Dialectical Behavior Therapy For Self Injury

"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.

  • stephanie

    If you get help but are still forced to go through and live in situations where the same thing continusly happens then getting the help serves no perpuse and the same behaivor will be the result. being as i am 16 and have been through this i didnt stop until i was permited to move with my mother. people tried to get me to stop then tried forcing me it didnt help at all it only made the situtation more stessed. but when u have no say in your life what else is their to resort to. i am simply saying no one helped me stop only when my situation change thats when i did as well.

  • Anonymous-1

    I'm 56-years-old & have the diagnosis of bipolar I disorder, acute anxiety, PTSD, & ADHD. A man in my DBSA (Depression & Bipolar Support Alliance) spoke about how DBT was the only thing that helped him w/his treatment-resistant depression. I have been suffering since my 1st suicide attempt at 15. My mother also had bipolar & did commit suicide after many hospitilizations, suicide attempts, ECT's, etc.

    I have been to so many therapists & gained insight but didn't get any real relief (meds for bipolar helped a lot, but still I didn't have a good quality of life due to over-emotional reactions to EVERYTHING). My 1st 3 months in the DBT group I just cried at every meeting. I started individual therapy w/the therapist leading the group & she is so helpful.

    I had a suicide attempt 3 years ago & was just stuck. I couldn't get out of the deep depression & suicidal thoughts & shame despite working w/my meds provider. After about 3 mos. of DBT & individual therapy my suicidal thoughts stopped, I no longer felt "triggered" at every turn I started to get hope. My meds provider was very impressed in the changes she observed. I've been able to cut down on dosages of some meds & eliminate others altogether.

    My therapist is retiring in a few weeks & we haven't been able to locate another DBT group for me. She has been working to find me another therapist who does EMDR as that has also helped me w/my chronic insomnia so I no longer have to take a bunch of sedating medications. Love all the acronyms!!

  • dave simpson

    Changing the situation may be impossible,but then again that may not be the answer.Changoing oneself may be the answer then one can tolerate the situation or maybe change it