Cue reactivity to self-harm cues: the development of a systematic treatment intervention for deliberate self-harm

Abstract

There is increasing awareness of the prevalence of deliberate self-harm (DSH) although the phenomenon is still poorly understood. Those who self-harm often have a poor long-term prognosis, yet systematic focused treatment interventions are scarce. DSH appears to share fundamental characteristics with addictive behaviour, including; impulsive or compulsive urges to act in the presence of triggers, positive and negative reinforcing consequences and endorsement of the diagnostic criteria for clinical dependence. Given this fact, a behavioural mode of DSH may be appropriate. A range of events are anecdotally reported to trigger DSH. This thesis was designed to identify these cues, to develop an understanding of how those who self-harm respond to these cues and the processes by which these cues may operate to maintain DSH. An intervention based on the management of urges to self-harm in the presence of these cues was developed.
Study I identified that triggers for DSH (interpersonal, intrapersonal and environmental) were similar to those that reliably predict addictive behaviour. Respondents endorsed the diagnostic criteria for dependency and reported that the act of DSH reduced negative emotions. The second two studies identified self-reported cue reactivity, and generalised hyperarousal to both DSH and neutral stimuli in those who self-harm but no evidence of psychophysiological cue reactivity. Study IV used ERP methodology to evaluate cue reactivity at the CNS level and to evaluate two mechanisms by which cues might operate to maintain DSH. There was some preliminary support for enhanced preconscious attentional bias towards emotional, but not environmental DSH cues, and no support for emotional interference. Study V identified that those who self-harm exhibited enhanced tolerance to physical and psychological stressors, and that priming with interpersonal distress did not impact on this tolerance. Finally, a single case intervention study identified a reduction in DSH, reduced psychophysiological arousal and urges to self-harm and improved clinical symptomatology. However, clinical improvements were not time-locked to targeted exposure intervention phases. The clinical and theoretical implications for these findings are discussed.

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