Internet based intervention (Emotion Regulation Individual Therapy for Adolescents) as add-on to treatment as usual versus treatment as usual for non-suicidal self-injury in adolescent outpatients: The TEENS randomised feasibility trial

Britt Morthorst; Markus Harboe Olsen; Janus Christian Jakobsen; Jane Lindschou; Christian Gluud; Michella Heinrichsen; Bo Møhl; Lotte Rubæk; Olivia Ojala; Clara Hellner; Johan Bjureberg; Anne Katrine Pagsberg

doi:10.1002/jcv2.12115

Internet based intervention (Emotion Regulation Individual Therapy for Adolescents) as add-on to treatment as usual versus treatment as usual for non-suicidal self-injury in adolescent outpatients: The TEENS randomised feasibility trial

JCPP Adv. 2022 Dec 3;2(4):e12115. doi: 10.1002/jcv2.12115. eCollection 2022 Dec.

Authors

Britt Morthorst^{1

2}, Markus Harboe Olsen^{3

4}, Janus Christian Jakobsen^{3

5}, Jane Lindschou³, Christian Gluud^{3

5}, Michella Heinrichsen¹, Bo Møhl⁶, Lotte Rubæk⁷, Olivia Ojala⁸, Clara Hellner⁸, Johan Bjureberg^{8

9}, Anne Katrine Pagsberg^{1

2}

Affiliations

¹ Research Unit Child and Adolescent Mental Health Center Copenhagen University Hospital-Mental Health Services CPH Copenhagen Denmark.
² Department of Clinical Medicine Faculty of Health University of Copenhagen Copenhagen Denmark.
³ Copenhagen Trial Unit Centre for Clinical Intervention Research The Capital Region Copenhagen University Hospital-Rigshospitalet Copenhagen Denmark.
⁴ Department of Neuroanaesthesiology Neuroscience Centre Copenhagen University Hospital-Rigshospitalet Copenhagen Denmark.
⁵ Department of Regional Health Research The Faculty of Health Sciences University of Southern Denmark Odense Denmark.
⁶ Department of Communication and Psychology Aalborg University Aalborg Denmark.
⁷ Team of Self-Injury Child and Adolescent Mental Health Services Copenhagen Denmark.
⁸ Department of Clinical Neuroscience Centre for Psychiatry Research Karolinska Institutet, & Stockholm Health Care Services Region Stockholm Stockholm Sweden.
⁹ Department of Psychology Stanford University Stanford California USA.

Abstract

Background: Non-suicidal self-injury (NSSI) is common in adolescents receiving psychiatric treatment and is a significant risk factor for suicidal behavior. There are few randomised clinical trials assessing interventions for NSSI in youth, and knowledge about internet-delivered interventions is limited.

Objective: We assessed the feasibility of Internet based Emotion Regulation Individual Therapy for Adolescents (ERITA) in psychiatric outpatients aged 13-17 years who engaged in NSSI.

Method: A randomised clinical feasibility trial with a parallel group design. Non-suicidal self-injury engaging patients were recruited from Child and Adolescent Mental Health Outpatient Services in the Capital Region of Denmark from May to October 2020. ERITA was provided as add-on to treatment as usual (TAU). ERITA is a therapist-guided, internet-based program of emotion regulation and skills training involving a parent. The control intervention was TAU. Feasibility outcomes were the proportion who completed follow-up interviews at end of intervention; proportion of eligible patients who participated in the trial; proportion of participants completing ERITA. We further investigated relevant exploratory outcomes, including adverse risk-related events.

Results: We included 30 adolescent participants, 15 in each group (ERITA vs. Treatment as usual). 90% (95% CI, 72%-97%) of the participants completed post-treatment interviews; 54% (95% CI, 40%-67%) of the eligible participants were included and randomised; and 87% (95% CI, 58%-98%) of the participants completed at least six out of 11 ERITA modules. We identified no difference for the primary exploratory clinical outcome of NSSI between the two groups.

Conclusion: There are few randomised clinical trials assessing interventions for NSSI in youth, and knowledge about internet-delivered interventions is limited. Based on our results we conclude that a large-scale trial seems feasible and warranted.

Keywords: ERITA; emotion regulation individual therapy for adolescents; feasibility trial; internet based intervention; non‐suicidal self‐injury; randomised.