Targeting self‐criticism in the treatment of nonsuicidal self‐injury in dialectical behavior therapy for adolescents: a randomized clinical trial

Background The Benefits and Barriers Model proposes both benefits and barriers associated with nonsuicidal self‐injury (NSSI) and that a negative association with the self plays a key role in the initial selection of and acute motivation for NSSI. The current investigation builds upon previous findings by assessing the added benefit of targeting self‐criticism in the treatment of NSSI. Methods Sample included 40 participants (30 females; M age = 14.92) enrolled in dialectical behavior therapy for adolescents within a partial hospitalization program. All study participants received dialectical behavior therapy for adolescents, and those randomized to the experimental condition received an additional brief cognitive intervention developed to decrease self‐criticism. Results There was no evidence of an indirect effect of targeting self‐criticism upon NSSI at post‐treatment via post‐treatment self‐criticism ( b = −0.98, p = .543); however, there was evidence of a significant interaction between treatment condition and self‐criticism at pretreatment in the prediction of NSSI at post‐treatment ( b = 0.33, p = .030). Analyses of simple slopes indicated the conditional direct effect of targeting self‐criticism varied as a function of patient’s level of self‐criticism at the onset of treatment, such that individuals −1 SD below the mean ( b = −5.76, p = .037) and at average pretreatment levels of self‐criticism ( b = −4.09, p = .042), but not + 1 SD above the mean ( b = −2.42, p = .056), experienced fewer incidents of NSSI at post‐treatment. Conclusions The results of this investigation support the added benefit of targeting self‐criticism in the treatment of NSSI for adolescents.