"It wasn't a suicide attempt. It was an escape from everything awful." This is an anonymous quote about self-injury that illustrates the torment many people who engage in self-injury are attempting to escape.
People who self injure have often found themselves either the victims of abuse or otherwise powerless and helpless in the midst of terrible circumstances. Self-abuse often provides an escape from overwhelming feelings of isolation, fear, humiliation or fury. Some who self-injure explain that it gives a sense of control in a world where they feel helpless. It can also be a physical sign of emotional pain.
Although self-injury can produce short term relief from emotional pain, it also can create shame and humiliation. Some who self-injure report feeling "bizarre" and "crazy" for engaging in the behavior. Others see it as a sign of emotional distress, but worry about the scars that will never go away.
Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy starts with a set of assumptions. The lives of people who self injure are currently unbearable. They are doing the best that they can and want to improve. They have not caused all their problems, but they are going to have to solve them. In order to solve these problems they must learn new behaviors and try harder than they've ever tried before.
The central goal of DBT is to change problem behaviors. This is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors.
Acceptance and tolerance are core concepts that are viewed as a necessary balance to change. Validation and active listening decrease intense emotions, help to identify the right problems to solve, and help people to understand and accept themselves. Balanced with change, acceptance is necessary in order for people to:
- modulate extreme emotions and reduce negative behaviors that result from those emotions and
- trust their own emotions and thoughts.
In DBT, change is accomplished through multiple treatment modalities, including: skills training, individual therapy, coaching in crisis, structuring the environment and consultation teams for providers. The primary focus across the treatment is to help people reduce life threatening and self-injurious behavior and to stay motivated and in treatment, despite the tremendous difficulties they may face.