Deliberate self-harm in 15-year-old adolescents: a pilot study with a modified version of the Deliberate Self-Harm Inventory

The purpose of the present study was to investigate the rate of deliberate self-harm in 15-year-old Swedish adolescents, gender differences in this behavior, and possible associations with self-esteem and mindfulness. For this purpose, we developed a simplified version of Gratz's (2001) Deliberate Self-Harm Inventory (DSHI), and carried out a pilot study with 123 adolescents from three different schools in southern Sweden. The results showed that 65.9% of the adolescents reported having engaged in some kind of deliberate self-harm at least once; 41.5% reported at least one kind of self-harm more than once; and 13.8% reported at least one kind of deliberate self-harm behavior "many times". Although there were no overall gender differences in self-harm, the girls reported significantly more of cutting wrists, arms and other body areas than the boys. High rates of deliberate self-harm were associated with low self-esteem and low mindfulness.     

Dialectical Behavior Therapy: An Emotion-Focused Treatment for Borderline Personality Disorder

Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment for borderline personality disorder (BPD) that is based on the theory that emotion dysregulation is the core feature of BPD. This article focuses on aspects of DBT theory and techniques that specifically address emotion. The dialectical and biosocial theories that underlie DBT are reviewed with an emphasis on how each relates to emotional experiencing in BPD. Selected treatment strategies that address emotion dysregulation and their hypothesized mechanisms of change are also described. Relevant research findings are incorporated throughout to provide an empirical foundation for the DBT theories and strategies that are discussed.     

Measurement of Deliberate Self-Harm: Preliminary Data on the Deliberate Self-Harm Inventory

Deliberate self-harm has recently begun to receive more systematic attention from clinical researchers. However, there remains a general lack of consensus as to how to define and measure this important clinical construct. There is still no standardized, empirically validated measure of deliberate self-harm, making it more difficult for research in this area to advance. The present paper provides an integrative, conceptual definition of deliberate self-harm as well as preliminary psychometric data on a newly developed measure of self-harm, the Deliberate Self-Harm Inventory (DSHI). One hundred and fifty participants from undergraduate psychology courses completed research packets consisting of the DSHI and other measures, and 93 of these participants completed the DSHI again after an interval of 2–4 weeks (M = 3.3 weeks). Preliminary findings indicate that the DSHI has high internal consistency; adequate construct, convergent, and discriminant validity; and adequate test-retest reliability.     

Emotion-Focused Therapy: A Synopsis

The basic principles of an emotion-focused approach to therapy (EFT) are presented. In this view, emotion is seen as foundational in the construction of the self and is a key determinant of self-organization. As well as simply having emotion, people also live in a constant process of making sense of their emotions. Personal meaning emerges by the self-organization and explication of one’s own emotional experience, and optimal adaptation involves an integration of reason and emotion. In EFT, distinctions between different types of emotion (i.e., primary versus secondary, adaptive versus maladaptive) provide therapists with a map for differential intervention. Therapists are viewed as emotion coaches who help people become aware of, accept, and make sense of their emotional experience. Four major empirically supported principles of emotion awareness, emotion regulation, emotion transformation and reflection on emotion guide emotion coaching and serve as the goals of treatment. A case example illustrates how the principles of EFT helped a young woman to overcome her core maladaptive fears and mobilize her ability to protect herself.     

Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients

Bulimia nervosa and non-suicidal self-injury (NSSI) co-occur at high rates, and both have been conceptualized as maladaptive emotion regulation strategies. Treatments focusing on emotion regulation have been designed for both problem behaviors, yet, there exists very little research examining the temporal emotional states surrounding acts of NSSI. Using ecological momentary assessment (EMA) methodology, the current study examined the temporal association between positive and negative emotional states prior to and consequent to acts of NSSI within a subset of bulimia nervosa patients. Results indicate significant increases in negative affect, and decreases in positive affect, prior to an NSSI act. Post-NSSI, positive affect significantly increased while negative affect remained unchanged. The findings offer partial support for an emotion regulation paradigm to understanding NSSI within bulimic populations and implications for treatment are discussed.     

Individual differences in attachment and dispositional mindfulness: The mediating role of emotion regulation

Recent interest in the relationship between individual differences in attachment and dispositional mindfulness has led to empirical investigations into this association. Although several studies have demonstrated an association between attachment and mindfulness, little is known as to why these two seemingly distinct constructs are related. In a sample of 572 individuals we explored whether the relationship between attachment and mindfulness was mediated by emotion regulation difficulties. Difficulties in emotion regulation fully mediated the association between attachment anxiety and mindfulness, and between attachment avoidance and mindfulness. Thus, the mechanism by which attachment and mindfulness are related is through emotion regulation difficulties. Theoretical and clinical implications are discussed.     

The Contribution of Emotionally Focused Couples Therapy

This article describes emotionally focused couple therapy and the contribution of this model to the field of couple therapy. A focus on emotional processing in the present moment, on process factors and on a genuine empathic connection with both clients is at the heart of this model. The creation of new patterns of emotional responses results in the creation of key new interactional responses. EFT is empirically validated on several levels: on the level of treatment outcome, and on the levels of the relational theory in which it is based and key moments and factors in the change process.     

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.     

Deliberate Self-Harm and State Dissociation: An Experimental Investigation

The purpose of this study was to test the relation between deliberate self-harm (DSH) and state dissociation. Participants (N = 85) were randomly assigned to self-administer either a very mild electric shock below their pain threshold (a no-self-harm control condition) or an electric shock they were told could “cause minor tissue damage that would heal quickly,” but which was in fact equal to a predetermined pain threshold (a DSH condition). After task completion, 42 participants rated the extent of their dissociation before the shock and 43 rated the extent of their dissociation after the shock. Results indicated that women in the DSH group experienced more dissociation compared to men, but only after the shock. Potential reasons for this gender effect are discussed.     

Emotion-Focused Therapy for Couples in the Treatment of Depression: A Pilot Study

Emotion-focused therapy (EFT) for couples was compared to pharmacotherapy in the treatment of major depressive disorder. Eighteen distressed couples in which the female partner met diagnostic criteria for major depressive disorder were randomly assigned to 16 weekly sessions of emotion-focused therapy or pharmacotherapy with desipramine, trimipramine, or trazadone. Twelve couples completed the study. Both interventions were equally effective in symptom reduction. There was some evidence that females receiving EFT made greater improvement after the conclusion of treatment than those receiving pharmacotherapy. The results suggest EFT might be useful in the treatment of comorbid major depressive disorder and relational distress.     

Attachment representations and characteristics of friendship relations during adolescence

Attachment theory proposes that experiences with the primary caregivers are an important basis for the development of close social relationships outside the parent-child relationship. This study examined the association between representations of attachment, as assessed with the Adult Attachment Interview (AAI), representations of friendship and peer relations, as assessed with an interview in a sample of 43 adolescents. Secure attachment representations were significantly related to interview-based assessments of close friendships, friendship concept, integration in a peer group, and emotion regulation within close friendships. Attachment experiences reported during the AAI, their integration, and their coherency were related to friendship quality and friendship concept. Results show the close associations between attachment representations and friendship relationships during adolescence. The associations between peer relations and attachment representations differed depending on whether an interview approach or a questionnaire approach was used.     

Mediating and Moderating Processes in the Relation between Maltreatment and Psychopathology: Mother-Child Relationship Quality and Emotion Regulation

The present study investigated underlying processes of the effect of maltreatment on psychopathology (i.e., internalizing and externalizing problems) in a group of 111 maltreated and 110 nonmaltreated 7–10 year-old children (60% boys). We tested the moderating and/or mediating roles of emotion regulation and the mother-child relationship quality (pattern of relatedness) using Structural Equation Modeling. Emotion regulation, but not the pattern of relatedness, mediated the relation between maltreatment and psychopathology. This mediation was moderated by the pattern of relatedness: For the group of children with an insecure pattern of relatedness, maltreatment was related to lower levels of emotion regulation, which was predictive of higher levels of internalizing and externalizing symptomatology. In contrast, for the secure relatedness group, there was no mediation by emotion regulation since the impact of maltreatment on emotion regulation was not significant. Implications of the mediating role of emotion regulation and the buffering role of the mother-child relationship quality were discussed.

Proposal for a Distinctive Diagnosis: the Deliberate Self-Harm Syndrome (DSH)

ABSTRACT: Self-destructive behavior is a major clinical problem in psychiatry. A review of the literature reveals the existence of enough clinical data to identify a diagnostic entity, “The Deliberate Self-Harm Syndrome” (DSH). The authors present a diagnostic formulation of the DSH syndrome (in the DSM-III format) which consists of four essential clinical features, a group bof associteds features, clinical features, a group of associated features, a clinical course of typical onset in late adolescence, with multiple recurent episodes, with multiple methods of low lethality physical self-injury, extending over many years. On the basis of relatively exclusive association of clinical signs and symptoms a heuristic clinical entity is proposed.     

Infant emotion regulation: Relations to bedtime emotional availability,attachment security,and temperament

The present study examines the influences of mothers’ emotional availability toward their infants during bedtime, infant attachment security, and interactions between bedtime parenting and attachment with infant temperamental negative affectivity, on infants’ emotion regulation strategy use at 12 and 18 months. Infants’ emotion regulation strategies were assessed during a frustration task that required infants to regulate their emotions in the absence of parental support. Whereas emotional availability was not directly related to infants’ emotion regulation strategies, infant attachment security had direct relations with infants’ orienting toward the environment and tension reduction behaviors. Both maternal emotional availability and security of the mother–infant attachment relationship interacted with infant temperamental negative affectivity to predict two strategies that were less adaptive in regulating frustration.     

Emotion-Focused Therapy: An Interview with Leslie Greenberg

Over the past 30 years Leslie Greenberg has developed and refined the Emotion-Focused Therapy (EFT) approach. This therapy model stands apart from other, humanistic-based approaches in its focus on empiricism. In addition, EFT is one of the few therapy models that is truly integrative in nature, combining client-centered, gestalt, and cognitive principles. This paper includes a recent interview with Greenberg in which he describes the development of EFT and his views regarding future directions of EFT, as well as his views on the field of psychotherapy more generally.     

Care vs Food as an Emotional Regulation Strategy in Elementary School Children: The Role of the Attachment Style

Abstract

According to attachment theory, potentially threatening stimuli tend to activate the attachment system for the search of the protective figure. In secure attachments, the experience of responsive relationships increases the probability of resorting to available figures as a strategy for regulating emotions in stressful situations. The aim of the research was to verify whether, in conditions of mild threat, children’s attachment styles affect the choice between caring relationships and food as a form of emotion regulation. We used a mixed experimental design to perform this research. Here, we presented children (N?=?65; M_age= 9.4) with threatening and neutral images and, afterwards, asked them to select from images of caring relationship or images of food. The results indicate that securely and ambivalently attached but not avoidantly attached children under both the neutral and threatening image conditions chose the care pictures over the food pictures. Second, only the securely attached increased their choice of care over food images in the threatening condition, and third, this difference was significant when compared with the avoidant children. In conclusion, the results show that although in general the choice of care is primary with respect to food, children with insecure attachments differ from secure children between the two options of emotional regulation.     

Preschoolers’ distress and regulatory behaviors vary as a function of infant–mother attachment security

Children (N = 98) with higher attachment security scores, and lower resistance and avoidance scores during the Strange Situation at 16 months demonstrated somewhat more adaptive observed and mother-reported emotion regulation as preschoolers independent of maternal behavior.     

Emotion-Focused Cognitive-Behavioral Therapy for Youth with Anxiety Disorders: A Randomized Trial

Difficulties with emotion regulation are a core feature of anxiety disorders (ADs) in children and adults. Interventions with a specific focus on emotion regulation are gaining empirical support. Yet, no studies to date have compared the relative efficacy of such interventions to existing evidence-based treatments. Such comparisons are necessary to determine whether emotion-focused treatments might be more effective for youth exhibiting broad emotion-regulation difficulties at pretreatment. This study examined an emotion-focused cognitive-behavioral therapy (ECBT) protocol in comparison to traditional cognitive-behavioral therapy (CBT) in a sample of children with a primary anxiety disorder diagnosis. Moderation analyses examined whether children with higher levels of emotion dysregulation at pretreatment would show greater levels of improvement in ECBT than CBT. Ninety-two youth ages 7 to 12 years (58% male) with a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia were included. Participants were randomly assigned to ECBT or CBT. Results showed that youth in both conditions demonstrated similar improvements in emotion regulation and that pretreatment levels of emotion dysregulation did not moderate treatment outcomes. Additional analyses showed that ECBT and CBT were similarly effective on diagnostic, severity, and improvement measures. Future work is needed to further explore the ways that emotion regulation is related to treatment outcome for anxious youth.