Extending research on Emotion Regulation Individual Therapy for Adolescents (ERITA) with nonsuicidal self-injury disorder: open pilot trial and mediation analysis of a novel online version

Abstract

BackgroundNonsuicidal self-injury (NSSI) is common among adolescents and associated with negative outcomes. However, treatments developed specifically for NSSI and the proposed NSSI disorder (NSSID) are scarce, and access to empirically supported treatments for NSSI in many areas is limited. Online treatments carry the potential to increase the availability of evidence-based treatments. Emotion regulation individual therapy for adolescents (ERITA) has shown promise in the treatment of adolescents with NSSID.MethodThe present study examined the feasibility, acceptability, and utility of an online version of ERITA. Twenty-five adolescents (aged 13–17) with NSSID and their parents were included in an uncontrolled open trial. Self-report and clinician-rated assessments of outcomes such as NSSI, self-destructive behaviors, emotion dysregulation, and global functioning were administered at pre-treatment, post-treatment, 3- and 6- month follow-up. Measures of NSSI, self-destructive behaviors, and emotion dysregulation were also assessed weekly during treatment.ResultsRatings of treatment credibility, expectancy, and satisfaction were acceptable, and the therapeutic alliance and treatment completion rate (96%) were high. Adolescent participation in the treatment was associated with a statistically significant increase in past-month NSSI abstinence (p = .007), large-sized improvements in past-month NSSI frequency (55% reduction, 95% confidence interval [CI]: 29, 72; Cohen’s d = 0.88, 95% CI: 0.73, 1.06) and global functioning (d = 1.01, 95% CI: 0.77, 1.32), and medium-sized improvements in emotion dysregulation (d = 0.75, 95% CI: 0.59, 0.90) and NSSI versatility (d = 0.63, 95% CI: 0.54, 0.77) from pre- to post-treatment. These improvements were further strengthened at 3-month follow-up and maintained at 6-month follow-up. The online therapist-guided parent program was associated with small- to large-sized (ds = 0.47–1.22) improvements in adaptive parent behaviors, and these improvements were maintained or further improved upon at 6-month follow-up. Moreover, in line with the theoretical model underlying ERITA, change in emotion dysregulation mediated changes in both NSSI frequency and self-destructive behaviors over the course of treatment.ConclusionsTogether, results suggest that online ERITA is an acceptable, feasible, and promising low-intensity treatment for adolescents with NSSID. The results of this open trial must be replicated in controlled studies.Trial registrationClinicalTrials.gov (NCT02697019). Registered 2 March 2016Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1885-6) contains supplementary material, which is available to authorized users.

Nonsuicidal Self-Injury Disorder in Adolescents: Clinical Utility of the Diagnosis Using the Clinical Assessment of Nonsuicidal Self-Injury Disorder Index

“…CANDI was originally developed for adults and has been psychometrically validated on an adult population (23). The Swedish version has also been used to assess adolescents that participated in an emotion regulation treatment study (29,30), suggesting that it has potential for this population. There is a need for studies that examine the feasibility of structured measures to assess NSSID, especially in psychiatric adolescent populations, in order to validate and document NSSID prevalence across development, to identify risk and facilitate treatment planning.…”

A Systematic Review of the Evidence Supporting Mobile‐ and Internet‐Based Psychological Interventions For Self‐Harm

“…() report that 88% using app over 2 weeks versus 59% over 6 weeks. Completion rates for other mobile apps (85%; Tighe et al., ) and Web sites (average completion rate of 9.7 of 11 modules; Bjureberg et al., ) were good. Hooley et al.…”

“…Four trials (Bjureberg et al., ; Franklin et al., ; Hooley et al., ; Rizvi et al., ) investigated the effect of therapeutic interventions on NSSI with mixed findings. Two trials (Bjureberg et al., ; Rizvi et al., ) reported significant effects of time characterized by reductions in NSSI for individuals using a DBT‐informed mobile app (frequency of app use associated with declines in NSSI over 3 months) or online emotion‐regulation therapy (e.g., 69% reduction in NSSI frequency over 6 months, d = 1.36, 95% CI: 1.12, 1.63). However, the absence of a control group means these effects cannot be attributed to the interventions.…”

“…Internet‐delivered CBT and DBT approaches were largely seen as helpful (91% of participants; Robinson et al., ) or rated useful across two studies ( M usefulness rating = 3.91 of 5; Wilks et al., ). Overall satisfaction was only moderate for one Internet‐delivered emotion regulation therapy ( M rating = 17.8 of 32; Bjureberg et al., ). Hooley et al.…”

“…For example, Bush et al (2015) report that 88% using app over 2 weeks versus 59% over 6 weeks. Completion rates for other mobile apps (85%; Tighe et al, 2017) and Web sites (average completion rate of 9.7 of 11 modules; Bjureberg et al, 2018) were good. Hooley et al (2018) also reported good engagement (mean completion of 21.31 sessions of a possible 28), but engagement was incentivized.…”