Self-harm affects millions of people each year, with 22.1% of children and adolescents experiencing non-suicidal self-injury (NSSI) in their lifetime, showing an upward trend that needs attention. While self-harm can serve as a form of emotional release, 30.92% of individuals with a history of NSSI have engaged in medically severe self-harm requiring medical attention. Therapy and professional support can help people who self-injure develop healthier coping mechanisms to address their emotional pain and work toward recovery.
If you or a loved one is in crisis, you can call, text, or chat 988 to reach the 988 Suicide & Crisis Lifeline, which is available 24/7/365. Your conversations are free and confidential.
Table of Contents
- Treatment Options for Self-Harm
- Dialectical Behavior Therapy (DBT)
- Other Evidence-Based Treatments
- Self-Help Strategies for Managing Urges
- Supporting a Loved One Who Self-Harms
- Recovery and Moving Forward
- Frequently Asked Questions
- Find a Therapist
Treatment Options for Self-Harm
Therapy remains the most effective treatment for self-harm behaviors. Research has shown cautious optimism regarding the possible efficacy of emotion regulation group therapy, manual-assisted cognitive therapy, atypical antipsychotics, and SSRIs for reducing NSSI. Treatment approaches focus on identifying the underlying emotional pain and developing healthier coping strategies.
Structured psychotherapeutic approaches focusing on collaborative therapeutic relationships, motivation for change, and directly addressing NSSI behaviors seem to be most effective in reducing self-harm. During therapy, you'll work with a mental health professional to:
- Explore feelings of inadequacy or emotional distress that drive self-harm behaviors
- Identify triggers and patterns in your self-injury
- Develop alternative coping strategies
- Process any underlying trauma or mental health conditions
- Build a supportive recovery plan
Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy (DBT) has emerged as one of the most researched treatments for self-harm, particularly for adolescents and young adults. Meta-analysis of DBT for adolescents (DBT-A) shows small to moderate effects for reducing self-harm (g = -0.44; 95% CI -0.81 to -0.07) and suicidal ideation.
DBT teaches four core skill modules:
- Mindfulness - Being present and aware of thoughts and emotions without judgment
- Distress Tolerance - Managing crisis situations without self-harm
- Emotion Regulation - Understanding and managing intense emotions
- Interpersonal Effectiveness - Communicating needs and maintaining relationships
Analysis of clinical trial data shows that improvements in emotion regulation in youth at high risk for suicide who received dialectical behavior therapy (DBT) led to a reduction in self-harm behaviors. DBT can be delivered in individual therapy, group skills training, or a combination of both.
Other Evidence-Based Treatments
Several other therapeutic approaches have shown promise in treating self-harm:
Cognitive Behavioral Therapy (CBT)
CBT helps identify and change negative thought patterns that contribute to self-harm. Research indicates CBT combined with intensive support programs can significantly reduce NSSI rates and improve depressive symptoms, self-efficacy, and life satisfaction.
Family Therapy
For adolescents referred to mental health services after self-harm, family therapy approaches address the varied and heterogeneous nature of self-harm, recognizing it as a final common pathway for a wide range of problems. Family therapy can be particularly helpful when self-injury relates to home life stressors or family dynamics.
Group Therapy
Group therapy provides peer support and reduces the stigma and isolation often associated with self-injury. Participants share experiences and coping strategies in a supportive environment with others facing similar challenges.
Medication
While no medications specifically target self-harm, pharmacological treatment can be used to treat underlying conditions such as depression or anxiety that may contribute to self-harm behaviors. Medications are typically used alongside psychotherapy for optimal results.
Self-Help Strategies for Managing Urges
When the urge to self-harm feels overwhelming, these evidence-based strategies can help you cope without hurting yourself:
For Expressing Intense Emotions:
- Write down your feelings in a journal, then tear up the paper
- Exercise vigorously or punch a pillow to release physical tension
- Listen to music that matches and validates your emotions
- Create art that expresses your inner pain
For Calming and Grounding:
- Practice slow, deep breathing exercises
- Take a warm bath or wrap yourself in a soft blanket
- Use a stress ball or knead clay
- Try progressive muscle relaxation
For Connection and Support:
- Call or text a trusted friend (you don't have to discuss self-harm)
- Spend time with a pet
- Engage your senses with strong tastes (peppermint, cinnamon) or textures
- Call 988 to connect with trained crisis counselors who are available 24/7, 365 days a year. Once connected, this person will listen to you, work to understand what you're experiencing, provide support, and collaborate with you on ways to feel better
Safer Alternatives:
If you feel you must experience physical sensation:
- Snap a rubber band against your skin
- Hold ice cubes against the area you want to harm
- Draw on your skin with a red marker
Remember: The majority of people with NSSI (56.20%) have not received psychiatric care for this behavior, indicating a high rate of unmet treatment needs. Seeking help is a sign of strength, not weakness.
Supporting a Loved One Who Self-Harms
Discovering that someone you care about is self-harming can be frightening and overwhelming. Here's how to provide compassionate support:
Do:
- Listen without judgment
- Focus on their emotions rather than their injuries
- Express concern for their wellbeing
- Encourage professional help without forcing it
- Learn about self-harm to better understand their experience
- Contact the 988 Lifeline if you're worried about a loved one who may need crisis support
Don't:
- Issue ultimatums or threats
- React with anger or disgust
- Minimize their pain or problems
- Promise to keep it secret if they're in danger
- Try to be their therapist
While NSSI is considered an effective way to resist suicidal ideation in the short term, repeated NSSI may make an individual less pain sensitive and thus enhance the ability to transform suicidal thoughts to behavior, with studies showing NSSI increases suicide risk by up to seven-fold. Professional support is crucial.
Recovery and Moving Forward
Recovery from self-harm is possible, though the journey is unique for each person. Person-centered and compassionate care is essential, as negative experiences of clinical services may perpetuate a cycle of self-harm.
Physical Scars and Healing
Many people in recovery have physical scars from self-harm. These marks are symbols of survival and strength. You can choose to:
- Wear them openly - Your scars tell your story of resilience
- Cover them - Use clothing, scar cream, or specialized plasters
- Transform them - For someone who has faced depression, grief, self-harm, trauma, or suicidal thoughts, the semicolon tattoo can represent a pause in the story and a decision to continue writing the next line
The semicolon tattoo movement, founded in 2013, aims at "presenting hope and love to those who are struggling with depression, suicide, addiction and self-injury" and encourages people to tattoo the punctuation mark semicolon (;) as a form of solidarity.
Building Long-Term Recovery
Successful recovery often includes:
- Regular therapy sessions
- Developing a strong support network
- Practicing healthy coping skills daily
- Addressing underlying mental health conditions
- Creating a crisis plan for difficult moments
- Celebrating small victories along the way
Frequently Asked Questions
How effective is therapy for treating self-harm?
Meta-analysis demonstrates that DBT reduces self-harming behaviors and alleviates depression, with effects on suicidal ideation and anger being less significant. Studies show that DBT-A leads to significantly larger long-term reduction in self-harm behavior compared to enhanced usual care, suggesting it may be a favorable treatment alternative for adolescents with repetitive self-harming behavior.
What should I expect when calling the 988 Lifeline?
By calling or texting 988, you'll connect with trained counselors within the 988 Suicide & Crisis Lifeline network. Live chat services are also available at 988lifeline.org. If there is imminent risk to someone's life that cannot be reduced during the call, the 988 Lifeline will activate the 911 system. More than 98% of calls are handled without involving emergency services.
Can teenagers get help without parental involvement?
This depends on your location and age. Many areas allow adolescents to consent to mental health treatment independently. Many states have dedicated 988 contact centers for people experiencing a mental health crisis. Your local contact center serves your entire community 24/7 for free and will connect you to providers in the community that will support your needs.
Is online therapy effective for self-harm?
Recent research on a 12-week therapist-guided internet-delivered emotion regulation therapeutic approach found it effective in reducing both self- and other-reported NSSI frequency at 1-month and 3-month post-treatment assessments.
How common is self-harm recovery without professional help?
While some people do stop self-harming on their own, professional support significantly improves outcomes. 50.6% of U.S. youth ages 6-17 with a mental health disorder received treatment in 2016, suggesting many struggle without adequate support.
What if traditional therapy hasn't worked for me?
Briefer intervention options may increase access to care, as many traditional interventions for self-harm take 6 months or more to complete. Research is exploring brief psychosocial interventions not exceeding four 60-minute sessions.
Find a Therapist
If you're ready to seek professional help for self-harm, finding the right therapist is an important step in your recovery journey. Look for mental health professionals who specialize in:
- Self-harm and self-injury behaviors
- Dialectical Behavior Therapy (DBT)
- Trauma-informed care
- Adolescent or young adult mental health (if applicable)
GoodTherapy.org can help you find qualified therapists in your area who understand self-harm and can provide compassionate, evidence-based treatment. Use our therapist directory to search by location and specialty.
Remember: NSSI is prevalent in the general population and associated with considerable psychiatric comorbidity. Those at the greatest lifetime risk for NSSI may also be particularly limited in their resources to cope with this behavior. You deserve support, and help is available.
References:
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