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Using DBT’s Four Main Skills to Prevent Self-Injury

Using DBT’s Four Main Skills to Prevent Self-Injury

March 1 is Self-Injury Awareness Day and every year, this global event helps raise awareness for self-injury. Though it’s an isolating coping mechanism, it’s a struggle shared by millions of people around the world.

Self-injury, more commonly known as self-harm, involves any intentional, self-inflicted harm that lacks suicidal intent. Anyone with personal experience understands how serious and severe the problem can be. Unfortunately, those with no experience often make false assumptions about people who self-harm. Self-Injury Awareness Day is vital because increasing awareness leads to a greater sense of understanding and empathy. It reduces the sense of shame and judgment associated with self-injury and hopefully encourages people to seek help.

Those who struggle with self-injury tend to feel isolated and alone, separated from friends, family, and loved ones by their secret. Self-harm offers relief from emotional pain or a sense of control over life. That sense of relief and control is temporary, though, and typically creates a deepening and destructive cycle.

Adam’s Recovery Story

At his family’s urging, Adam showed up at Lifeskills after getting a DUI and medically withdrawing from college. He felt nervous, anxious, and most of all, defeated. Now, years later, after completing treatment at Lifeskills, he’s an Admissions Coordinator at Family First, an adolescent treatment center that helps others on their recovery journeys.

Many are scared to seek treatment for their self-harm and wonder whether it can truly help. However, support and treatment are available if you’re trying to overcome your struggles with self-injury. For example, a therapy called dialectical behavior therapy (DBT) teaches four behavior skills that help individuals stop their self-harm behaviors. Read on to learn more about how DBT can help.

Types of Self-Harm

Self-injury is defined as the practice of intentional but non-suicidal self-inflicted harm. In clinical settings, it’s referred to as non-suicidal self-injury or NSSI. Self-injury is typically thought of as any behavior that causes physical damage or harm. It also includes other forms of damaging or harmful actions like eating disorders, drug and alcohol abuse, and other risky behavior.

Self-harm is a common practice among adolescents and young adults according to extensive research. An international meta-analysis of over 50 studies revealed that 17% of adolescents have self-injured at least once in their life. Another study showed that around 15% of college students have engaged in self-harm at least once. Additionally, according to the American Journal of Psychiatry, the most common types of self-harm are:

  • Skin cutting
  • Head banging or hitting
  • Burning

People engage in different types of self-harm for a variety of reasons. Many explain that physical pain is easier to deal with or offers some relief from or control over their extensive emotional pain. Some struggle with the invisibility of emotional pain and find validation in the physical results of their self-harm. Others find the physical pain cuts through the sense of emotional numbness. Whatever the reason for self-harm behaviors, they only offer a temporary distraction from the underlying issues. Unfortunately, some people believe that self-injury is a cry for attention. Regardless of the method or intent, though, self-harm is dangerous and may be life-threatening if left untreated.

Additionally, self-injury usually co-occurs with other mental health conditions. Most people who practice these behaviors suffer from severe anxiety or depression. Eating disorders like anorexia and binge eating disorder are other common overlapping conditions.

Self-Injury Awareness Day exists to educate people who don’t understand self-injury as well as to help those who do. They hope that by opening discussions about self-harm, people will feel encouraged to ask for help.

Using DBT to Stop Self-Harm

Thankfully, treatment for self-harm is available. Talk therapy is the primary method of treatment when working to resolve self-injury behaviors. The patient and their therapist examine and address the immediate motives for these behaviors. Then they delve deeper into and work through the root causes of their self-harm.

Dialectical behavior therapy (DBT) is one of the most effective therapies when it comes to helping individuals who self-harm. It was initially developed to treat individuals with chronic suicidal ideation, particularly those with a borderline personality disorder. DBT is now also used in the treatment for self-harm as it provides helpful cutting coping skills.

DBT is a solution-focused therapy that helps individuals identify unhealthy behaviors and focus on replacing them with healthy ones. There are four main DBT coping skills including mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. All four DBT coping skills are essential tools for overcoming self-injury.


Mindfulness is a practice centered on developing awareness and acceptance of the present moment. It’s about teaching individuals to stop focusing on the past or the future and instead direct all their attention to what’s directly in front of them. Using mindfulness allows individuals to notice their thoughts and feelings as they arise, and then accept them without judgment. Detaching judgment from thoughts, feelings, and experiences is a key component of mindfulness.

Self-injury is an impulsive, reactive behavior based on extreme emotions. Mindfulness as one type of cutting coping skills works by placing a pause between feeling the extreme emotion and acting on the impulsive behavior. With practice, this pause allows time for an individual to consider utilizing another coping mechanism instead.

Distress Tolerance

Life is full of unpredictable ups and downs and for some people, self-harm is a way for them to cope with this unpredictability. Distress tolerance teaches individuals to tolerate this uncertainty and the painful feelings that result. People learn to manage their heightened emotions without resorting to harmful coping mechanisms.

The practice of mindfulness feeds into distress tolerance. Being aware of and accepting the present moment isn’t an easy thing to do but it’s a part of tolerating and working through discomfort. Distress tolerance is another way to place a pause between the initial destructive thought or feeling and the harmful coping mechanism.

Interpersonal Effectiveness

Self-harm often rises from difficulties with communication. Instead of someone reaching out for help, they self-harm. Interpersonal effectiveness focuses on helping individuals build their interpersonal communication skills so they can express their needs instead of burying them.

In addition to teaching individuals how to ask for what they need, interpersonal effectiveness also teaches them how to say no. Individuals learn to establish and maintain boundaries which leads to a sense of self-respect and healthier relationships with those around them.

Emotional Regulation

Emotional regulation is the most difficult skill to master but it’s also the most important one. Self-injury occurs during moments of extreme emotional highs or lows. To overcome struggles with self-harm, individuals must learn to keep regulate their emotions. Emotional regulation helps people understand that emotions are not permanent and that feelings are fleeting. Individuals can develop control over their emotions and eliminate their impulse to react whenever these emotions arise.

Taking the Steps to Seek Help for Self-Harm

If you’re struggling and need treatment for self-harm, we’re here for you.  At Lifeskills South Florida, we offer dialectical behavior therapy (DBT) via a comprehensive Linehan compliant 13-week program, as well as auxiliary DBT groups. Our self-harm treatment plans also incorporate other treatment methods and therapies, like cognitive behavioral therapy (CBT).

For more information on our self-harm treatment plans, call our admissions team today at 954-953-1742 or complete our contact form. Let Lifeskills help you take the next step toward recovery.




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