Internet-based therapy found to be effective against self-harm in adolescents

Self-harming behavior in young people causes suffering and increases the risk of suicide. Researchers at Karolinska Institutet and Region Stockholm have now investigated whether an internet-delivered emotion regulation therapy can reduce self-harm in youth. The study, which is published in JAMA Network Open, suggests that the therapy is effective.

"The therapy is based on the expectation that if you teach young people more adaptive ways for regulating their emotions, they will have less need to harm themselves and our results indicate that this assumption is correct," says corresponding author Johan Bjureberg, docent at the Department of Clinical Neuroscience, Karolinska Institutet.

Self-harming behavior often serves to regulate emotions in the moment, but has many adverse consequences. The idea behind the treatment, called Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA), is to reduce self-harming behavior by helping young people to handle and regulate their emotions in a more adaptive way.

The therapy comprises eleven modules delivered across twelve weeks. Meanwhile, parents participate in a separate six-module online course on supporting their children. During the therapy, both parties have online contact with a therapist.

The efficacy of IERITA has now been tested by researchers at the Center for Psychiatry Research at Karolinska Institutet and Region Stockholm. The study involved 166 young people between the ages of 13 and 17 who had harmed themselves at least five times in the past year, including once in the past month, and their parents.

The participants were randomly assigned to test IERITA as an add-on to the regular care provided by the child and adolescent psychiatry service (BUP) or primary care. A control group received regular care only, but were offered IERITA at a later date. The study was conducted between 2017 and 2020 at clinics in the Stockholm, Västra Götaland and Skåne regions in Sweden.

IERITA as add-on to regular care resulted in an 82% reduction in self-harm episodes and other destructive behavior and an improved ability to regulate emotions and greater level of functioning after treatment, compared with 47% after treatment with regular care only. The effects of IERITA were still significant at a three-month follow-up.

The researchers are now working to ensure that the internet format makes the therapy more accessible in more regions.

"There are few scientifically evaluated therapies for self-harm, and those that do exist have long waiting times and are offered primarily in urban areas," says last author Clara Hellner, adjunct professor at the Department of Clinical Neuroscience, Karolinska Institutet. "The aim of the project was to increase accessibility to the therapy by offering low-threshold treatment that doesn't require physical presence at a clinic."