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.
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Several measures of psychopathology (Inventory of statements about self-injury, Klonsky and Glenn 2009; Beck Depression Inventory; Beck et al. 1996; Beck Anxiety Inventory; Beck and Steer 1990; Difficulties with Emotion Regulation Scale; Gratz and Roemer 2004; & Ruminative Response Scale; Nolen-Hoeksema and Morrow 1991) completed by participants were also included as potential covariates in our analyses, however none were significant predictors of variables of interest (described below in analysis plan) when included in models containing momentary assessment items. Therefore, in the interest of clarity and brevity, the measures were not described in the methods or results sections of this paper.
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This study was funded by NSF Grant #1211079.
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.
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 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.
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Hughes, C.D., King, A.M., Kranzler, A. et al. Anxious and Overwhelming Affects and Repetitive Negative Thinking as Ecological Predictors of Self-Injurious Thoughts and Behaviors. Cogn Ther Res 43, 88–101 (2019). https://doi.org/10.1007/s10608-019-09996-9