Efficacy of dialectical behaviour therapy based on emotion regulation in non suicidal self injurious behaviour

Abstract

The alarming prevalence and gateway effect of Non-Suicidal Self-Injury (NSSI) underscorethe urgent need for targeted interventions. This study explores the efficacy of Dialectical BehaviourTherapy (DBT) in reducing NSSI behaviour among individuals who engage in self-injury as amaladaptive coping mechanism to manage overwhelming emotions. In the Indian context, particularlyin Kerala, where mental health resources are limited and NSSI behaviour is on the rise, this researchis crucial to inform culturally-sensitive interventions and address the growing concern of self-injuryamong young adults. By addressing the underlying emotion regulation deficits DBT aims to providemore adaptive coping strategy ultimately reducing the frequency and severity of NSSI behaviour. Thestudy aimed to explore the natur¢ and psychological correlates of NSSI among young adults andevaluate the efficacy of DBT in enhancing psychological well-being (PWB).There are two phases in study. Phase I of the study followed a descriptive and predictiveresearch approach which focused on the nature and characteristics of self-injurious behaviour in thelast year and assessed effects of CER strategies on PWB among young adults with and without SIB.Participants for Phase -1 of the study comprised of 691 young adults aged 19 to 30 years. Phase IIconsisted of 21 partjcipants from three outpatient clinics in south Kerala, India. A quasi-experimentalresearch des"i"‘gn of one-group pre-post-test with an extended group was employed in phase IIintervention study. Participants who fulfilled the criteria for NSSI and who had not received anypsychological intervention in the past were selected for the study. Individuals taking medication forany chronic physical or mental illness or having any significant medical or neurodevelopmentaldisorder were excluded from the study.After obtaining informed consent from the participants and awareness of the research, threemeasurement scales Functional Assessment of Self-Mutilation (Lloyd et al., 1997), Cognitive EmotionRegulation Questionnaire (CERQ), (Garnefski & Kraaij, 2001), Ryff’s Scale for Psychological WellBeing(SPWB) (Ryff et al., 2007) were administered to individuals in the group with clear instructions.In Phase II after preliminary assessments with all measures participants underwent 14-week NeacsiuAdult DBT based on emotion regulation skill training. Post-intervention assessment was done withDeliberate Self Harm Inventory- Clinical Change Version II, CERQ, and SPWB. After 6 months offollow-up, final assessments were done with all measures by blind assessors. The study receivedcthical clearance from the Human Ethical Committee at the University of Calicut. Clear guidelineswere set foi'rconfidentiality and handling immediate suicide risks. Dropout cases were offeredtreatment upon return.The normality of the data was assessed using the Kolmogorov-Smirnov test in Phase I andShapiro-Wilk test in second phase. In Phase I Chi-square test, Mann-Whitney U test, Correlationanalysis, Linear Regression and Binary Logistic Regression were used in data analysis. In Phase IlFriedman test with pairwise comparisons by Wilcoxon signed-rank tests applying a Bonferronicorrection was used. Research reveals 11.3% of participants engaged in self-injurious behaviour (SIB) with cuttingbeing the most prevalent method. Social negative reinforcement including avoiding unpleasant tasksand evading social situations were highlighted as a common motive for SIB alongside social positivereinforcement such as seeking attention or elieiting reactions from others. Negative cognitive processesSelf-Blame and Rumination negatively impact Psychological Well-Being and are associated withincreased self-injury. 14-week adult DBT based on Emotion Regulation is found efficacious inreducing Self-Injurious by increasing and reducing in adaptive and non-adaptive strategies of EmotionRegulation and enhancing PWB. The study emphasizes the need for integrated approaches addressingcognitive and emotional factors in young adults with Non-Suicidal Self-Injurious Behaviour, bridgingtherapeutic modalities with positive psychological aspects in clinical psychology.