Robert L. Findling, MD

Effective therapy for Self Injury.

Hello. My name is Dr. Robert Findling. I'm Director of the Division of Child and Adolescent Psychiatry at University Hospital at Case Medical Center and Professor of Psychiatry and Pediatrics at Case Western Reserve University. In today's posting, I'll be talking about a treatment study that was conducted in a group of teenagers who were repeatedly self-harm. This study was recently published in the British Medical Journal and the first study author is J. M. Green. As viewers likely know, teenagers who self-harm are often a group that is very difficult to treat. Moreover, it's important to think about these patient populations because self-harm can be quite pernicious and often a recurring phenomenon. Moreover, self-harm is associated with psychosocial difficulties, emotional distress, human suffering, risk for suicide, poor long-term outcomes, and increased service utilization, both in the medical field, the mental health systems, school systems, and even the justice systems.

So, it's a very important condition to think about the means in which to address self-harm that are scientifically based to allow us to effectively help these vulnerable and suffering youth. Previously pilot data have suggested that a developmental group psychotherapy, when added to usual care, is associated with significant benefit in teenagers who self-harm. Group therapy focuses on key aspects that are developmentally appropriate. These include peer relationships, bullying, and family difficulties. The study that was published in the British Medical Journal was designed to more definitively assess the putative value of developmental group psychotherapy in teenagers who self-harm. For purposes of this study, self-harm included the following acts: nonaccidental overdoses, scratching, cutting, burning, and strangulation. Ultimately, 180 adolescents who received treatment as usual were compared with a comparable number of adolescents who had developmental group psychotherapy added on to their usual treatment.

So, what were the results? Overall, patients in both groups had significant improvements over time. However, on measures of self-harm, no between-group differences were observed. On other secondary outcome measures that were assessed (mood and suicidality), likewise, no between group differences were observed. So, ultimately, this is an important study for several reasons. First of all, although the study failed to show any between group differences, stringent research can be applied to this very difficult-to-treat and often understudied population. The study also demonstrates the need to perform more definitive follow-up studies when smaller pilot studies suggest benefit, in contrast to simply relying on smaller preliminary data or clinical impressions. The good news is that, overall, both patient groups benefited.

Certainly, teenagers who deliberately self-harm are a vulnerable patient group.

This study demonstrates that high-quality treatment research can, in fact, be conducted in this patient population. Hopefully, this demonstration of feasibility will facilitate future research in a group of youngsters who certainly deserve evidence-based and effective care. I'm Dr. Robert Findling. Thank you for watching.