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Mental Health

Cutting Through the Urge

Overcoming self-injury

Stephen P. Lewis, PhD, and Nancy L. Heath, PhD

Reprinted from "Young People: Self-Injury" issue of Visions Journal, 2017, 13 (2), p. 37

Self-injury is a significant mental health concern facing today’s youth and young adults. As many as one in five young people will report having self-injured at some point in their lives; many do so on more than one occasion.1

Individuals who struggle with self-injury say they also experience anxiety, depression, eating disorders and other mental health difficulties.1 This may help to explain why most youth and young adults who self-injure say they do so to help cope with difficult emotions such as sadness, distress and anger. In fact, this is the most common reason for self-injury.2,3 There are other reasons for self-injury, however. For example, some young people self-injure to express anger towards themselves or to communicate something to others, such as their need for help.

Although self-injury can be a very difficult experience, it is important to keep in mind that recovery is possible. Overcoming self-injury involves many things, particularly learning how to cope with urges to self-injure. There are various strategies that can help with this. One thing we know is that not all strategies work for everyone. In other words, what may work well for one individual who self-injures may not work well for another person. This is why it is important to recognize that there are many strategies, and that it may take time to find the strategies that work best.

We have aimed this article at those who struggle with self-injury. But we also provide information for those who care about them. Below, we describe a few possible strategies that may help you to cope with self-injury urges. At the end of the article, we provide more information and resources to access other strategies.

Following the 15-minute rule

One strategy that you might find helpful is to follow “the 15-minute rule.” This strategy involves trying to resist an urge to self-injure by not acting on it immediately but instead allowing 15 minutes to pass. You can even keep track of the time with a watch or clock (the timer on your phone, for example). This strategy may sound odd at first, but it can be quite helpful. By waiting 15 minutes, you may find that the urge to self-injure decreases over time. During the 15 minutes, you may also find it helpful to use some of the other strategies we describe below. Combining strategies in this way can be more effective.

Riding the wave

Another strategy that can help is to “ride the wave.” When you experience an urge to self-injure, it can be helpful to learn how the urge starts and how the intensity of the urge can change over time—just like a wave. Like any wave, the urge may start out small. Over time, the urge may get stronger. If you can learn to picture yourself “riding the wave” (or even surfing it), you may find that you can “ride out” the urge as it increases, peaks and then gradually weakens and disappears.

This kind of exercise can be helpful for two reasons. First, it allows you to realize that you can have an urge and not act on it. Second, it can help you understand what might lead to an urge and at what point an urge begins. This can help you to identify ways to cope—both when the urge starts and before it becomes stronger.

Getting active

Doing something active can also help you deal with self-injury urges. Specifically, if you feel an urge to self-injure, you might find it helpful to do some kind of physical exercise. Any kind of physical exercise will do: running, jumping, climbing stairs, cycling, dancing, fast push-ups—the list goes on! What’s important is to make sure the activity is intense and that it lasts until the urge has passed.

You might find it helpful to do some kind of creative activity. This could involve playing a musical instrument, singing, sketching, painting, writing or sculpting something with clay, among other things. Creative activities can help you express some of the intense emotions that go along with self-injury while at the same time distracting you from the urge to self-injure.

Reaching out

Talking about self-injury is difficult for many people. But while it can be hard to reach out to someone and find social support when you’re having an urge, it can be helpful.

Luckily, there are a few ways you can do this. First, you can share your current urge with someone and talk about what you’re experiencing and how to not act on it. This approach may be difficult, though, if you have not already told that person about your self-injuring. If this is the case, you could reach out to someone and just talk about your feelings generally, without discussing your urge to self-injure.

If you find it too difficult to share your urges or your feelings generally, it can still help to talk to someone and distract yourself from the urge. The conversation can really be about anything, but it should last until the urge goes away. In all cases, it can help to have a list of people you can call (or text). This way, you can contact someone else on your list if the first (or second) person is not available.

Finally, if you find yourself unable to call or text anyone you know, you can go online. For instance, you can see if a friend or relative is available to chat on Facebook. You might try calling a helpline in your area, such as the Kids Help Phone (1-800-668-6868 or kidshelpphone.ca) or a local distress line.

These strategies are just some of the ways that people learn to cope with urges to self-injure. To learn about other strategies to cope with urges and difficult emotions that often go along with self-injury, we encourage you to access our mobile-friendly website at Self-injury Outreach & Support, www.sioutreach.org. In addition to offering different coping strategies, we collect and share recovery stories and words of inspiration from others who have struggled with self-injury. Sometimes reading about others who have overcome self-injury can be very helpful.

The SiOS site also has social media content. You can read about self-injury and mental health topics and get regular updates. In addition, the website has information for those who play a supportive role in helping people who self-injure, providing guidance for friends, romantic partners, families, schools and medical and mental health professionals.

Remember, recovery is possible.

 
About the authors

Stephen is an associate professor in the Psychology Department at the University of Guelph and an international expert in self-injury. In 2015, he shared his lived experience with self-injury in a TEDx Talk (see youtu.be/G17iMOw0ar8). He is co-founder of Self-injury Outreach and Support (SiOS) and current President of the International Society for the Study of Self-Injury

Nancy is a James McGill Professor in the Department of Educational & Counselling Psychology at McGill University and has focused for 20 years on understanding self-injury. She has published extensively and presented at more than 200 conferences. She is co-founder of the non-profit Self-injury Outreach and Support (SiOS)

Footnotes:
  1. Lewis, S.P. & Heath, N.L. (2015). Non-suicidal self-injury among youth. Journal of Pediatrics, 166(3), 526-530. doi: 10.1016/j.jpeds.2014.11.062.

  2. Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27(2), 226-239.

  3. Klonsky, E.D. (2009). The functions of self-injury in young adults who cut themselves: Clarifying the evidence for affect-regulation. Psychiatry Research, 166(2-3), 260-268

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