How DBT Can Be Helpful for Self-Harm Addiction

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Suicide is the 3rd largest leading cause of teen death in the United States, followed by accidental injury and homicide [5]. Individuals who injure themselves, without the intent of committing suicide are referred to as self-harm patients [3,1].

Self harm is typically defined as behavior where a person cuts self, engages in skin picking or hair pulling compulsively, burning, and clawing with nails or other sharp objects. Self-harm behaviors can be a symptoms of underlying issues such as abuse or trauma or sexual trauma, and mental conditions [3].

Those individuals who self-harm typically do so to regulate their emotions, relieve or distract from pain, or to stimulate a pain-relief response to the body. Behaviors are deliberate and used to inflict damage but there is no real or immediate desire to die. This differs from those who are actively suicidal who do have a desire to die [1,5].

Understanding Factors That Influence Self-Harm Addiction

Woman struggling with addictionIndividuals who self-harm may show signs of abnormal changes in emotions, and have difficulty returning to an emotional homeostasis [4, 5]. To try to cope with the emotional instability, individuals will use self-harm to regulate their feelings.

Other impulsive behaviors common with those who self-harm are substance abuse, indiscriminate sexual behavior, excessive or reckless spending, and risk taking. Impulsive behaviors may also lead to a decline in supportive relationships, issues with employment or school, and activities of daily living.

Individuals who self harm may also feels intense emotions of shame and guilt and use self-harm or parasuicidal behaviors to self soothe.

DBT can be helpful for individuals learning how to cope effectively with stressful situations, which can trigger self-harm behaviors. Stress is a common reason for self harm engagement. Individuals also can benefit from enhancing their worldview so they have a deeper understanding on their own actions and personal responsibility [3].

Dialectical Behavioral Therapy (DBT) is a highly effective therapy to use with individuals who self harm. This type of therapy engages the client in a comprehensive, modular, cognitive-behavioral treatment that was originally developed to treat chronic suicidal patients and those suffering with borderline personality disorder. DBT was later identified to be the most treatable and applicable therapy for suicidal behavior and other addictions [1].

Components Involved With DBT

True DBT therapy is a 1 year outpatient treatment modality with 4 components. DBT has been shown to significantly decrease self-harm and suicide-related outcomes[1]. DBT works off the premise that individuals who self-harm are lacking in skill mastery and fail to use more effective behaviors when needed. DBT uses skill during DBT therapy and DBT skills training to teach and guide the individual to master healthy, adaptive coping skills and strategies [1, 4).

Research has looked at the differences in outcomes when individuals receive either 1 year of DBT therapy, or 1 year of standard psychotherapy. Research assessed its effectiveness in self-harm behaviors and hospitalizations [2].

Patients were interviewed at 2 month intervals who received DBT for 1 year and then at a 6 month follow-up. Those receiving the DBT therapy reported reduced self harm urges, and attempted suicide with a mean average of 1.79 days in a 8 week period of engaging in self harm behaviors. Researchers concluded that DBT is a more effective therapy for individuals struggling with self harm than traditional psychotherapies [2].

DBT works through the 5 core skills of DBT which are mindfulness, distress tolerance, emotional regulation, the middle path, and interpersonal effectiveness. Mindfulness helps individuals learn how to experience emotion without acting on the emotions, helping create a delay in self-harming behaviors.

Woman on the beachDistress tolerance focuses on teaching alternative coping skills to self-harm ones. Distress tolerance reaches individuals how to manage the urges to self harm. Emotional regulation allows the individual to learn, control, and understand painful emotions. The Middle Path works on cognitive distortions and Interpersonal Effectiveness teaches the individual how to meet with own needs but also act in a way that promotes self respect [4, 5].

In summary, DBT is a therapy that engages the individual to learn and gain new life skills to prevent serious self harm and/or suicidal behaviors [4]. It works to help individuals break away from unhealthy coping skills and learn how to effectively manage emotions, gain mindfulness skills, learn effective interpersonal skills and manage triggers.

Community Discussion – Share Your Thoughts Here!

What skills have you learned through DBT that you find most helpful?

Image of Libby Lyons and familyAbout the Author: Libby Lyons, MSW, LCSW, CEDS, is a Certified Eating Disorder Specialist (CEDS) who works with individuals and families in the area of eating disorders. Mrs. Lyons works in the metropolitan St. Louis area and has been practicing in the field for 11 years. Libby is also trained in Family Based Therapy (FBT) to work with children-young adults to treat eating disorders. Mrs. Lyons has prior experience working with the United States Air Force, Saint Louis University, Operating Officer of a Private Practice, and currently works with both Saint Louis Behavioral Medicine Institute within their Eating Disorders Program and Fontbonne University



The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.

Reviewed By: Jacquelyn Ekern, MS, LPC on December 28, 2016
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About Jacquelyn Ekern, MS, LPC

Jacquelyn Ekern founded Addiction Hope in January, 2013, after experiencing years of inquiries for addiction help by visitors to our well regarded sister site, Eating Disorder Hope. Many of the eating disorder sufferers that contact Eating Disorder Hope also had a co-occurring issue of addiction to alcohol, drugs, and process addictions.