Fluctuations in Affective States and Self-Efficacy to Resist Non-Suicidal Self-Injury as Real-Time Predictors of Non-Suicidal Self-Injurious Thoughts and Behaviors

Abstract

Introduction: Although research over the past decade has resulted in significantly increased knowledge about distal risk factors for non-suicidal self-injury (NSSI), little is known about short-term (proximal) factors that predict NSSI thoughts and behaviors. Drawing on contemporaneous theories of NSSI, as well as the concept of ideation-to-action, the present study clarifies (a) real-time factors that predict NSSI thoughts and (b) the extent to which theoretically important momentary factors (i.e., negative affect, positive affect, and selfefficacy to resist NSSI) predict NSSI behavior in daily life, beyond NSSI thoughts.Methods: Using experience sampling methodology, intensive longitudinal data was obtained from 30 young adults with frequent NSSI episodes in the last year. Participants completed assessments up to eight times per day for 12 consecutive days (signal-contingent sampling). This resulted in the collection of 2,222 assessments (median compliance = 79.2%) during which 591 NSSI thoughts and 270 NSSI behaviors were recorded. Using the dynamic structural equation modeling framework, multilevel vector autoregressive models were constructed.Results: Within the same assessment, negative affect was positively associated with NSSI thoughts, whereas positive affect and self-efficacy to resist NSSI were each negatively associated with NSSI thoughts. Across assessments, higher-than-usual negative affect and self-efficacy to resist NSSI were predictive of short-term change in NSSI thoughts. While fluctuations in both negative affect and positive affect prospectively predicted NSSI behavior, these factors became non-significant in models that controlled for the predictive effect of NSSI thoughts. In contrast, self-efficacy to resist NSSI incrementally predicted a lower probability of engaging in NSSI, above and beyond NSSI thoughts.Discussion: This study provides preliminary evidence that affective fluctuations may uniquely predict NSSI thoughts but not NSSI behaviors, and point to the role of personal belief in the ability to resist NSSI in preventing NSSI behavior. These findings illustrate the need to differentiate between the development of NSSI thoughts and the progression from NSSI thoughts to behavior, as these are likely distinct processes, with different predictors.

Nonsuicidal self-injury thoughts and behavioural characteristics: Associations with suicidal thoughts and behaviours among community adolescents

“…Despite evidence that NSSI thoughts are distinct from NSSI behaviour (Kiekens et al, 2020;Nock et al, 2009), little research has considered NSSI thoughts that occur in the absence of any NSSI behaviour. In addition, despite mounting evidence that engaging in NSSI is associated with greater suicidal thoughts and behaviours (Kiekens et al, 2018;Mars et al, 2019;Ribeiro et al, 2016), questions remain regarding whether characteristics of NSSI behaviour are associated with suicidal thoughts and behaviours among community adolescents.…”

“…In addition to NSSI behaviour, thoughts of engaging in NSSI are conceptualized as a component of self-injurious thoughts and behaviours (Nock, 2010). However, despite evidence that NSSI thoughts and behaviour are separable phenomena (Kiekens et al, 2020;Nock, Prinstein, & Sterba, 2009), little research has investigated adolescent NSSI thoughts in the absence of any NSSI behaviour. The ideation-to-action framework of suicidal thoughts and behaviours argues that the factors which underlie ideation may differ from those which underlie action (Klonsky & May, 2014), highlighting the need to consider NSSI thoughts as distinct from NSSI behaviours.…”

Self‐injury recovery: A person‐centered framework

“…Self‐efficacy to resist NSSI coincides with time since a person has self‐injured, with stronger self‐efficacy associated with a longer time since NSSI engagement (Dawkins et al, 2019a, 2019b, in press). A recent ecological momentary assessment study found that fluctuations in self‐efficacy to resist NSSI are associated with short‐term changes in NSSI thoughts, and with a lower probability of NSSI, even after controlling for NSSI thoughts and urges (Kiekens et al, 2020). Recognizing that one has the capacity to accept thoughts and urges, but not act on them, fosters self‐efficacy and may aid recovery even in the face of intense or ongoing urges to self‐injure (Kiekens et al, 2020).…”

“…A recent ecological momentary assessment study found that fluctuations in self‐efficacy to resist NSSI are associated with short‐term changes in NSSI thoughts, and with a lower probability of NSSI, even after controlling for NSSI thoughts and urges (Kiekens et al, 2020). Recognizing that one has the capacity to accept thoughts and urges, but not act on them, fosters self‐efficacy and may aid recovery even in the face of intense or ongoing urges to self‐injure (Kiekens et al, 2020). At the same time, developing self‐efficacy to engage in alternative behaviors that meet the same needs as NSSI is important (Heath et al, 2016).…”

Impact of the COVID-19 pandemic on students at elevated risk of self-injury: The importance of virtual and online resources

“…The economic consequences of COVID-19 are predicted to be wide ranging (OECD, 2020), and thus parents and caregivers are likely also experiencing elevated stress and anxiety regarding potential job loss and financial insecurity. Given the evidence that higher-than-usual negative affect predicts subsequent NSSI thoughts and behaviour (Kiekens et al., 2020), these additional stressors are likely to impact NSSI engagement and recovery among young people with a history of NSSI. In addition, the number of life stressors (e.g., changing school, parental unemployment, major personal injury or illness, trouble with parents), in the past six months predicts the onset of self-injury among adolescents (Kaess et al., 2019).…”