Solving the puzzle of deliberate self-harm: the experiential avoidance model

Despite increasing attention to the phenomenon of deliberate self-harm (DSH), the literature currently lacks a unifying, evidence-based, theoretical framework within which to understand the factors that control this behavior. The purpose of the present paper is to outline such a framework-the Experiential Avoidance Model (EAM) of DSH. The EAM poses that DSH is primarily maintained by negative reinforcement in the form of escape from, or avoidance of, unwanted emotional experiences. Literature on factors that may lead to experiential avoidance is reviewed, along with the mounting empirical evidence that DSH functions to help the individual escape from unwanted emotional experiences. The EAM integrates a variety of research on emotions, experiential avoidance, and DSH within a clinically useful framework that sparks novel research directions.     

Audience reaction as a determinant of the speaker's self-persuasion

This paper tests effects of audience feedback on speaker attitudes. One hundred and seven male subjects with initial beliefs on both sides of an issue (women's role) were assigned to speak for or against their own position; then an “audience” provided one of three types of feedback (speaker was sincere, speaker was insincere, no feedback) in a 2 × 2 × 3 design. Subjects who received sincere feedback showed greater change in the direction of their speech than did those who received insincere feedback. No feedback treatments resulted in intermediate change. This sincere > no feedback > insincere ordering of means held for both pro- and counterattitudinal speakers and for both pretest attitudes. A main effect for pretest attitude was also obtained. Two additional control groups allow for a separate analysis of the effects of (1) preparing and delivering the speech, and (2) audience reaction to the speech.     

The deliberate control of emotional experience through control of expressions

Recent research suggests that deliberate manipulation of expressive behaviours might self-regulate emotional experiences. Eighty people were first induced to adopt emotional expressions in a successfully disguised procedure that identified whether their feelings were affected by their expressive behaviour when they were unaware of the nature and purpose of that behaviour. They then deliberately attempted to change emotional feelings by adopting or inhibiting emotional behaviours, or by focusing on or being distracted from situational cues for emotion. Participants more responsive to their own behaviour in the disguised procedure felt more intensely when they adopted emotional behaviours, and less intensely when they inhibited those behaviours. In contrast, people identified as unresponsive to their own emotional behaviour were most affected by deliberate focus on or distraction from emotional thoughts. The effectiveness of techniques for emotional self-regulation depends on a match with characteristics of the person.     

The purposes of laboratory experimentation and the virtues of deliberate artificiality

Critics of the laboratory experiment have maintained that artificiality (the intrusion into the experiment of “unrealistic” conditions) vitiates any possibility of generalizability beyond the confines of the laboratory. It is argued here that such artificiality in laboratory experimentation is a defect or flaw only within the context of verification and may be a distinct virtue in the context of discovery. Indeed it is argued that social psychological experiments may not be artificial enough when contrasted with the most fruitful experiments in the natural sciences. One purpose of an experiment may be to maximize artificiality deliberately so as to discover regularities that do not presently obtain under the “real” conditions outside the laboratory but which are capable of existing. When such observed laboratory regularities produce potentially beneficial outcomes, an attempt may be made to create the specific artificial laboratory conditions outside the laboratory to benefit mankind. This logic, exceedingly common in the natural sciences, has been virtually ignored in social psychology, even in the laboratory experiment, in favor of “realistic” reproduction of existing or reasonably plausible situations. Theoretical benefits of this additional modality of experimentation are illustrated by two recent developments in psychology.     

A strategic assessment of deliberate self-harm

This paper describes how patients are interviewed in the context of a general hospital after they have been involved in an episode of self-harm. The interview schedule is structured upon the principles of brief therapy, and uses the 'neutral' approach of the Milan Team (Weakland 1974; Palazzoli et al. 1980). The schedule provides information for referring on and has proved to be 'therapeutic' in itself. The method of interviewing has been used in other hospital contexts with families where a member has been referred 'in a crisis' threatening, or indicating suicidal behaviour. It is suggested that the identification of who is involved systemically is of paramount importance, and that this may not involve 'the family' but significant others in the social network. The important systemic involvement of the general practitioner is recognized.     

Psychiatric pain and deliberate suffering

In public opinion and in medical practice the suffering of psychiatric patients is often considered self‐induced. Freudian psychoanalysis embraced this notion but managed to reconcile it with the pleasure principle only by positing an instinctual craving for death, to which Freud reduced instances of deliberate and repetitive suffering. In a simultaneous but separate line of thought, he also reduced all habits, including self‐destructive ones, to masturbation and all inhibitions of constructive drives to inhibitions of masturbation. This article explores this seeming paradox.

The transition from a paranoid‐schizoid position to a depressive one begins with the dawning assumption of ownership of certain aspects of one's being, with the correlative attribution of other aspects to the world outside the self. Inevitable errors in this process create tensions that may be discharged by suffering, either by atonement or by assuming ownership of the pain that one's dependency might otherwise inflict on one's objects. Eros serves Thanatos to preserve self‐ownership. Pragmatically, owning one's fate can feel more important than enjoying it, a fact the author dubs the “Principle of Ownership”; and illustrates with a number of literary and clinical vignettes.

The idea that psychiatric suffering is self‐induced contributes to the stigma that so commonly attends it. Ironically, this same idea makes psychological treatment possible: if painful adjustments replace relationships, then new relationships may have the power to correct them.     

Painful engagement in deliberate self-harm: The role of conditional goal setting

Conditional goal setting is the tendency for people to see attainment of their future personal goals as necessary for their well-being. It has been argued that this represents an unhealthy way of relating to one’s goals, as well as being particularly problematic when goals are perceived as unlikely. High conditional goal setting has been found to be related to depression and to hopelessness. The present study examined conditional goal setting in deliberate self-harm, where problematic thinking about the future is very prominent. A group of individuals attending hospital for a recent episode of deliberate self-harm (N = 25) were compared with controls attending hospital for minor injuries (N = 25) as well as a psychologically disordered but non-suicidal control group (N = 25). Participants generated goals and rated goal likelihood, the extent to which those goals were seen as necessary for their future well-being (conditional goal setting), and also the extent to which the goals were seen as sufficient for their future well-being (goal sufficiency). Deliberate self-harm patients showed a higher degree of both conditional goal setting and goal sufficiency than did both of the other groups, further confirming the idea of painful engagement with personal goals, rather than disengagement, as characterising deliberate self-harm.     

Understanding deliberate practice in preschool-aged children

Deliberate practice is essential for skill acquisition and expertise and may be a direct consequence of episodic foresight. However, little is known about how deliberate practice develops in children. We present two experiments testing children's ability to selectively practise a behaviour that was going to be useful in future and to reason about the role of practice in skill formation. Five-year-olds demonstrated an explicit understanding of deliberate practice both in selectively choosing to practise a future-relevant skill and in predicting skill change in others based on their practice. Four-year-olds showed some capacities, but failed to demonstrate consistent understanding of the relationship between practice and skill improvement. Children's understanding of this relationship was significantly related to their understanding of how information leads to knowledge, suggesting that both may draw on similar cognitive developmental changes.     

The influence of cognitive emotion regulation strategies and depression severity on deliberate self-harm

Elaborating on previous studies on emotion regulation and deliberate self-harm (DSH), in the present study we distinguish between strategies of cognitive content (e.g., suicidal cognitions of perceived burdensomeness, helplessness, poor distress tolerance) and cognitive process (e.g., nonacceptance of emotional responses, lack of awareness of emotional responses). Young women who harmed themselves (n = 85) were compared with young women without a history of DSH (n = 93) across a broad range of strategies. Significant group differences were found for all measures, even when depression severity was controlled for. In addition, logistic regression analyses showed that both cognitive content strategies and cognitive process strategies made significant independent contributions to the prediction of group membership. Controlling for depression severity, suicidal cognitions, and nonacceptance of emotional responses independently predicted DSH. The strong association between suicidal cognitions and DSH seems to indicate the important role of these cognitions in recurrent and chronic DSH. The strong association between nonacceptance of emotional responses and DSH underscores the notion that DSH can be a way to avoid emotional problems. These findings are discussed in relation to recent cognitive-behavioral interventions and specific therapeutic techniques to further insight into how these interventions might work.     

The ventriloquist effect does not depend on the direction of deliberate visual attention

It is well known that discrepancies in the location of synchronized auditory and visual events can lead to mislocalizations of the auditory source, so-called ventriloquism. In two experiments, we tested whether such cross-modal influences on auditory localization depend on deliberate visual attention to the biasing visual event. In Experiment 1, subjects pointed to the apparent source of sounds in the presence or absence of a synchronous peripheral flash. They also monitored for target visual events, either at the location of the peripheral flash or in a central location. Auditory localization was attracted toward the synchronous peripheral flash, but this was unaffected by where deliberate visual attention was directed in the monitoring task. In Experiment 2, bilateral flashes were presented in synchrony with each sound, to provide competing visual attractors. When these visual events were equally salient on the two sides, auditory localization was unaffected by which side subjects monitored for visual targets. When one flash was larger than the other, auditory localization was slightly but reliably attracted toward it, but again regardless of where visual monitoring was required. We conclude that ventriloquism largely reflects automatic sensory interactions, with little or no role for deliberate spatial attention.     

The effect of the validity of co‐occurrence on automatic and deliberate evaluations

Co‐occurrence of an object and affective stimuli does not always mean that the object and the stimuli are the same valence (e.g., false accusations that Richard is a crook). Contemporary theory posits that information about the (in)validity of co‐occurrence has stronger influence on deliberate than automatic evaluation. However, available evidence supports that hypothesis only when the (in)validity information is delayed. Further, the existing evidence is open to alternative methodological accounts. In six high‐powered experiments (total N = 1750), we modified previous procedures to minimize alternative explanations and examine whether delayed (in)validity information has a discrepant effect on automatic versus deliberate evaluation. Casting doubt on the generality of the hypothesis, we found more sensitivity of deliberate than automatic evaluation to delayed validity information only when automatic evaluation was measured with the Implicit Association Test and not with the evaluative priming task or the affective misattribution procedure.     

To deliberate or not to deliberate: Interactions between age,task characteristics,and cognitive activity on decision making

The effects of aging and deliberative activities on decision making were examined. In two separate tasks, young, middle‐aged, and older adults were presented with four alternatives and given instructions to choose the best one. Following study, participants were either given additional time to think about their decision or were prevented from doing so. Decision quality did not benefit from additional deliberative activity when the structure of the stimuli facilitated fluent online processing. In contrast, deliberation promoted performance when such processing was more difficult. In addition, those individuals who focused on attribute information relevant to the decision context performed better than those who did not. Age differences in performance were minimal, but older adults with lower levels of education or cognitive ability tended to perform worse than the rest of the sample under conditions where deliberative skills were required to promote performance. The results are inconsistent with recent proposals regarding the benefits of passive deliberation. In addition, the results support the general assertion that the age effects in decision making will be most evident in situations dependent upon deliberative skills. Copyright © 2010 John Wiley & Sons, Ltd.     

A deliberate practice account of typing proficiency in everyday typists

The concept of deliberate practice was introduced to explain exceptional performance in domains such as music and chess. We apply deliberate practice theory to intermediate-level performance in typing, an activity that many people pursue on a regular basis. Sixty university students with several years typing experience participated in laboratory sessions that involved the assessment of abilities, a semistructured interview on typing experience as well as various typing tasks. In line with traditional theories of skill acquisition, experience (amount of typing since introduction to the keyboard) was related to typing performance. A perceptual speed test (digit-symbol substitution) and a measure of motor abilities (tapping) were not significantly related to performance. In line with deliberate practice theory, the highest level of performance was reported among participants who had attended a typing class in the past and who reported to adopt the goal of typing quickly during everyday typing. Findings suggest that even after several years of experience engagement in an everyday activity can serve as an opportunity for further skill improvement if individuals are willing to push themselves.     

Emotional antecedents and consequences of deliberate self-harm and suicide attempts

Emotional experiences immediately prior to (emotional antecedents) and following (emotional consequences) deliberate self-harm and suicide attempts in female inmates (N = 63) were examined. Anger was the antecedent emotion reported by the largest proportion of individuals who had engaged in deliberate self-harm (45.16%), suicide attempts (40.9%), and ambivalent suicide attempts (30%). Relief and other positive emotional shifts were more common in deliberate self-harm (41.94%) (involving no intent to die) than in suicide attempts or ambivalent suicide attempts, particularly for persons with borderline personality disorder. These findings underscore the utility of discriminating between deliberate self-harm and suicidal behavior and highlight the potential role of anger in triggering such behaviors.