Dr. Sarah Reynolds, our guest speaker, is an expert on Dialectical Behavior Therapy (DBT), a type of psychotherapy used for reducing self-injury and suicidal behaviors.
David Roberts is the HealthyPlace.com moderator.
The people in blue are audience members.
David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com.
Our topic tonight is "Self-Injury: What it takes for you to stop self-injuring and DBT for treating self-injury." Our guest is Sarah Reynolds, Ph.D., who is a research coordinator at the Behavioral Research and Therapy Clinic (BRTC). The BRTC, directed by Dr. Marsha Linehan, is devoted to the study and treatment of self-injury and suicide. Dr. Reynolds has extensive training and experience with Dialectical Behavior Therapy (DBT), a well-known and scientifically based outpatient psychotherapy for reducing suicidal behaviors.
Good evening, Dr. Reynolds and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Many people talk about wanting to quit self-injuring, yet they find it extremely difficult to accomplish that. Why is that?
Dr. Reynolds: People self-injure, usually to regulate extreme negative emotions. It is often their only way to cope. It is the only way that they have learned, and so they keep coming back to it. It is obviously ineffective for having a reasonable quality of life, but it can work in the short-term for reducing emotional pain.
David: What skills, exactly, do they lack?
Dr. Reynolds: Well, first of all, they usually are quite emotionally vulnerable, that is, they have a lot of ups and downs in their moods. Thus, they have a lot of emotionality to try to deal with, just because of their biology. Further, people who self injure, typically have a lot of difficulty tolerating their negative emotions without doing something impulsive to try to stop them, and they may have difficulty forming good relationships with others.
David: Is it possible for someone to learn to stop self-injuring on their own, without professional treatment?
Dr. Reynolds: It may be possible, depending on the severity of their self-harm, but it might be quite difficult.
David: And I want to get into the treatment aspect in a moment, but you mentioned that some people use self-injury to regulate their emotions. How does that work?
Dr. Reynolds: A lot of emotional regulation skill involves refocusing attention away from emotional pain, a skill that self-injurers often lack. So, self-injury can focus attention away from the original problem and onto the physical injury. It can also validate for the person their own sense (although it is false) that they are a bad person and deserve to be punished. So, in this way, it can be calming because it validates their sense of the world.
Finally, people sometimes self injure because it can take them out of a difficult situation that causes stress. This indirectly reduces negative emotions.
David: What is the most effective method of treatment for self-injury?
Dr. Reynolds: The only treatment that has been shown to be effective in a scientific study is Dialectical Behavior Therapy (DBT). Several studies have shown that DBT reduces self-injury (both self mutilation and suicide attempts) for women diagnosed with borderline personality disorder (BPD). There may be other treatments out there that people consider "effective" but none have been researched. Unfortunately, not much research is done on this problem.
David: Can you please explain what Dialectic Behavior Therapy is and how it works?
Dr. Reynolds: DBT is an outpatient (out of hospital) psychotherapy that views self-injury as an ineffective attempt to solve problems. Therefore, the goal of DBT is to stop self-injury, and figure out better solutions. It is a structured treatment that is cognitive-behavioral. It has a number of different parts, including individual therapy, and a skills group that teaches skills for tolerating distress, increasing awareness of surroundings (mindfulness), regulating emotions, and interacting effectively with others.
David: We have a lot of audience questions, Dr. Reynolds. Let's get to some of those and then we'll continue on with our discussion about treatment of self-injury.
Fragil Heart: My neighbor Michele, a single mom of three, is a self-injurious person who cuts herself repeatedly. I know that she refused treatment for her drug addiction and Department of Human Services is going to remove her children. She has no knowledge of this. My question is, after the kids are gone her chances of cutting are great and she has begun to hide her cuts. How can I help her, if I can? I do support and listen to her.
Dr. Reynolds: Well, the best thing is to encourage her to get into treatment. I would also consider telling her that you think her kids will be removed from the home. Often times, it can take major consequences as a result of our behavior before we can change. I am sure that even your emotional support is a great comfort to her, as many people who cut are very socially isolated.
2nice: How common is self injury in people with a depressive illness?
Dr. Reynolds: Self injury is very often associated with a diagnosis of BPD (Borderline Personality Disorder), and very often with a mood disorder, such as depression. People who self-injure are often chronically miserable.