Hanna Sahlin

Self-harm is a serious and growing public health concern among adolescents, strongly associated with suicide risk and mental health problems. It imposes significant societal costs through increased demand for psychiatric and emergency medical care, school absenteeism, and parental sick leave, both short- and long-term. Early interventions, including parental support and psychological treatment focused on emotion regulation may help prevent further deterioration. There is a clear need for brief, accessible treatments tailored to patients within child and adolescent psychiatry services (CAMHS), as well as for effective collaboration models between families and CAMHS. Following a promising feasibility study, we now want to assess the effectiveness of a novel group-based intervention, ERGT-A, for self-harming adolescents and their parents in a single blinded clinical randomized controlled effectiveness study including 166 adolescents (ages 13–18). The control group will receive TAU and cross over to ERGT-A treatment after the primary end-point. This study combines quantitative measures and repeated assessments to identify change processes and long-term effects. This project involves parents, and bridges the gap between research and practice, promoting early intervention and long-term health for a vulnerable and growing patient group.

Research problem and specific questions Self-harm in adolescents is a serious and growing concern, inked to increased risk of suicide attempts, psychiatric disorders, substance use, and inpatient care. Early detection and intervention is crucial for improving long-term outcomes and well-being. Although clinical guidelines recommend treatments focusing on emotion regulation, access remains largely restricted to specialist clinics, leaving many adolescents at risk of receiving no or non-specific care. To adress this, we have developed a group-based emotion regulation treatment for self-harming adolescents, showing promising results. The group format integrates well into healthcare structures, fosters social skills training, and reduces stigma – key challenges for this patient group. Schools are primary environments in adolescents' lives and often the first to identify self-harm. However, limited knowledge of appropriate responses and concerns about contagion effects creates barriers to effective management. Strengthening collaboration between healthcare and schools is essential to enhance early detection and support. Data and Method A single-blind randomized controlled trial will be conducted to evaluate the effectiveness of this novel treatment. Adolescents (N=166) age 13–17, will be randomized to emotion regulation treatment plus treatment-as-usual (TAU) or TAU only. The content of TAU will be carefully monitored. Cost-effectiveness, mechanisms of change, and treatment effects up to 12 months post-treatment will be assessed. Focus group interviews with school health professionals will be conducted to identify collaboration needs between schools and healthcare. Societal Relevance and utilization This unique project addresses a critical scientific and clinical challenge by increasing access to treatment for self-harming adolescents. By mitigating the long-term health and social consequences associated with self-harm the project aims to improve outcomes for affected youth. Strengthening collaboration between healthcare, families and schools will enhance early detection and timely interventions. Plan for project realisation The project team consists of researchers with expertise in self-harm, emotion regulation, clinical trials, and child and adolescent psychiatry. Feasibility has been tested, infrastructure is being developed, and recruitment will be carried out through established collaboration with regional and national child and adolescent psychiatry clinics.

Deliberate self-harm (DSH) involves intentional injury without suicidal intent, often co-occurring with impulsive behaviors and psychiatric disorders, particularly in adolescents. DSH is associated with lower quality of life and increased risk of suicide. The prevalence is 16-23% in the general adolescent population and 30-45% in psychiatric populations. Psychological treatments focusing on increasing emotion regulation abilities has shown promising results for adolescents in a recent SBU-report (2024) and a Cochrane review (2021). Adolescents engaging in self-harm often face peer rejection, bullying, and dysfunctional family relationships, including emotional neglect. Group therapy could potentially offer cost-effective benefits by fostering a sense of belonging, peer learning, and enhancing self-esteem. However, to prevent potential negative effects, such as social contagion of DHS, treatment protocols should include strategies like addressing self-injury in individual sessions, monitoring internet exposure, covering scars, and promoting healthy coping. Thus, treatment evaluation needs to focus on safety when disseminating treatment in groups. We are currently investigating the feasibility of an Emotion Regulation Group Therapy for Adolescents (ERGT-A), a 12-week group-based intervention aimed at improving emotion regulation in self-harming adolescents and a parallel intervention to support their parents, in order to increase treatment availability, reduce stigma and parental burden in a quantitative (N=20 adolescents and 20 parents) and a qualitative study including a subset of the adolescents and parents in the feasibility study. ERGT-A focuses on teaching adaptive emotion regulation skills to reduce reliance on maladaptive strategies like DSH. The parallel program for parents is designed to support emotional regulation, improve family dynamics, and reduce stigma and burden. This application focuses on the completion of data collection, analysis of the two ongoing studies (the feasibility pilot and the qualitative study), the writing of two scientific articles describing the outcomes of both studies and the preparation for a randomized controlled trial (RCT) which will be needed to establish its efficacy compared to treatment-as-usual (TAU), assess cost-effectiveness, and explore emotion regulation as a mediator in reducing DSH.