinhoevelstrasse 5, 89075, Ulm, Germany

    Isabel Boege, Nicole Schubert & Joerg M. Fegert

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  1. Isabel Boege
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  2. Nicole Schubert
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  3. Nina Scheider
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  4. Joerg M. Fegert
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Correspondence to Isabel Boege.

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Boege, I., Schubert, N., Scheider, N. et al. Pilot Study: Cut the Cut—A Treatment Program for Adolescent Inpatients with Nonsuicidal Self-Injury. Child Psychiatry Hum Dev 53, 928–940 (2022). https://doi.org/10.1007/s10578-021-01174-x

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