CBT FOR SELF-HARM

• Unexplained scars, cuts, bruises or other wounds, usually on someone’s wrists, arms, thighs or chest
• Keeping themselves fully covered at all times, even in hot weather
• Keeping sharp objects on hand
• Looking for excuses to avoid sports
• Frequently wearing bandages
• Plasters and antiseptics hidden in room
• Behavioral and emotional instability, unpredictability and impulsivity
• Becoming very withdrawn
• Talking about themselves in a negative way, expressions of self-loathing, shame, worthlessness, and/or hopelessness.

Concerned friends or family sometimes jump to the conclusion that self-harm is a suicide attempt or gesture. However, note that researchers commonly refer to self-harm as NSSI – non-suicidal self-injury. People who self-harm do so in an effort to feel better and to cope with very painful emotions, not to end their life. To counteract physical pain, the brain releases endorphins, resulting in a short-lived sense of well-being and relief. Over time, people who self-harm associate self-injury with relief and consequently return for more.

Usually, the urge to hurt oneself is triggered by specific situations or events that result in a person feeling overwhelmed and upset. The person resorts to self-harming to calm themselves down and regain a sense of control. Thus, self-harm is a form of emotional regulation, a way of dealing with tension, distress and psychological pain, a coping mechanism that aims to reduce feelings of anxiety, depression, anger, guilt, shame, or numbness/deadness. Sometimes, it is a cry for help, an attempt to communicate emotional distress to others, although it’s more common for people who self-harm to be secretive and ashamed about their self-harming behaviours.

Lay people who don’t self-harm are often puzzled as to why someone would injure themselves; they may think people who self-harm ‘like’ pain because they are ‘wired differently’. However, that’s not the case at all – studies show that while people who self-harm are able to endure more pain, they find this pain to be very unpleasant.

Secondly, research shows almost everyone – not just people who self-harm – experience what’s known as pain offset relief (anyone who dips their hands into ice-cold water, for example, will experience a brief feeling of intense relief or euphoria after they remove their hands from the water).

So why do more people not inflict pain on themselves? Or, put another way, why do self-injurers harm themselves instead of choosing more pleasant ways of reducing painful emotions? Researchers have found that the more negative one’s self-image, the more likely one is to endure pain, and that people who self-harm are much more likely to describe themselves as “bad”, “defective” or “deserving of punishment”.

Misunderstanding in relation to the self-injurer’s actions and motives – in particular, the false notion that s/he is attention-seeking – only worsens the situation. Building self-esteem and repairing negative self-image is vital, so anyone looking to support someone who is self-harming should aim to be empathetic, patient, low-key and non-judgemental.  

Self-harming is a symptom of emotional distress, but also a cause of it.

• It can lead to unintended physical problems. College studies have found that about a third of self-injurers hurt themselves so badly that they should have been seen by a doctor, but only a very small minority sought treatment.
• It can lead to permanent scars or disfigurement.
• It compounds existing emotional problems by worsening feelings of shame, guilt and low self-esteem.
• Self-harming attempts should not, as noted earlier, be confused with suicide attempts. However, people who self-harm are more prone to depression and at greater risk of suicide, so it’s crucial to learn healthier ways of regulating emotional difficulties.

Self-harming can provide short-term relief from painful emotions, but it doesn’t address the underlying problems that are causing this distress.

Cognitive behavioural therapy (CBT) uses practical, evidence-based techniques to help people cope more effectively with life’s difficulties and to understand how thoughts, feelings and behaviours interact to influence mood. In therapy, we will work together to devise specific treatment goals, to manage your stresses and anxieties, to spot the triggers that cause you to self-harm, and to use coping strategies that help you to manage your distress in healthier ways.

There's a lot more to CBT than identifying and managing psychological vulnerabilities. I believe in strengths-based CBT, which means highlighting your signature strengths and interests, habitually engaging in everyday activities that boost mood and help you to flourish. 

Building self-esteem is also likely to be a core part of treatment. Low self-esteem is like a prejudice directed towards yourself, one underpinned by biased perceptions (you’re quick to spot things that confirm a negative self-image while downplaying or ignoring your strengths) and biased interpretations (for example, if someone says you are looking well, you take it to mean you had previously looked terrible or that they are ‘only being nice’). The damage caused by low self-esteem cannot be underestimated, and self-harming unfortunately compounds the problem; people berate themselves for their coping abilities and it leads to a vicious circle, whereby negative behaviours confirm negative thoughts and feelings.