I have struggled with self-harm since I was in my early teens. Although the type of self-harm has changed, it has gotten steadily worse. How can I stop this behavior?

For some people, urges to self-harm (like cutting) are related to suicidal thoughts or a wish to die. For others, it is not about wanting to die. In either case, self-harm is often a response to painful or overwhelming feelings or thoughts.

While medications can help reduce mood or anxiety symptoms, they do not help with urges to self-harm. There are, however, specific kinds of psychotherapy that help. Effective psychotherapy for self-harm focuses on specific skills to manage the painful or overwhelming emotions that can trigger self-harm urges and behavior.

The best-known psychotherapy specific for self-harm is called Dialectical Behavior Therapy or DBT. DBT was developed by Marsha Linehan, a clinical psychologist who has lived with suicidal thoughts and self-harm urges since she was a teenager. Dr. Linehan’s program includes skills you can practice every day to build your resilience, like learning to observe strong emotions without either ignoring them or being overwhelmed by them. It also includes skills to help in crisis when self-harm urges are strong—like breathing exercises and “opposite action.”

If you are seeing a counselor or therapist, it’s important to speak openly about urges to self-harm and ask directly for help in managing them. Ask specifically about skills-based treatments like DBT. When you do, expect your therapist to focus on teaching. You’ll practice specific skills and work on actual homework assignments between sessions.

If you are looking for a new counselor or therapist, be sure to talk about self-harm as a problem you want help with and ask them about skills-based treatments like DBT.

You can learn more about DBT skills at NowMattersNow.org or DBTSelfHelp.com.

About the Doc

About the Doc

Greg Simon, MD, MPH, is a psychiatrist and researcher at  Kaiser Permanente Washington Health Research Institute in Seattle. His research focuses on improving the quality and availability of mental health services for people living with mood disorders, and he has a specific interest in activating consumers to expect and demand more effective mental health care.

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