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Self-Injurious Thoughts & Behaviors

Created on August 5, 2017. Last updated on September 15th, 2019 at 09:28 am

Take me to the effective therapies for self-injurious thoughts & behaviors

Thoughts and behaviors about harming oneself are not common in childhood, but increase during the teenage years. They can cause big problems in a young person’s social, family, and school life.

Each year, about 16 percent of teens in U.S. high schools will consider killing themselves and 8 percent will attempt killing themselves, also known as suicide. Non-suicidal self-injury, or causing self-harm without wanting to die, is even more common among youth: around 18 percent of teens report these behaviors.

What are Self-Injurious Thoughts and Behaviors?

Self-injurious thoughts refer to thinking about hurting oneself. Self-injurious behaviors are actions that are harmful to oneself. Both can be suicidal or non-suicidal.

  • Suicidal self-injurious thoughts (suicidal ideation) are thoughts about killing oneself and can include making suicide plans. Suicidal self-injurious behaviors (suicide attempts) are behaviors that are harmful to oneself and can lead to injury, (e.g., attempted overdose) in which a child or teen wants to die
  • Non-suicidal self-injury (NSSI) refers to injuries cause by oneself but a child has no wish to die. The most common forms are skin cutting, burning, scratching, and banging/hitting oneself. These NSSIs are used to make oneself feel better and to stop feelings of sadness, anxiety, and anger

Effective Therapies for Self-Injurious Thoughts and Behaviors

There are currently no well-established, effective therapies for these problems. But, many therapies appear to work, including:

  • Cognitive-behavioral therapy (CBT) for the youth and his/her family
  • Psychodynamic therapy for the youth and her/his family
  • Interpersonal therapy for the youth
  • Two different family-based treatments (attachment-based and parent training)

The following child therapy activities may improve treatment for children with self-injurious thoughts or behaviors, even though there is no clear-cut, evidence-based therapy for these individuals:

  • Developing and maintaining family and other relationships (e.g., increased parent/teen communication)
  • Improving parent education and training (e.g., parental monitoring, including restricting access to things that teens could hurt themselves with)
  • Strengthening teens’ coping skills (e.g., emotion regulation)
Tested Therapies for Children and Adolescents
Level One:
Works Well
Level Two:
  • Combined CBT that includes individual, family, and parent training
  • Family-based therapy (attachment and parent training)
  • Psychodynamic therapy (individual and family)
Level Three:
Might Work
  • Family-based therapy-ecological
Level Four:
  • CBT
    • Individual
    • Family
    • Skills group
  • Dialectical behavior therapy (DBT)
    • Group
  • Family-based therapy
    • Emergency
    • Problem-focused
  • Resources interventions-individual
  • Support-based interventions-individual
Level Five:
Tested and Does Not Work
  • CBT-skills + DBT skills + psychodynamic therapy skills-group

To find out more about how these treatment levels are defined, click here.

Therapies and Terms Defined:

  • CBT: cognitive behavioral therapy
  • DBT: dialectical behavior therapy


Catherine R. Glenn, Erika C. Esposito, Andrew C. Porter & Devin J. Robinson (2019) Evidence Base Update of Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth, Journal of Clinical Child & Adolescent Psychology, 48:3, 357-392, DOI: 10.1080/15374416.2019.1591281

Partner Sites:

Evidence-based Services Committee of Hawaii