Acceptance and Commitment Therapy for Nonsuicidal Self-injury

Non-suicidal self-injury is the direct and purposeful harming of one's bodily tissue outside
of social and religious norms and lacking suicidal intent. The most common NSSI behaviors
include cutting (70-90%), banging or hitting (21-44%), and burning (15-35%) (Rodham & Hawton,
2009); but many report utilizing multiple methods (50-70%; Klonsky, 2011; Whitlock,
Eckenrode, & Silverman, 2006). NSSI has an alarming prevalence among college students, with
rates ranging from 17-38% (Whitlock et al., 2006; Gratz, Conrad, & Roemer, 2002). NSSI occurs
in the context of many psychological disorders (Nock, 2010), and is associated with anxiety
and mood disturbances (Andover et al., 2005). This is a prevalent problem and lacks an
efficacious treatment. As a result, this study can shed insight into possible treatments.

The experiential avoidance model of deliberate self-harm posits that a function of
self-injury is maintained through negative reinforcement by reducing unpleasant emotional
arousal (Chapman et al. 2006). Therefore a treatment that directly targets reducing
experiential avoidance is likely to be effective.

ACT is based on the theory that rigid attempts to control internal states, thoughts and
feelings, and other forms of experiential avoidance contribute to symptom development and
maintenance of anxiety and self-injury. The training includes three components: (a) educating
Ps about the exacerbation of anxiety symptoms and problem behaviors through rigid attempts at
experiential avoidance, (b) introducing acceptance and the willingness to experience
anxiety-related sensations and cognitions as an alternative to experiential control, through
the practice of intentional and non-judgmental paying attention to one's thoughts, feelings,
images and bodily sensations (including aversive symptoms of anxiety) and learning to see
thoughts as an ongoing process distinct from self rather than merely an event with literal
meaning (cognitive defusing), and (c) instructing Ps in between-session exercises
incorporating awareness of present, internal experiences and cognitive defusion exercises
while engaging in exercises that give rise to them.

Inclusion Criteria:

1. If applicable, be stabilized on their current medications for at least two months.

2. Must report at least one incidence of self-injuring during the past six months.

Exclusion Criteria:

- Active psychosis, schizophrenia and schizoaffective disorder Current active suicidal
ideation Individuals with a history of seizure disorders, angina, myocardial
infarction, congestive heart failure, clinically significant arrhythmias, transient
ischemic attacks, cerebrovascular accidents, diabetes mellitus, significant asthma,
emphysema, chronic obstructive pulmonary disease or a family history of heart disease
before age 55 are also excluded.