Understanding the lived experience of students who self-injure during an educational intervention based on neuroscientific and functional behavioural perspectives

Understanding the lived experience of students who self-injure during an educational intervention based on neuroscientific and functional behavioural perspectives

Self-injury among adolescents is a problem that many school guidance officers and other professionals face every day. These professionals often express their desire to better understand this phenomenon in order to be better equipped to reduce or eliminate the incidence of self-injury and to prevent a possible fatal outcome in the form of suicide. Despite being a well-researched topic, there is a relative paucity of research that explains self-injury as a lived experience. Hermeneutic phenomenology provided an opportunity to the researcher to gain a qualitative understanding of the ‘in-the-moment’ experience of adolescents during self-injury incidents.

Numerous treatment options for self-injury are available, such as face-to-face cognitive behaviour therapeutic approaches and online interventions. A number of these approaches hold the promise of being successful in treating self-injury, but more so in relation to treating the underlying symptoms of other comorbid conditions such as depression or eating disorders. These approaches were considered to be too expensive and require a commitment over a long period, which make them less feasible for use with adolescents.

This thesis incorporates an understanding of self-injury from a number of perspectives. The information about the three adolescents who participated in this research was generated by means of instruments specifically developed for this study. These instruments were embedded in a brief, online educational intervention and focused on determining the reasons for the onset and continuation of self-injury from a functional behavioural viewpoint in terms of setting events, antecedents and the role of self-injury in maintaining consequences. Instruments included an initial questionnaire, quizzes, checklists, and an ecological momentary assessment instrument where the participants recorded their thoughts, feelings, and other circumstances at the time of self-injury.

A website called ‘Help for Harm’ was developed for the purpose of both information (data) gathering and containing the intervention which provided the adolescents with knowledge and information about self-injury from both functional behavioural and neurobiological perspectives. Topics included behaviour basics, how the brain works, mindfulness, as well as explanations of how what had happened in the past led to problems encountered in the present, to the extent of leading to employing self-injury as coping mechanism. This was followed by alternatives to self-injury while still meeting the functions of self-injury, namely to relieve high negative affect, among other functions.

This thesis also includes a presentation of the adolescents’ lived experiences in the form of narratives, and the identification of themes in the hermeneutic phenomenological tradition. The study confirmed, as setting events, the findings of numerous previous studies regarding trauma, insecure attachment and the quality of the family context, as well as several difficulties the adolescents experience as a result. The study also confirmed that self-injury continues to be a feasible, albeit maladaptive, coping strategy to alleviate high levels of negative emotions, and that the functions that self-injury have for the individual serve to maintain self-injury over time. Underlying these findings is the neuroscientific understanding of the various aspects of self-injury.

The findings of this research expanded on the existing understanding of self-injury in a number of significant ways. This study provided an opportunity to assess the various thoughts and feelings that adolescents experience at the time of a self-injury incident, the strength of the various thoughts and feelings, other conditions that may influence the urge to self-injure, as well as the experiences immediately after an incident. Additional understanding regarding the lived experience of being involved in an online intervention also contributed to the existing understanding of self-injury. The adolescents reported that by being involved in the study they reduced the incidence of self-injury, and that further gaining an understanding of the maintaining consequences of self-injury enabled them to apply alternative behavioural choices to replace self-injury.

We can only truly understand what the ‘in-the-moment’ experiences of those who self-injure are by approaching such experiences from a combined functional behavioural assessment and neurobiological viewpoint, which this study has successfully accomplished. Future research endeavours should seek to replicate this study among younger adolescents as well as diverse cohorts such as immigrants, those from mixed ethnic backgrounds, and persons of sexual orientations other than heterosexuality.