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Evidence-Based Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth
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The purpose of this study was to review the current evidence base of psychosocial treatments for suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) in youth. We reviewed major scientific databases (HealthSTAR, MEDLine, PsycINFO, PubMed) for relevant studies published prior to June 2013. The search identified 29 studies examining interventions for suicidal or nonsuicidal SITBs in children or adolescents. No interventions currently meet the Journal of Clinical Child and Adolescent Psychology standards for Level 1: well-established treatments. Six treatment categories were classified as Level 2: probably efficacious or Level 3: possibly efficacious for reducing SITBs in youth. These treatments came from a variety of theoretical orientations, including cognitive-behavioral, family, interpersonal, and psychodynamic theories. Common elements across efficacious treatments included family skills training (e.g., family communication and problem solving), parent education and training (e.g., monitoring and contingency management), and individual skills training (e.g., emotion regulation and problem solving). Several treatments have shown potential promise for reducing SITBs in children and adolescents. However, the probably/possibly efficacious treatments identified each have evidence from only a single randomized controlled trial. Future research should focus on replicating studies of promising treatments, identifying active treatment ingredients, examining mediators and moderators of treatment effects, and developing brief interventions for high-risk periods (e.g., following hospital discharge).
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“Similarly, a systematic review of 29 treatment studies (including 18 RCTs) for suicidal and nonsuicidal self-injurious thoughts and behaviours (SITBs) in youth found that no intervention met the standard to be classified as a ‘well-established intervention’, and only six interventions could be classified as ‘probably efficacious’ [21].”
From Does treatment method matter? A meta-analysis of the past 20 years of research on therapeutic interventions for self-harm and suicidal ideation in adolescents (2020) · cites this paper as [21]
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“However, previous meta-analysis focused exclusively on a small number (k = 3) of randomized controlled trials (RCTs; Kothgassner et al., 2020), and the systematic review of controlled clinical trials (CCTs, trials including a control group, but which lack randomization) and pre-post evaluations only included studies published prior to July 2013 (k = 5, no RCTs; Glenn et al., 2015).”
From Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis (2021) · cites this paper as Glenn et al., 2015
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“Until recently, standard treatment of suicidality consisted of cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and/or medication, but all showed limited effects on suicidality [11, 13, 14].”
From The effectiveness and cost-effectiveness of attachment-based family therapy for young adults with high suicidal ideation: protocol of a randomized controlled trial (2024) · cites this paper as [13]
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“To date, two reviews evaluating the efficacy of psychosocial treatments for reducing adolescent self-harm and suicidal ideation have highlighted DBT-A as a promising treatment (Glenn, Franklin, & Nock, 2015; Kothgassner, Robinson, Goreis, Ougrin, & Plener, 2020).”
From Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis (2021) · cites this paper as Glenn, Franklin, & Nock, 2015
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Cited by
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Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research
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“…controlled trials (RCTs; Kothgassner et al., 2020), and the systematic review of controlled clinical trials (CCTs, trials including a control group, but which lack randomization) and pre-post evaluations only included studies published prior to July 2013 ( k = 5, no RCTs; Glenn et al., 2015).”
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“Second, and consistent with the 2015 review (Glenn et al., 2015), we elected to include only interventions specifically designed to treat SITBs in at-risk youth.”
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“Future research should focus on replicating studies of promising treatments, examining mediators and moderators of treatment effects, and developing brief interventions for high-risk periods (e.g. following hospital discharge) (Turner et al. 2014; Glenn et al. 2015).”
BackgroundA systematic review of psychosocial suicide prevention interventions for youth
Calear, A. L., Christensen, H. M., Freeman, A., Fenton, K., Grant, J. B., van Spijker, B. A. J., & Donker, T. (2015) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-015-0783-4 · Cited by 243
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“More recently, an update to the systematic review of treatment interventions for SITBs in youth [21] focused exclusively on RCTs, including the 9 new trials available since 2015 [20].”
BackgroundResultDiamond, G. S., Kobak, R. R., Krauthamer Ewing, E. S., Levy, S. A., Herres, J. L., Russon, J. M., & Gallop, R. J. (2019) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2018.10.006 · Cited by 147
“Using broad selection criteria, a recent review found 18 randomized control trials (RCTs) that examined psychosocial (with or without medication) treatments for adolescents with suicide ideation or behaviors.(2) Only 6 of these treatments met criteria for being probably or possibly efficacious.”
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Witt, K. G., Hetrick, S. E., Rajaram, G., Hazell, P., Taylor Salisbury, T. L., Townsend, E., & Hawton, K. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013667.pub2 · Cited by 149
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“However, evidence regarding effective prevention and interventions for adolescents with suicidal thoughts or behaviors is extremely limited (Robinson et al. 2011; Glenn et al. 2015).”
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“, 2015) and several reviews (Brent et al., 2013; Glenn et al., 2015) of interventions for suicidal adolescents concluded that family involvement plays a key role in positive intervention effects.”
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“Some interventions need to be tested in independent and larger samples to verify their utility before translation into common clinical practice could be considered (Glenn et al., 2015).”
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“Notably, efficacious psychosocial treatments for self-harm thoughts and behaviors for young people focus on treating the family, as well as the young person [35].”
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“these interventions has been well reviewed in several other papers (Brent et al., 2013; Glenn et al., 2015; Ougrin et al., 2015).”
BackgroundPrevention of internalizing disorders and suicide via adolescent sleep interventions
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“Although the number of controlled studies on psychotherapeutic interventions in NSSI is still limited, evidence on the efficacy of psychotherapy in the treatment of NSSI accumulates [34, 35].”
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“In support of this, in their review of psychosocial treatments for NSSI, Glenn et al. (2014) noted that familybased treatments such as attachment-based family therapy, combined individual and family therapy, and parent training were promising, but further research is required.”
BackgroundParents’ Experiences of Nonsuicidal Self-Injury Among Adolescents and Young Adults
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Self-citationNovel online daily diary interventions for nonsuicidal self-injury: a randomized controlled trial
Hooley, J. M., Fox, K. R., Wang, S. B., & Kwashie, A. N. D. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1840-6 · Cited by 66
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Oppenheimer, C. W., Glenn, C. R., & Miller, A. B. (2022) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2022.2051526 · Cited by 62
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Waraan, L., Siqveland, J., Hanssen‐Bauer, K., Czjakowski, N. O., Axelsdottir, B., Mehlum, L. I., & Aalberg, M. (2022) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045221125005 · Cited by 56
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Affect toward the self and self-injury stimuli as potential risk factors for nonsuicidal self-injury
Fox, K. R., Ribeiro, J. D., Kleiman, E. M., Hooley, J. M., Nock, M. K., & Franklin, J. C. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.11.083 · Cited by 54
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“For example, by improving family support and psychoeducation, the Youth-Nominated Support Team-Version II intervention was found to be more cost-effective and efficient than traditional intervention (Glenn et al., 2015).”
MethodUnderstanding and treating suicidal risk in young children.
Ridge-Anderson, A., Keyes, G. M., & Jobes, D. A. (2016) · Practice Innovations · doi:10.1037/pri0000018 · Cited by 49
“As Glenn, Franklin, and Nock (2015) have remarked, “there are currently no wellestablished treatments for suicidal or nonsuicidal self-injurious behaviors in youth.””
BackgroundLüdtke, J., In‐Albon, T., Michel, C., & Schmid, M. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.02.026 · Cited by 48
“A recent review on psychosocial treatment for selfinjurious thoughts and behavior by Glenn et al. (2015) concluded that an essential part of effective treatment is the training of skills to regulate emotion.”
BackgroundInfluentialEfficacy of interventions for suicide and self-injury in children and adolescents: a meta-analysis
Harris, L. M., Huang, X., Funsch, K. M., Fox, K. R., & Ribeiro, J. D. (2022) · Scientific Reports · doi:10.1038/s41598-022-16567-8 · Cited by 47
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“Moreover, parent involvement has been identified as a key factor of efficacious interventions for suicidal adolescents (Brent et al., 2013; Glenn et al., 2015) and has been integrated into promising interventions for high-risk teens during or following an ED visit (e.g., Asarnow et al., 2011, 2017;…”
BackgroundPosition paper for guiding response to non-suicidal self-injury in schools
Hasking, P. A., Heath, N. L., Kaess, M., Lewis, S. P., Plener, P. L., Walsh, B. W., Whitlock, J. L., & Wilson, M. (2016) · School Psychology International · doi:10.1177/0143034316678656 · Cited by 43
“in emotion regulation), motivation for treatment, and a focus on improving family and other interpersonal relationships (Glenn et al., 2015; Turner et al., 2014).”
BackgroundMehlum, L., Schmahl, C., Berens, A., Doering, S., Hutsebaut, J., Kaera, A., Kramer, U., Moran, P. A., Renneberg, B., Ribaudi, J. S., et al. (2020) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-020-00131-9 · Cited by 42
Meza, J. I., Patel, K., & Bath, E. P. J. (2022) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20210034 · Cited by 42
Cottrell, D. J., Wright-Hughes, A. M., Collinson, M., Boston, P., Eisler, I., Fortune, S. A., Graham, L., Green, J., House, A. O., Kerfoot, M., et al. (2018) · Health Technology Assessment · doi:10.3310/hta22120 · Cited by 43
Weinstein, S. M., Cruz, R. A., Isaia, A., Peters, A. T., & West, A. E. (2017) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12416 · Cited by 41
“Across the youth suicide intervention literature, treatments that have shown promise for decreasing suicidal thoughts and behaviors in adolescents share several common elements, including improving family and other relationships, parenting skills, and individual coping skills (Glenn et al., 2015).”
InfluentialN -Acetylcysteine for Nonsuicidal Self-Injurious Behavior in Adolescents: An Open-Label Pilot Study
Cullen, K. R., Klimes‐Dougan, B., Schreiner, M. W., Carstedt, P. A., Marka, N. A., Nelson, K. J., Miller, M. J., Reigstad, K. M., Westervelt, A., Gunlicks‐Stoessel, M., et al. (2017) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2017.0032 · Cited by 40
“…therapy (CBT), mentalization-based therapy (MBT), and some specific family-based interventions are psychotherapeutic approaches that have some preliminary support for treating self-injurious behavior (pooling both suicidal and NSSI together) in adolescents (Glenn et al. 2015; Ougrin et al. 2015).”
BackgroundAnti-Suicide Function of Nonsuicidal Self-Injury in Female Inpatient Adolescents
Kraus, L., Schmid, M., & In‐Albon, T. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00490 · Cited by 39
“A review has shown that all efficacious NSSI treatments include individual skills training as a common element, such as emotion regulation or problem-solving strategies (47).”
BackgroundReyes, A. D. L. (2017) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2016.1266649 · Cited by 38
“After 3 years, updates such as those by Smith and Iadarola (2015) on treatments for autism spectrum disorder and by Glenn, Franklin, and Nock (2015) on treatments for self-injurious thoughts and behaviors are among the most highly cited articles in JCCAP.”
BackgroundBrausch, A. M., O’Connor, S. S., Powers, J. T., McClay, M. M., Gregory, J. A., & Jobes, D. A. (2019) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12587 · Cited by 37
Parent–teen communication predicts treatment benefit for depressed and suicidal adolescents.
Zisk, A., Abbott, C. H., Bounoua, N., Diamond, G. S., & Kobak, R. (2019) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000457 · Cited by 41
“, 2014) is a 16week manualized treatment that has demonstrated efficacy in treating suicidal and depressed adolescents (Glenn et al., 2015).”
BackgroundBeidas, R. S., Ahmedani, B. K., Linn, K. A., Marcus, S. C., Johnson, C., Maye, M. P., Westphal, J. A., Wright, L., Beck, A. L., Buttenheim, A. M., et al. (2021) · Implementation Science · doi:10.1186/s13012-021-01154-8 · Cited by 39
“promising yet underused suicide prevention strategy [28].”
Lee, J., Chun, J., Kim, J., Lee, J.-E., & Lee, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182010623 · Cited by 40
“Moreover, some prior studies indicate that there are currently no wellestablished treatments shown to prevent or reduce suicidal ideation and behavior in youth [68,69].”
BackgroundDigital self‐harm and suicidality among adolescents
Patchin, J. W., Hinduja, S., & Meldrum, R. C. (2022) · Child and Adolescent Mental Health · doi:10.1111/camh.12574 · Cited by 43
Simes, D., Shochet, I. M., Murray, K. E., & Sands, I. G. (2021) · Adolescent Research Review · doi:10.1007/s40894-021-00164-3 · Cited by 36
Baker, A. C., Wallander, J. L., Elliott, M. N., & Schuster, M. A. (2022) · Child Psychiatry & Human Development · doi:10.1007/s10578-022-01319-6 · Cited by 42
“Reviews of interventions for self-harm behaviors including NSSI have found that the most efficacious interventions focused on improving adolescents’ relationships with parents and family [66, 67].”
BackgroundNon-suicidal Self-injurious Thoughts and Behaviors Among Adolescent Inpatients
Millon, E. M., Alqueza, K. L., Kamath, R. A., Marsh, R., Pagliaccio, D., Blumberg, H. P., Stewart, J. G., & Auerbach, R. P. (2022) · Child Psychiatry & Human Development · doi:10.1007/s10578-022-01380-1 · Cited by 36
Thoughts, images, and appraisals associated with acting and not acting on the urge to self-injure.
McEvoy, P. M., Hayes, S., Hasking, P. A., & Rees, C. S. (2017) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2017.05.010 · Cited by 34
“A recent systematic review suggests cognitive-behavioural treatments are “probably efficacious” in treating NSSI (Glenn et al., 2015; also; Muehlenkamp, 2006), but they are typically not aimed at selfinjury (Klonsky, 2007; Washburn et al., 2012).”
BackgroundAdolescent Admissions to Emergency Departments for Self-Injurious Thoughts and Behaviors
Zanus, C., Battistutta, S., Aliverti, R., Montico, M., Cremaschi, S., Ronfani, L., Monasta, L., & Carrozzi, M. (2017) · PLoS ONE · doi:10.1371/journal.pone.0170979 · Cited by 34
Acceptability and Use of Evidence-Based Practices for Firearm Storage in Pediatric Primary Care
Beidas, R. S., Jager‐Hyman, S., Becker‐Haimes, E. M., Wolk, C. B., Ahmedani, B. K., Zeber, J. E., Fein, J. A., Brown, G. K., Gregor, C. A., Lieberman, A., et al. (2018) · Academic Pediatrics · doi:10.1016/j.acap.2018.11.007 · Cited by 34
What suicide interventions should target
Franklin, J. C., Huang, X., Fox, K. R., & Ribeiro, J. D. (2017) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2017.08.002 · Cited by 34
Self-citationDevelopment and efficacy of a family-focused treatment for depression in childhood
Tompson, M. C., Langer, D. A., & Asarnow, J. R. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.06.057 · Cited by 36
Czyz, E. K., Arango, A., Healy, N. A., King, C. A., & Walton, M. A. (2020) · JMIR Mental Health · doi:10.2196/17345 · Cited by 47
Pan, C.-H., Lee, M., Wu, C., Liao, S., Chan, C., & Chen, C.-Y. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.12.139 · Cited by 34
Itzhaky, L., Davaasambuu, S., Ellis, S. P., Cisneros-Trujillo, S., Hannett, K., Scolaro, K., Stanley, B. H., Mann, J. J., Wainberg, M. L., Oquendo, M. A., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.12.094 · Cited by 33
Risk Assessment and Crisis Intervention for Youth in a Time of Telehealth
Holland, M. L., Hawks, J. L., Morelli, L. C., & Khan, Z. S. (2021) · Contemporary School Psychology · doi:10.1007/s40688-020-00341-6 · Cited by 37
Hasking, P. A. (2017) · Prevention Science · doi:10.1007/s11121-017-0755-7 · Cited by 35
“Evidencebased interventions that specifically target NSSI are rare (see Andover et al. 2015; Gratz et al. 2015 for notable exceptions).”
BackgroundReview of family‐based treatments from 2010 to 2019 for suicidal ideation and behavior
Frey, L. M., Hunt, Q. A., Russon, J. M., & Diamond, G. (2022) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12568 · Cited by 32
Scopetti, M., Morena, D., Padovano, M., Manetti, F., Fazio, N. D., Delogu, G., Ferracuti, S., Frati, P., & Fineschi, V. (2023) · Healthcare · doi:10.3390/healthcare11101470 · Cited by 33
Esposito-Smythers, C. L., Hadley, W. S., Curby, T. W., & Brown, L. K. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.11.005 · Cited by 30
“Given that rates of suicide attempts were very low, and suicidal and non-suicidal self-injury were significantly correlated over follow-ups (r = .38-.44, p=.001 to .004), these forms of DSH were collapsed into one item as is common in suicide treatment research (Glenn et al., 2015).”
BackgroundTreatments for Self-Injurious Thoughts and Behaviors in Youth: Progress and Challenges
Bettis, A. H., Liu, R. T., Walsh, B. W., & Klonsky, E. D. (2020) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2020.1806759 · Cited by 32
Chen, X., Zhou, Y., Li, L., Hou, Y., Liu, D., Yang, X., & Zhang, X. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.681985 · Cited by 34
“Factors that have been identified to date remain poorly understood (12, 14), and results have been inconsistent (2, 15).”
ResultPredicting Patterns of Treatment Response and Outcome for Adolescents Who Are Suicidal and Depressed
Abbott, C. H., Zisk, A., Bounoua, N., Diamond, G. S., & Kobak, R. (2019) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2018.12.013 · Cited by 34
Tschan, T., Lüdtke, J., Schmid, M., & In‐Albon, T. (2019) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-019-0275-2 · Cited by 30
Simonsson, O., Engberg, H., Bjureberg, J., Ljótsson, B., Stensils, J., Sahlin, H., & Hellner, C. (2021) · JMIR Formative Research · doi:10.2196/17910 · Cited by 32
“The availability of frequent and flexible online and telephonic contact was important for the participants, in line with previous findings [25,27].”
BackgroundResultRees, C. S., Hasking, P. A., Breen, L. J., Lipp, O. V., & Mamotte, C. D. S. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0527-5 · Cited by 33
Metadata
- Authors
- Glenn, C. R., Franklin, J. C., & Nock, M. K.
- Affiliations
- Harvard University (US)
- Corresponding author
- Glenn, Catherine R.
- Venue
- Journal of Clinical Child & Adolescent Psychology
- Publisher
- Informa UK Limited
- Published
- 2014-09-25
- Volume
- 44
- Issue
- 1
- Pages
- 1-29
- ISSN
- 1537-4416 (ISSN-L)
- 1537-4424
- PMC
- PMC4557625
- OpenAlex
- W2081568229
- Cited by
- 288
- References
- 133
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 29 · 2023: 26 · 2022: 24 · 2021: 56 · 2020: 32 · 2019: 25 · 2018: 29 · 2017: 23 · 2016: 16 · 2015: 6
- FWCI
- 17.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Child & Adolescent Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- The research was supported, in part, by a grant from the National Institute of Mental Health (F32 MH097354) awarded to Catherine R. Glenn and a MacArthur Fellowship awarded to Matthew K. Nock. We thank Daniel Coppersmith, Sima Shabaneh, and Suzanne Shdo for their assistance reviewing the relevant literature for this manuscript.
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- self-injurious thoughts and behaviors, suicidal ideation, non-suicidal self-injury, youth, psychosocial interventions, treatment efficacy, family skills training, parent training, contingency management, emotion regulation, problem solving, children and adolescents
- MeSH terms
- Adolescent, Behavior Therapy, Child, Humans, Randomized Controlled Trials as Topic, Self-Injurious Behavior, Treatment Outcome, Evidence-Based Medicine, Suicidal Ideation
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