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Evidence Base Update of Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth
Abstract
The current review provides an evidence base update of psychosocial treatments for self-injurious thoughts and behaviors (SITBs) in youth. A systematic search was conducted of 2 major scientific databases (PsycInfo and PubMed) and ClinicalTrials.gov for relevant randomized controlled trials (RCTs) published prior to June 2018. The search identified 26 RCTs examining interventions for SITBs in youth: 17 were included in the 2015 review and 9 trials were new to this update. The biggest change since the prior review was the evaluation of Dialectical Behavior Therapy for adolescents (DBT-A) as the first Level 1: Well-established intervention for reducing deliberate self-harm (composite of nonsuicidal and suicidal self-injury) and suicide ideation in youth and Level 2: Probably efficacious for reducing nonsuicidal self-injury and suicide attempts. Five other interventions were rated as Level 2: Probably efficacious for reducing SITBs in youth, with the new addition of Integrated Family Therapy. This evidence base update indicates that there are a few promising treatments for reducing SITBs in youth. Efficacious interventions typically include a significant family or parent training component as well as skills training (e.g., emotion regulation skills). Aside from DBT-A, few treatments have been examined in more than one RCT. Given that replication by independent research groups is needed to evaluate an intervention as Well-established, future research should focus on replicating the five promising interventions currently evaluated as Probably efficacious. In addition, an important future direction is to develop brief efficacious interventions that may be scalable to reach large numbers of youth.
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“An evidence update concluded that DBT was the only intervention to meet the threshold for ' well established treatments ' for reducing suicidal ideation and suicidal behaviour in children and adolescents 273 .”
From Suicide and suicide risk (2019) · cites this paper as [273]
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In the citing paper
“Across several different treatment interventions, certain elements seemed to increase treatment efficacy, such as a family-centred approach, the inclusion of skills-training, and (except for suicide attempts) longer treatment duration.”
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 [20]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
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“In light of this additional evidence, DBT-A now met the standard to be classified as a ‘well-established intervention’ for reducing both self-harm and suicidal ideation and was classified as ‘probably efficacious’ for reducing NSSI and suicide attempts.”
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“According to international standards, Dialectical Behavior Therapy for Adolescents (DBT®-A) is an evidence-based treatment for these patients, especially concerning the reduction of self-harm (8–11).”
From Radical Acceptance of Reality: Putting DBT®-A Skill Groups Online During the COVID-19 Pandemic: A Qualitative Study (2022) · cites this paper as [8]
In the citing paper
“We must emphasize that a range of psychosocial interventions, including cognitive-behavioural therapy, dialectical behaviour therapy and mentalization based therapy have all been shown to reduce suicidal and self-harming behaviour in randomized trials with both adolescents [21] and adults [22].”
From Euthanasia and assisted suicide in patients with personality disorders: a review of current practice and challenges (2020) · cites this paper as [21]
In the citing paper
“However, there is ample empirical data to show that suicidal tendencies and behaviour can be treated and that they fluctuate rapidly over time.”
From Euthanasia and assisted suicide in patients with personality disorders: a review of current practice and challenges (2020) · cites this paper as [21]
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“…interventions that can potentially be scaled to provide more rapid access to large numbers of youth presenting, without necessarily needing to attend more resource-intensive psychiatric or multi-disciplinary specialist mental health services that may be limited in availability (Glenn et al., 2019).”
InfluentialYuan, G. F., Lu, Y., Tao, Y., & Shi, W. X. (2025) · European Journal of Psychotraumatology · doi:10.1080/20008066.2025.2521917 · Cited by 8
“Given the complex, multifaceted nature of NSSI and its risk factors, clinicians should prioritise evidence-based interventions with demonstrated efficacy from controlled trials rather than relying on correlational findings such as ours to guide treatment decisions (Glenn et al., 2019; Nock, 2010).”
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BackgroundSuicide and Suicide Attempts During Adolescence
Esposito-Smythers, C. L., Whitmyre, E. D., Defayette, A. B., López, R., Maultsby, K. D., & Spirito, A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00059-5 · Cited by 5
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“…evidence-based practices include mandated caregiver participation in the treatment (Iyengar et al., 2018), a focus on improving coping skills and family relationships (Calear et al., 2016; Glenn et al., 2019), and establishing a good therapeutic alliance early in treatment (Huggett et al., 2022).”
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InfluentialBrief interventions for self-injurious thoughts and behaviors in young people: A systematic reviewPreprint
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“While the increased work absence observed among parents of self-harming youths was anticipated, given clinical recommendations 16–18 and qualitative reports, 12 its magnitude has not been previously quantified.”
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Esposito-Smythers, C. L., Fischer, S. F., Whitmyre, E. D., Defayette, A. B., Maultsby, K. D., & Renshaw, K. D. (2022) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2022.2124556 · Cited by 3
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“Trotz der hohen Prävalenz von Suizidgedanken und Suizidversuchen im Jugendalter [28], hat sich – mit Ausnahme der DBT – keine Psychotherapieform als wirksam in dieser Altersgruppe herausgestellt [29].”
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“DBT is now the leading treatment for youth experiencing suicidal ideation and non-suicidal self-injury (Busby et al., 2020; Glenn et al., 2019).”
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“Treatment for this behavior requires various approaches, including parent training, brief skills training, and behavioral therapies (6).”
Ergenlik Döneminde Kendine Zarar Verme Davranışı: Bir Mesleki Uygulama Olarak Klinik Sosyal Hizmet
Sağlam, Ö. (2025) · Tıbbi Sosyal Hizmet Dergisi · doi:10.46218/tshd.1617478 · Cited by 1
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Esposito, E. C., Patel, K. K., Hull, S., Johnson, C. N., Patel, M. A., & Glenn, C. R. (2026) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2026.2613368 · Cited by 1
“Further, a follow-up publication to Diamond et al. (2019) RCT (cited in Glenn et al., 2019 as “Diamond et al., 2018”) did not find significant moderation by SM status (45% SM) on reduction in adolescent SI during treatment for youth randomized to either attachment-based family therapy or…”
InfluentialSelf-citationKwak, H., & Ahn, U. K. (2026) · Behavioral Sciences · doi:10.3390/bs16020308 · Cited by 1
“Glenn et al. (2019) reported an average effect size of d = 0.34 for psychosocial treatments targeting suicidal ideation in youth, while Ougrin et al. (2015) reported pooled effects of d = 0.34 for interventions targeting NSSI.”
InfluentialKim, S., Berg, A., Walker, D. M., Teuschler, L., Sinclair, A., & Hughes, J. L. (2026) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2026.2673505 · Cited by 1
Programa psicoterapêutico de prevenção do suicídio em adolescentes: estudo de Delphi
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Treatment Approaches with Suicidal Adolescents
Spirito, A., Webb, M. A., Wolff, J. C., & Esposito-Smythers, C. L. (2021) · Springer eBooks · doi:10.1007/978-3-030-41319-4_21-1 · Cited by 1
Perspectives on General Partial Hospital Programs for Children
Barnes, S. E., Boekamp, J. R., Davis, T., de Steiguer, A., Hunter, H. L., Lin, L. W., Martin, S. E., Morrison, R., Parade, S. H., Partridge, K., et al. (2022) · Issues in clinical child psychology · doi:10.1007/978-3-031-14567-4_6 · Cited by 1
The Brain and Body’s Threat System Functioning in Those with NSSI
Carosella, K. A., Wiglesworth, A., Başgöze, Z., Cullen, K. R., & Klimes‐Dougan, B. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197611272.013.14 · Cited by 1
Correlates of informant discrepancies in self-harm among youth involved in child protective services
Rabinowitz, J. A., Kahn, G. D., Felton, J. W., Drabick, D. A. G., & Wilcox, H. C. (2023) · Children and Youth Services Review · doi:10.1016/j.childyouth.2023.107200 · Cited by 1
Janackovski, A., Deane, F. P., Hains, A. R., Kelly, P. J., & Robinson, L. D. (2023) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12512 · Cited by 1
Albright, J., Hernandez, A., Piotrowski, Z., Russo, J., Cooney, D., Nutini, M., Sabatino, N., Dodd, D., Mandell, D. S., & Worley, J. A. (2024) · Journal of Educational and Psychological Consultation · doi:10.1080/10474412.2024.2303512 · Cited by 1
Siciliano, R. E., McGonigle, T., Benningfield, M. M., Vandekar, S., Owens, M. V., Felts, B., Anderson, A. S., Cole, D. A., & Bettis, A. H. (2024) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2024.2358494 · Cited by 1
“For example, evidence suggests that psychosocial treatments that incorporate parents and/ or family are more effective for high-risk youth, highlighting the need to examine the impact of these aspects of treatment on PHP outcomes (Bettis, Liu, et al., 2020; Glenn et al., 2019).”
Chen, J. T., DiPierro, M., Cullinan-Ludwig, C., & Stinson, D. (2024) · Issues in clinical child psychology · doi:10.1007/978-3-031-62749-1_25 · Cited by 1
Assessment and Treatment of Mood Disorders in Child and Adolescent Inpatient Mental Health Settings
Leffler, J. M., & Shekunov, J. (2024) · Issues in clinical child psychology · doi:10.1007/978-3-031-62749-1_17 · Cited by 1
Aunon, F. M., Ingram, P. F., Wolkowicz, N. R., Martino, S., Kacos, H. N., Spana, E., Honsberger, M., Rielage, J. K., Doran, N., Carretta, R. F., et al. (2025) · Counselling and Psychotherapy Research · doi:10.1002/capr.70000 · Cited by 1
Goger, P., Nam, R. J., Lowry, N. J., Cha, C. B., Ribeiro, J. D., Huang, X., & Fox, K. R. (2025) · Journal of Applied Research on Children Informing Policy for Children at Risk · doi:10.58464/2155-5834.1543
Champion, K. M., & Trane, S. T. (2020) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2020.1784059 · Cited by 1
Flygare, O., Ojala, O., Pontén, M., Klintwall, L., Karemyr, M., Sjöblom, K., Wallert, J., Hellner, C., Nilbrink, J., Bellander, M., et al. (2023) · doi:10.31234/osf.io/vd6yx · Cited by 1
Donnelly, H. K., Solberg, V. S. H., Green, J. G., Wijaya, D. T., & Jobes, D. A. (2025) · medRxiv · doi:10.1101/2025.06.09.25329115 · Cited by 1
“DBT has been suggested as a valuable psychosocial intervention program for youth with relational stress and suicidality (Glenn et al., 2019).”
Developing and Evaluating Novel Treatments for Nonsuicidal Self-Injury Within Swedish Health Care
Bjureberg, J. (2021) · Suicidologi/Nytt i suicidologi · doi:10.5617/suicidologi.8534
“Finally, we included a parent program because analyses across treatment studies indicate that a family component is beneficial in treatment of adolescents with NSSI (Glenn et al., 2019; Iyengar et al., 2018; Ougrin et al., 2015).”
BackgroundMethodInfluentialFrom attachment insecurity to non-suicidal self-injury: The mediating role of emotion regulation
Miles, N. (2021) · Open Access Victoria University of Wellington | Te Herenga Waka (Figshare) · doi:10.26686/wgtn.14788827.v1
Conclusion: The Future of Youth Suicide Prevention
Jeglic, E. L., & Miranda, R. (2021) · Springer eBooks · doi:10.1007/978-3-030-82465-5_24
Training Mental Health Providers to Prevent Teen Suicide Using Evidence-Based Approaches
Clarke, S. B., Ross, A. M., Avina, C., Allerhand, L., & Berk, M. S. (2021) · Springer eBooks · doi:10.1007/978-3-030-82465-5_20
Silva, A. C. (2021) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/t.22.2021.tde-12052022-111535
Psychotherapie bei Kindern, Jugendlichen und Erwachsenen mit Suizidgedanken und -absichten
Teismann, T., & Kaurin, A. (2022) · Die Psychotherapie · doi:10.1007/s00278-022-00620-y
“Im internationalen Vergleich liegt die Suizidrate in Deutschland im mittleren Bereich – und dies sowohl im Kindes- und Jugendalter (Glenn et al. 2019) als auch im Erwachsenenalter (WHO 2014).”
BackgroundChild and adolescent suicidal and self-harm behavior
Goldman-Mellor, S. J., Cruz, S. S., Jensen, J., & Hall, C. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-818872-9.00182-5
Development and Implementation of an Intensive Outpatient Program for Suicidal Youth
Heerschap, J. K., Michaels, M. M., Hughes, J. L., & Kennard, B. D. (2022) · Issues in clinical child psychology · doi:10.1007/978-3-031-14567-4_13
NSSI Among Sexual and Gender Diverse Youth
Zullo, L., Rogers, M. L., & Taliaferro, L. A. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197611272.013.33 · Cited by 1
New Studies on Suicide and Self-Harm
Hocaoğlu, Ç. (2023) · IntechOpen eBooks · doi:10.5772/intechopen.1000386
Managing NSSI Across Different Treatment Contexts
Rockstroh, F., & Kaess, M. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197611272.013.51
Nonsuicidal Self-Injury and Suicidal Thoughts and Behaviors
Corcoran, J., & Wolk, C. B. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197653562.003.0011
Simes, D. (2024) · Queensland University of Technology · doi:10.5204/thesis.eprints.254566
The role of cognitive and personality factors in youth deliberate self-harm: a systematic review
Kpeno, A., Sahoo, S., Sahu, A. K., Sahu, P. K., & Bagson, E. (2024) · International Journal of Research in Medical Sciences · doi:10.18203/2320-6012.ijrms20244133
“25 The findings from this study revealed a reduction in eating disorders behaviour at different frequency, however, adolescents with other specified feeding or eating disorder (OSFED)-other 1 OSFED-other 2 were associated with depression, anxiety disorders and DSH. 19 Also utilized a…”
Borderline Personality and Other Personality Disorders
Paris, J. (2025) · Cambridge University Press eBooks · doi:10.1017/9781009086264.016
Treatment of Suicidal Thoughts and Behaviors in Children and Adolescents
Balser, D., Padron, M., & Pettit, J. W. (2025) · Advances in Psychiatry and Behavioral Health · doi:10.1016/j.ypsc.2025.02.008
Campos, M., Canetti, A., & Blumkin, Z. K. (2025) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2025.2485081
“Following at least two RCTs conducted by two separate research groups, DBT-A has been identified as the only well-established empirically supported treatment for decreasing suicide attempts and NSSI for youth (Glenn et al., 2019).”
Developing a suicide risk prediction model for hospitalized adolescents with depression in China
Zhao, J., Li, Y., Chen, Y., & Shuid, A. N. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1532828
“In the short term, it may provide relief; however, longitudinal studies indicate that repetitive self-harm signi fi cantly increases the risk of transitioning to suicidal behavior, especially in individuals experiencing social isolation or depression (69, 70).”
Evaluating Standards of Care Training for Social Workers Completing Suicide Risk Assessment
Scott, M., & Underwood, M. (2025) · Research on social work practice · doi:10.1177/10497315251346037
“There is evidence that there are effective interventions available to work with clients at risk or who are suicidal (Doupnik et al., 2020; Glenn et al., 2019; Haroz et al., 2024; Mann et al., 2021; Stanley & Brown, 2012); and, there is evidence that trainings can improve knowledge, comfort/con fi…”
Zlotnik, D. M., Harris, K. M., & Rosario‐Williams, B. (2025) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2025.2522072
“Five out of six well-established or probably efficacious treatments for self-injurious behaviors include a parent training or family therapy component (Glenn et al., 2019).”
Stargell, N. A., Kress, V. E. W., Whisenhunt, J. L., & McAllister, C. A. (2025) · The Journal of Humanistic Counseling · doi:10.1002/johc.70001
Kuehn, K. S., & King, K. M. (2023) · doi:10.64628/aan.kux6qq34y
Kuehn, K. S., & King, K. M. (2022) · doi:10.64628/aai.j5ycgd53g
Profiles of Parenting and Adolescent Non-suicidal Self-injury, Function in a Depressed Sample
Yu, T., Shang, L., Xu, F., Zhang, Y., & Qian, L. (2025) · Journal of Child and Family Studies · doi:10.1007/s10826-025-03157-1
“Notably, family therapy often surpasses individual therapy in effectiveness (Glenn et al., 2019).”
Weber, A., Flanagan, T. J., & Darrow, S. M. (2025) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2025.2592923
“There are evidence-based interventions that directly target decreasing self-harming behaviors amongst youth (Bahji et al., 2021; Calear et al., 2016; Calvo et al., 2022; Glenn et al., 2019; Itzhaky et al., 2022).”
Lee, C. A., Gamino, D., Lore, M. H., Donelson, C., & Windsor, L. C. (2024) · Figshare · doi:10.6084/m9.figshare.26602690
Henderson, M. D., Wilcox, H. C., Raynor, P., Hanson, G. C., Reynolds, E. K., & Gross, D. A. (2025) · Research in Nursing & Health · doi:10.1002/nur.70051
Metadata
- Authors
- Glenn, C. R., Esposito, E. C., Porter, A. C., & Robinson, D. J.
- Affiliations
- University of Rochester (US)
- Corresponding author
- Glenn, Catherine R.
- Venue
- Journal of Clinical Child & Adolescent Psychology
- Publisher
- Informa UK Limited
- Published
- 2019-05-02
- Volume
- 48
- Issue
- 3
- Pages
- 357-392
- ISSN
- 1537-4416 (ISSN-L)
- 1537-4424
- PMC
- PMC6534465
- OpenAlex
- W4230498762
- Cited by
- 219
- References
- 105
- Citations by year
- 2026: 21 · 2025: 28 · 2024: 33 · 2023: 42 · 2022: 33 · 2021: 36 · 2020: 20 · 2019: 6
- FWCI
- 27.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Child & Adolescent Psychology (publishedVersion)
- Funders
- National Institute of Mental Health (L30 MH101616)
- 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, self-harm, non-suicidal self-injury, suicidal self-injury, suicidal ideation, youth, psychosocial interventions, dialectical behavior therapy for adolescents, parent training, emotion regulation skills, brief intervention, treatment efficacy
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