Brief Psychotherapeutic Intervention Compared with Treatment as Usual for Adolescents with Nonsuicidal Self-Injury: Outcomes over a 2-4-Year Follow-Up

Franziska Rockstroh; Alexandra Edinger; Johannes Josi; Gloria Fischer-Waldschmidt; Romuald Brunner; Franz Resch; Michael Kaess

doi:10.1159/000531092

Brief Psychotherapeutic Intervention Compared with Treatment as Usual for Adolescents with Nonsuicidal Self-Injury: Outcomes over a 2-4-Year Follow-Up

Psychother Psychosom. 2023;92(4):243-254. doi: 10.1159/000531092. Epub 2023 Jul 24.

Authors

Franziska Rockstroh¹, Alexandra Edinger^{2

3}, Johannes Josi¹, Gloria Fischer-Waldschmidt², Romuald Brunner⁴, Franz Resch, Michael Kaess²

Affiliations

¹ University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
² Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
³ Heidelberg Academy for Psychotherapy, SRH University Heidelberg, Heidelberg, Germany.
⁴ Clinic and Policlinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany.

Abstract

Introduction: The "Cutting Down Programme" (CDP), a brief psychotherapeutic intervention for treating nonsuicidal self-injury (NSSI) in adolescents, was comparable to high-quality treatment as usual (TAU) in a previous randomized controlled trial (RCT).

Objective: The aim of the study was to evaluate the long-term outcomes of the CDP over up to 4 years.

Methods: Assessments of NSSI, suicide attempts, borderline personality disorder (BPD), depression, and quality of life took place 2 to 4 years (T3) after enrollment in a RCT. The evolution of NSSI, suicide attempts, depression, and quality of life was analyzed using (generalized) linear mixed-effects models. Ordered logistic regression was used for analyzing BPD diagnoses. Data from T0, T2, and T3 are reported.

Results: Out of 74 patients, 70 (95%) were included in the T3 assessment. The frequency of NSSI events alongside with suicide attempts and depression further decreased between T2 and T3 and BPD between T0 and T3 in both groups. Quality of life remained stable in both groups between T2 and T3. Both groups received substantial but comparable additional treatment between T2 and T3. More treatment sessions during the follow-up period were linked to larger improvements of NSSI.

Conclusions: The CDP was found to be as effective as TAU in promoting recovery from NSSI and comorbid symptoms in the long term. Results suggest that treatment effects from a brief psychotherapeutic intervention may endure and even further improve after completion of the program. However, additional treatment seems to improve chances for recovery independent from CDP versus TAU.

Keywords: Adolescents; Longitudinal outcome; Nonsuicidal self-injury; Psychotherapy; Randomized controlled trial.

MeSH terms

Adolescent
Borderline Personality Disorder* / epidemiology
Borderline Personality Disorder* / therapy
Comorbidity
Follow-Up Studies
Humans
Self-Injurious Behavior* / diagnosis
Self-Injurious Behavior* / therapy
Suicide, Attempted / prevention & control

Grants and funding

The study was funded by the Dietmar Hopp Foundation (Grant No. 23011188) and additional research funds of the Clinic for Child and Adolescent Psychiatry at the University of Heidelberg.