Reduce self-injury behaviours by addressing what lies beneath them

In this article, I discuss ways to reduce non-suicidal self-injury behaviours by targeting the factors leading to the behaviours.

It may seem puzzling to an observer that someone would regularly choose to harm themselves through behaviours such as cutting, burning or head-banging. In reality, self-injury behaviours often represent ways of coping with various life issues much as many people use drinking, drugs, gambling, sex and various eating disorder behaviours for this purpose. In the following sections, I will distinguish non-suicidal self-injury from suicidal behaviours, describe how self-injury behaviours serve an emotion-management function and describe ways of reducing self-injury by helping people learn to manage their emotions constructively.

Non-suicidal self-injury

Non-suicidal self-injury (NSSI) is distinct from self-injury for the purpose of suicide. As its name indicates, when a person engages in NSSI they are not doing so with the motive of killing themselves although this dire consequence sometimes occurs. NSSI is primarily driven by the desire to cope with various life issues. One of the most frequent issues to which it is linked is difficulty in managing emotions.

Using self-injury to manage your emotions

Being able to manage your emotions can be challenging. For example, it can feel overwhelming to experience intense depression, anxiety, anger, frustration, guilt and many other emotions. People use self-injury behaviours to take the focus off these emotions so that they feel less overwhelmed. Self-injury helps them in this endeavor by creating a physical sensation on which they can focus rather than experiencing their emotions at a level they find intolerable.

In this sense, self-injury is one of many behaviours people may use when it is too difficult for them to experience their emotions. Alcohol and drug use, gambling, sex and eating disorder behaviours are also commonly used for this purpose. Like self-injury behaviours, each of these other behaviours comes with a steep price in return for the benefits they provide in terms of helping the person avoid having to deal with their emotions directly. In addition, self-injury and these other destructive ways of coping with emotions provide only a temporary respite from experiencing the emotions being avoided. That is, self-injury and these other behaviours do not provide strategies for managing one’s emotions so that the person is less likely to be overwhelmed while experiencing them.

Reduce the need for self-injury by practicing strategies to manage your emotions

Fortunately, there are many easy-to-learn strategies for managing emotions so that a person is not overwhelmed by them. These strategies fall into different categories: (1) Behavioural strategies focus on a person engaging in downtime/de-stressing behaviours as well as using distraction/attention-switching to take the focus off the negative thoughts which drive up the intensity of your emotions; (2) Physical relaxation strategies help a person manage their emotions by directly relaxing their body. Diaphragmatic breathing, muscle relaxation, meditation and imagery are examples of these strategies; (3) Cognitive strategies focus on identifying ‘hot thoughts’ which lead to intense emotional states and changing these to ‘balanced thoughts’ which lower the intensity of emotions to the point that they are manageable and not overwhelming; (4) Problem-solving strategies focus on addressing life problems such as those related to work, finances and relationships. Taking action on life problems helps to lower the intensity of emotions by targeting the events and situations which often precipitate the experience of emotions; (5) Communication/assertiveness skills help a person manage their emotions by providing them with effective ways to express their needs to others.

Giving the emotion-management strategies a chance to work

As with the other behaviours I’ve mentioned which focus on avoidance as an emotion-management strategy, with self-injury it takes practice to move away from this habit which provides quick relief from feeling overwhelmed. The key to success is in working with a therapist who will teach you emotion-management skills and help you practice using these skills rather than engaging in self-injury behaviours when situations in your life lead you to experience strong emotions. With practice, you will learn that you have skills to control the intensity of your emotional reactions so that you are not overwhelmed by them. With these skills in your repertoire, your need to engage in self-injury or any of the other emotion-avoidance strategies I discussed will diminish.

I teach my clients these skills in my practice as a Calgary psychologist and a Cochrane psychologist in depression counselling, anxiety counselling, trauma counselling, addiction counselling, eating disorders counselling, anger management counselling, stress management counselling, self-esteem counselling and couples counselling.

May you practice skills to manage your emotions,

-Dr. Pat