af Moshe Atlas 4 år siden
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NSSI (Hasking et al. 2016)
Nonsuicidal self-injury (NSSI) in preschoolers appears more common than previously thought, with studies indicating higher rates of suicidal ideation and behaviors in this age group.
af Moshe Atlas 4 år siden
166
Mere som dette
Behavioural/ computerised measures suggest that no
Self report suggests that yes (more self-critical?)
socially prescribed perfectionism predicts self-harm
emotional reactivity (Hasking et al. 2016)
low positive reactivity has a stronger association with NSSI than negative emotion reactivity (Gratz et al., 2006 - Is Allen & Hooley, 2015 related)?
emotional reactivity is associated with NSSI (but not hen physiological laboratory methods are used)
most naturally feeds into mindfulness based models
more easily aroused + greater aroused intensity
Experiential avoidance model (Chapman et al., 2006)
MY BOTTOM LINE: This has much in common with the previous model. The root of the problem is the inability to experience challenging emotions. This model adds expressly continued by explaining how NSSI is recruited to solve the problem, and how it can become a habit.
especially high amongst individuals with comorbid NSSI and ED
higher avoidance amongst NSSI than controls (both clinical BPD and community)
NSSI can become a classically conditioned response to difficulty
NSSI focuses attention away from the emotions
the need to avoid experiencing difficult emotions
difficulties in emotion regulation model (Gratz & Roemer, 2004)
MY BOTTOM LINE:
There's nothing wrong with aroused emotions and response-focused strategies if behavioural suppression is accompanied by the acceptance of powerful emotions and their accompanied physiological arousal. If difficult emotions don't result in distress, it is logical that dramatic actions such as NSSI are less necessary.
mindfulness moderates relationship between depression and NSSI
This is over and above the effects of mindfulness on becoming depressed in the first place
Choosing a behavioural response: two keys
flexibility/ situational appropriate strategy
impulse control
Acceptance of emotion - two keys:
acceptance of emotions
awareness and understanding of emotions
Emotional cascade model (Selby & Joiner, 2009)
many studies have found an association between rumination and NSSI
Some complication with distinction between brooding and reflection (what it means + relationship with NSSI)
Emotionally challenging moments can be tolerated, but repetitive rumination and re-experiencing of these moments can cause great distress.
Process model (Gross, 1998)
MY BOTTOM LINE
This is a cognitive (and behavioural) model emphasizing the importance of the correct perspective and interpretation of events. It makes sense that experiencing strong negative feelings results in distress and a search for means to reduce that stress.
RESEARCH
CR is negatively associated with NSSI
NSSI patients report emotional distress
cognitive reappraisal is negatively associated with distress, emotional suppression can exacerbate it
response-focused
emotional suppression
Antecedent (pre-arousal)
cognitive change
attentional deployment
this can include attentional biases
situation modification
situation selection
5 stages in the process of emotional arousal
NOTE: does this relate to the affect regulation and environmental models, or is it discreet? Klonsky et al. 2015 load this factor onto the intrapersonal factor, suggesting this has to do with affect regulation
relates to perfectionism and self criticism
relates to childhood emotional abuse
synonymous with interpersonal (see Klonsky et al., 2015; Taylor et al., 2018)
association between outcome expectancies, self-efficacy and NSSI
5. self-efficacy: belief in the anility to implement the self-injury
4. outcome expectancy: the belief that NSSI will provide relief
3. Negative self-schema: the way one views oneself (mediates the transition between negative emotional episodes and accumulated/ psychopathological negativity).
2. Poor emotional regulation abilities
see above for models/ competencies
1. High emotional reactivity
but why/ moderators/ mediators
trait-specific self-efficacy
JOINER, 1999
suicide requires self-efficacy for implementation
a more powerful predictor of behaviour
central to relapse, and prevention of subsequent episodes once a behaviour takes hold
general self-efficacy
the ability to handle situations as they arise. Stressful situations, or socially challenging environments may be especially relevant to NSSI.
Theory
maintaining or manipulating emotional states is a central function of NSSI (expecting to achieve that emotional outcome is thus fundamental)
strong association between positive outcome expectancies and indirect harmful behaviours (eating, alcohol, smoking)
NSSI is a big predictor for suicide. Red flag
Preoccupation with death important to distinguish between NSSI only children and NSSI + SI
2. no association with parental mood disorders, unlike previous research
1. higher prevalence of SI an SB than previously reported
parent report
MDD sample
all depressed
relies on parent report
largely caucasian
all treatment seeking
very small effects for
NO DIFFERENCE IN IMPULSIVITY
more violent life events
(look at CI - could be quite a large effect)
perhaps family history of bipolar (missed signficance)
higher externalising symptoms
higher irritability/ temper
increased depression severity
(remember all were depressed or almost depressed in the whole sample)
64.6% None
15.9% NSSI
anyone with NSSI and SI was upgraded
this messes up NSSI v other group matches
19.4% suicidal ideation
1.6% of sample had attempted
5.4% of sample also reported NSSI
(So NSSI = 21.3% of sample)
this messes up comaprisons
children on medication excluded
the healthy controls are therefore not typical healthy controls
findings support that there is no one causal pathway. a complex adaptive system
these models are the way forward
suggests no singular recipe for predicting the DV
high sufficiency, low necessity pattern = complex adaptive system. thought to be widespread in psychopathology.
NOTE. this does not represent a linear relationship between the IV and DV
forest plot
over 90% specificity, over 75% sensitivity
multivariate
a bit better than chance
univariate
chance sensitivity and specificty
4 (2*2) test of stimuli (positive/ death)(explicit/ implicit)
11 past suicide
7 past (intent) NSSI
12 cognitive/ emotional
6 demographic
specific focus on cutting
not very generalisable - this does not predict onset
moderator
68% suicide attempt
96% with suicide plans history
88% with lifetime NSSI history
does this generalise to community samples?
random forest model
look out for suicide ideation - strong association
studies look at risk factors for continued NSSI, but not for the onset
no standardised definition of the severity of self-harm necessary to be considered NSSI
many binary IV measures of past NSSI allowed one instance to be included
this may not apply to short-term prediction, which is the norm in clinical settings
see moderators
Once moderators included and then trimmed for publication bias, very small effects in some populations
altogether 52% of variance explained by moderators
binary IV measures were stronger predictors (1.5 times more)
harder to predict in adolescents than adults (1.5 times)
this may be due to more binary DVs in adolescents
harder to predict in general population than in clinical samples. Easiest in past-NSSI group
continuous DV measures had better prediction scores (1.5 times more)
was this included as a moderator?
BOTTOM LINE. no evidence for specificity. See Fox et al. 2019 (this is too simplistic - they are already inpatients here!)
a binary DV. (If a continuous DV is used, better prediction is possible (Fox et al., 2015)
This is explanation and not prediction (see Fox who cites Yarkoni & Westfall, 2017)
See Zelkowitz et al., 2018 - meta-analysis
in community samples
36 (25,45)
in clinical samples
47 (33,59)
The two samples here also show this - the correlation was almost double in the second sample
NSSI has been predominantly associated with BN/ purging (See Zelkowitz et al., 2018). This sample was predominantly AN. Nevertheless there was still a strong comorbidity. Questions about generalisability of findings. The high rates in this sample raise similar questions.
inpatients with comorbid EDs
different social factors?
high comorbid MHDs
only young adolescents
almost entirely female
for positive reinforcement interaction between SC and dependency
if both are high then no NSSI (perhaps issues with self-efficacy)
for 3 functions no significant prediction
suggests that there is overlap in motivations amongst all NSSI users
In the second sample
NSSI and SC correlation = .65
63% specificity
adding in suicidal ideation improves to 88% specificty
90% sensititvity
In the first sample
NSSI and SC correlation = .39
33% specificity
98% sensitivity
FASM measure (lowest)
most likely because rarely was not considered endorsement
ISAS measure (higher than FSAM) - double!?
adolescent populations (higher) v others
punish others
exert influence over others
communicate distress
self punishment
emotion regulation
