Experiences of an Online Treatment for Adolescents With Nonsuicidal Self-injury and Their Caregivers: Qualitative Study

Ojala, Olivia; Engberg, Hedvig; Bjureberg, Johan; Ljótsson, Brjánn; Stensils, Julia; Sahlin, Hanna; Hellner, Clara

doi:10.2196/17910

Cited by 9 publications

(10 citation statements)

References 55 publications

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“…The therapist-guided IERITA used in this study had been optimized based on feasibility studies, [15][16][17] and feedback from patients and end-user representatives. IERITA is a web-based, acceptance-based behavioral treatment that includes 11 modules for the adolescent participant and 6 modules for the parents delivered over the course of 12 weeks.…”

Section: Interventionsmentioning

confidence: 99%

“…8,9 Open trial data provide support for the utility of a 12-week internet-delivered emotion regulation individual therapy for adolescents (IERITA) in the treatment of NSSI. [15][16][17] Not only does this treatment aim to improve NSSI by directly targeting its underlying mechanism of emotion dysregulation, internet-delivered treatments with minimal clinician support have the potential to augment community therapy and increase availability of specialized psychological treatments. [18][19][20] This study presents the results from what is to our knowledge the first randomized clinical trial of internet-delivered treatment for adolescents with NSSID.…”

Section: Introductionmentioning

confidence: 99%

“…Emotion regulation has been identified as one of the most relevant mechanisms underlying this behavior, and a key mechanism of change in NSSI interventions . Open trial data provide support for the utility of a 12-week internet-delivered emotion regulation individual therapy for adolescents (IERITA) in the treatment of NSSI . Not only does this treatment aim to improve NSSI by directly targeting its underlying mechanism of emotion dysregulation, internet-delivered treatments with minimal clinician support have the potential to augment community therapy and increase availability of specialized psychological treatments …”

Section: Introductionmentioning

confidence: 99%

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Effect of Internet-Delivered Emotion Regulation Individual Therapy for Adolescents With Nonsuicidal Self-Injury Disorder

et al. 2023

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ImportanceNonsuicidal self-injury is prevalent in adolescence and associated with adverse clinical outcomes. Effective interventions that are brief, transportable, and scalable are lacking.ObjectiveTo test the hypotheses that an internet-delivered emotion regulation individual therapy for adolescents delivered adjunctive to treatment as usual is superior to treatment as usual only in reducing nonsuicidal self-injury and that improvements in emotion regulation mediate these treatment effects.Design, Setting, and ParticipantsThis 3-site, single-masked, randomized superiority trial enrolled participants from November 20, 2017, to April 9, 2020. Eligible participants were aged between 13 and 17 years and met diagnostic criteria for nonsuicidal self-injury disorder; they were enrolled as a mixed cohort of consecutive patients and volunteers. Parents participated in parallel to their children. The primary end point was at 1 month after treatment. Participants were followed up at 3 months posttreatment. Data collection ended in January 2021.InterventionsTwelve weeks of therapist-guided, internet-delivered emotion regulation individual therapy delivered adjunctive to treatment as usual vs treatment as usual only.Main Outcomes and MeasuresPrimary outcome was the youth version of the Deliberate Self-harm Inventory, both self-reported by participants prior to treatment, once every week during treatment, and for 4 weeks posttreatment, and clinician-rated by masked assessors prior to treatment and at 1 and 3 months posttreatment.ResultsA total of 166 adolescents (mean [SD] age, 15.0 [1.2] years; 154 [92.8%] female) were randomized to internet-delivered emotion regulation therapy plus treatment as usual (84 participants) or treatment as usual only (82 participants). The experimental intervention was superior to the control condition in reducing clinician-rated nonsuicidal self-injury (82% vs 47% reduction; incidence rate ratio, 0.34; 95% CI, 0.20-0.57) from pretreatment to 1-month posttreatment. These results were maintained at 3-month posttreatment. Improvements in emotion dysregulation mediated improvements in self-injury during treatment.Conclusions and RelevanceIn this randomized clinical trial, a 12-week, therapist-guided, internet-delivered emotion regulation therapy delivered adjunctive to treatment as usual was efficacious in reducing self-injury, and mediation analysis supported the theorized role of emotion regulation as the mechanism of change in this treatment. This treatment may increase availability of evidence-based psychological treatments for adolescents with nonsuicidal self-injury.Trial RegistrationClinicalTrials.gov Identifier: NCT03353961

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Section: Interventionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Internet-Delivered Emotion Regulation Individual Therapy for Adolescents With Nonsuicidal Self-Injury Disorder

et al. 2023

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“…The STAR consortium behind this cognitive intervention has now taken on the task of investigating I‐CDP as an online therapeutic intervention ( Star‐Projekt ). The Swedish and Danish feasibility studies of the internet‐based intervention ERITA (J Bjureberg et al., 2018 ; Morthorst et al., 2021 ; Simonsson et al., 2021 ) plus the completed Swedish randomised, controlled trial (Bjureberg, J. 2022 in review) suggest that ERITA is worthy of further studies.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, a parent program is included focusing on emotional awareness and how to support their adolescent. ERITA has shown promise in uncontrolled, open trial designs (Bjureberg et al, 2017(Bjureberg et al, , 2018Simonsson et al, 2021), but has yet to be tested in randomised clinical trials.…”

mentioning

confidence: 99%

Internet based intervention (Emotion Regulation Individual Therapy for Adolescents) as add‐on to treatment as usual versus treatment as usual for non‐suicidal self‐injury in adolescent outpatients: The TEENS randomised feasibility trial

et al. 2022

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Background Non‐suicidal self‐injury (NSSI) is common in adolescents receiving psychiatric treatment and is a significant risk factor for suicidal behavior. There are few randomised clinical trials assessing interventions for NSSI in youth, and knowledge about internet‐delivered interventions is limited. Objective We assessed the feasibility of Internet based Emotion Regulation Individual Therapy for Adolescents (ERITA) in psychiatric outpatients aged 13–17 years who engaged in NSSI. Method A randomised clinical feasibility trial with a parallel group design. Non‐suicidal self‐injury engaging patients were recruited from Child and Adolescent Mental Health Outpatient Services in the Capital Region of Denmark from May to October 2020. ERITA was provided as add‐on to treatment as usual (TAU). ERITA is a therapist‐guided, internet‐based program of emotion regulation and skills training involving a parent. The control intervention was TAU. Feasibility outcomes were the proportion who completed follow‐up interviews at end of intervention; proportion of eligible patients who participated in the trial; proportion of participants completing ERITA. We further investigated relevant exploratory outcomes, including adverse risk‐related events. Results We included 30 adolescent participants, 15 in each group (ERITA vs. Treatment as usual). 90% (95% CI, 72%–97%) of the participants completed post‐treatment interviews; 54% (95% CI, 40%–67%) of the eligible participants were included and randomised; and 87% (95% CI, 58%–98%) of the participants completed at least six out of 11 ERITA modules. We identified no difference for the primary exploratory clinical outcome of NSSI between the two groups. Conclusion There are few randomised clinical trials assessing interventions for NSSI in youth, and knowledge about internet‐delivered interventions is limited. Based on our results we conclude that a large‐scale trial seems feasible and warranted.

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Moderators and predictors of treatment outcome following adjunctive internet‐delivered emotion regulation therapy relative to treatment as usual alone for adolescents with nonsuicidal self‐injury disorder: Randomized controlled trial

Ojala,

Hesser,

Gratz

et al. 2024

JCPP Advances

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BackgroundDespite the wide‐ranging negative consequences of nonsuicidal self‐injury (NSSI), there are few evidence‐based treatments for NSSI among adolescents and little is known about what treatments that work best for whom. The objective of this study was to investigate moderators (i.e., for whom a specific treatment works) and predictors (i.e., factors associated with treatment outcome independent of treatment type) of treatment outcome in a randomized clinical trial comparing internet‐delivered emotion regulation individual therapy for adolescents (IERITA) plus treatment as usual (TAU) to TAU alone.MethodsAdolescents (N = 166; mean [SD] age = 15.0 [1.2] years) with NSSI disorder were randomized to IERITA plus TAU (n = 84) or TAU‐only (n = 82). Adolescent emotion regulation difficulties, suicidality, NSSI frequency, depressive symptoms, sleep difficulties, global functioning, and age, and parental invalidation, were measured pre‐treatment and investigated as moderators and predictors of treatment outcome (i.e., NSSI frequency during treatment and for 4 weeks post‐treatment). A zero‐inflated negative binomial generalized linear mixed effects regression model was used to estimate the rate of NSSI change as a function of both treatment condition and moderator/predictor.ResultsNo significant moderators of treatment outcome were found. Parental invalidation was a significant predictor of treatment outcome regardless of treatment condition, such that high levels of parental invalidation pre‐treatment were associated with a less favorable NSSI frequency.ConclusionsWe did not find evidence of a differential treatment effect as a function of any of the examined client factors. Future research should investigate moderation in larger samples and with sufficient statistical power to detect moderation effects of smaller magnitude. Results suggest that parental invalidation may have a negative impact on treatment response and highlight the importance of further investigating parental invalidation in the context of NSSI treatments.

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Experiences of an Online Treatment for Adolescents With Nonsuicidal Self-injury and Their Caregivers: Qualitative Study

Cited by 9 publications

References 55 publications

Effect of Internet-Delivered Emotion Regulation Individual Therapy for Adolescents With Nonsuicidal Self-Injury Disorder

Effect of Internet-Delivered Emotion Regulation Individual Therapy for Adolescents With Nonsuicidal Self-Injury Disorder

Internet based intervention (Emotion Regulation Individual Therapy for Adolescents) as add‐on to treatment as usual versus treatment as usual for non‐suicidal self‐injury in adolescent outpatients: The TEENS randomised feasibility trial

Moderators and predictors of treatment outcome following adjunctive internet‐delivered emotion regulation therapy relative to treatment as usual alone for adolescents with nonsuicidal self‐injury disorder: Randomized controlled trial

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