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Background: Nonsuicidal self-injury (NSSI) is a serious health risk behavior that forms the basis of a tentative diagnosis in DSM-5, NSSI Disorder (NSSID). To date, established treatments specific to NSSI or NSSID are scarce. As a first step in evaluating the feasibility, acceptability, and utility of a novel treatment for adolescents with NSSID, we conducted an open trial of emotion regulation individual therapy for adolescents (ERITA): a 12-week, behavioral treatment aimed at directly targeting both NSSI and its proposed underlying mechanism of emotion regulation difficulties., Methods: Seventeen girls (aged 13-17; mean = 15.31) with NSSID were enrolled in a study adopting an uncontrolled open trial design with self-report and clinician-rated assessments of NSSI and other self-destructive behaviors, emotion regulation difficulties, borderline personality features, and global functioning administered at pre-treatment, post-treatment, and 6-month follow-up. Measures of NSSI and emotion regulation difficulties were also administered weekly during treatment., Results: Ratings of treatment credibility and expectancy and the treatment completion rate (88%) were satisfactory, and both therapeutic alliance and treatment attendance were strong. Intent-to-treat analyses revealed significant improvements associated with large effect sizes in past-month NSSI frequency, emotion regulation difficulties, self-destructive behaviors, and global functioning, as well as a medium effect size in past-month NSSI versatility, from pre- to post-treatment. Further, all of these improvements were either maintained or further improved upon at 6-month follow-up. Finally, change in emotion regulation difficulties mediated improvements in NSSI over the course of treatment., Conclusions: Results suggest the acceptability, feasibility, and utility of this treatment for adolescents with NSSID., Trial Registration: ClinicalTrials.gov (NCT02326012, December 22, 2014, retrospectively registered).

Objective: Emotion regulation group therapy (ERGT) has shown promising results in several efficacy trials. However, it has not been evaluated outside a research setting. In order to increase the availability of empirically supported treatments for individuals with borderline personality disorder and deliberate self-harm, an evaluation of ERGT in routine clinical care was conducted with therapists of different professional backgrounds who had received brief intensive training in ERGT prior to trial onset., Design: Multi-site evaluation, using an uncontrolled open trial design with assessments at pretreatment, post-treatment and 6-month follow-up., Setting: 14 adult outpatient psychiatric clinics across Sweden., Participants: Ninety-five women (mean age=25.1 years) with borderline personality disorder (both threshold and subthreshold) and repeated self-harm were enrolled in the study. Ninety-three per cent of participants completed the post-treatment assessment and 88% completed the follow-up assessment., Primary and Secondary Outcome Measures: Primary outcome was self-harm frequency as measured with the Deliberate Self-Harm Inventory. Secondary outcomes included self-harm versatility, emotion dysregulation, other self-destructive behaviours, depression, anxiety, stress symptoms and interpersonal and vocational difficulties., Intervention: ERGT is an adjunctive, 14-week, acceptance-based behavioural group treatment that directly targets both self-harm and its proposed underlying mechanism of emotion dysregulation., Results: At post-treatment, intent-to-treat analyses revealed a significant improvement associated with a moderate effect size on the primary outcome of self-harm frequency (51%, reduction; Cohen's d=0.52, p<0.001) as well as significant improvements in the secondary outcomes of self-harm versatility, emotion dysregulation, other self-destructive behaviours and general psychiatric symptomatology. These results were either maintained or further improved on at 6-month follow-up., Conclusions: ERGT appears to be a feasible, transportable and useful treatment for deliberate self-harm and other self-destructive behaviours, emotion dysregulation and psychiatric symptoms when delivered by clinicians in the community., Trial Registration Number: NCT01986257; results., Competing Interests: Competing interests: HS, JBju, KLG, MTT, JBjä, L-GL, JJ and CH report no competing interests. EH and BL are shareholders of a company, Dahlia, specialised in psychiatric symptom assessment., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Emotion regulation group therapy (ERGT) is a novel treatment specifically targeting deliberate non-suicidal self-harm (DSH) in individuals with borderline personality disorder (BPD). Identifying robust predictors of positive response to ERGT could aid clinicians in treatment selection; however, to date, only one such study has been conducted. Thus, we aimed to replicate previously identified predictors of treatment response to ERGT by investigating demographic, clinical, and diagnostic predictors in 95 women with BPD or subclinical BPD who had participated in an open-trial evaluation of ERGT. Outcomes evaluated were frequency of DSH and emotion dysregulation. Assessments were conducted at pretreatment, post-treatment, and 6-month follow-up. Multilevel mixed linear models and multilevel negative binomial generalized estimated equations were used to identify significant interactions between the predictors and outcomes. We found that greater pretreatment DSH frequency was associated with greater improvements in DSH during treatment (b = 0.998, SE = 0.00, p = 0.03) and follow-up (b = 0.997, SE = 0.00, p < 0.01) and that greater BPD severity was associated with greater improvements in DSH during treatment (b = 0.84, SE = 0.06, p = 0.02) and in emotion dysregulation at follow-up (b = −3.05, SE = 1.47, p = 0.04). Co-occurring disorders were associated with poorer treatment response during follow-up. Results were generally consistent with a previous study of the predictors of response to ERGT. The findings provide further support for the utility of this treatment across a range of BPD patients, including patients with severe DSH and BPD. [ABSTRACT FROM AUTHOR]

The psychometric properties of the Swedish self-report version of the Strengths and Difficulties Questionnaire (SDQ-s), and the prevalence of emotional and behavioral problems as measured by the SDQ-s, were studied in 14 to 15-year-old adolescents. The psychometric properties were found to be similar to those found in other language versions, in terms of similar factor structure and acceptable test-retest stability, but low internal consistencies for some of the subscales. There was evidence of good convergent and discriminant validity. The results with regard to gender differences replicated previous findings in other countries, the girls reporting more emotional symptoms and more prosocial behavior, and the boys reporting more conduct problems and tending to report more peer problems. It is concluded that the results are in favor of using the Swedish SDQ-s as a screening instrument for adolescents, despite the low internal consistencies of some of its subscales. [ABSTRACT FROM AUTHOR]

Deliberate self-harm was studied in 14-year-old adolescents from four schools in southern Sweden with a test-retest design, using a nine-item version of the Deliberate Self-Harm Inventory. At Time 1, 40.2% of the adolescents indicated deliberate self-harm on at least one occasion compared with 36.5% at Time 2. Test-retest data showed high stability over periods of up to 2 months in duration. Cross-validation of the results from Time 1 to Time 2 showed robust correlations between deliberate self-harm and general psychopathology, a relative absence of positive feelings toward parents, and a ruminative style of emotional regulation. Further, rumination/negative thinking and a relative absence of positive feelings toward parents were predictors of self-harm independently of general psychopathology. In addition, deliberate self-harm correlated with symptoms of eating disorder and negative body esteem in girls. [ABSTRACT FROM AUTHOR]