The Psychology of Self-Injury: Exploring Self-Harm & Mental Health

Nicholas J. Westers Psy.D. ABPP
  • 5.0 (75)
  • Mental Health
  • Updated Monthly

Why do people self-injure? And what is the best way to respond when someone tells us they self-injure? Dr. Nicholas Westers, a clinical psychologist at Children's Health and Professor at the University of Texas Southwestern Medical Center, collaborates with the International Society for the Study of Self-Injury (ISSS) to interview the leading experts in the field of self-injury and self-harm as well as individuals with lived experience of self-injury and parents and family members of those who have self-injured. This podcast is meant to be a resource for parents, professionals, and people with lived experience.

  1. 5d ago

    Can Imagery Help Reduce Self-Harm?, with Dr. Nicholas Westers

    Mental imagery refers to sensory processing in the absence of sensory stimuli, and this can be through our visual senses or our senses of hearing, smell, taste, and touch. Below are links to some of the research referenced in this episode. If you want to go back and listen to each of the exercises, the time markers are 5:08 - 10:11 (Exercise #1), 24:53 - 36:48 (Exercise #2), and 42:26 - 50:50 (Exercise #3). Click here for the link to the Imaginator App on the App Store for iPhone. Lawrence, H. R., Balkind, E. G., Ji, J. L., Burke, T. A., & Liu, R. T. (2023). Mental imagery of suicide and non-suicidal self-injury: A meta-analysis and systematic review. Clinical Psychology Review, 103, 102302.McEvoy, P. M., Hayes, S., Hasking, P. A., & Rees, C. S. (2017). Thoughts, images, and appraisals associated with acting and not acting on the urge to self-injure. Journal of Behavior Therapy and Experimental Psychiatry, 57, 163-171.Cloos, M., Di Simplicio, M., Hammerle, F., & Steil, R. (2020). Mental images, entrapment and affect in young adults meeting criteria of nonsuicidal self-injury disorder (NSSID) – a daily diary study. Borderline Personality Disorder and Emotion Dysregulation, 7, 4.Ji, J. L., Kyron, M., Saulsman, L., Becerra, R., Lin, A., Hasking, P., & Holmes, E. A. (2024). Picturing self-harm: Investigating flash-forward mental imagery as a proximal and modifiable driver of non-suicidal self-injury. Suicide and Life-Threatening Behavior, 54, 713-727.Bang, S.-K., & Lee, E. (2024). Short imagery rescripting intervention effects on non-suicidal self-injury college students: A randomized controlled trial. The Open Psychology Journal, 17, e18743501342804.Schmied, E., Hack, L., Connemann, B., Sosic-Vasic, Z., & Kroener, J. (2024). You’re not alone: Imagery rescripting for adolescents who self-harm. Frontiers in Psychology, 15, 1395603.Di Simplicio, M., Appiah-Kusi, E., Wilkinson, P., Watson, P., Meiser-Stedman, C., Kavanagh, D. J., & Holmes, E. A. (2020). Imaginator: A proof-of-concept feasibility trial of a brief imagery-based psychological intervention for young people who self-harm. Suicide and Life-Threatening Behavior, 50(3), 724-740.Knäuper, B., McCollam, A., Rosen-Brown, A., Lacaille, J., Kelso, E., & Roseman, M. (2011). Fruitful plans: Adding targeted mental imagery to implementation intentions increases fruit consumption. Psychology and Health, 26(5), 601-617.Follow Dr. Westers on Instagram @DocWesters. To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS). The Psychology of Self-Injury podcast has been rated #1 by Feedspot  in their list of "10 Best Self Harm Podcasts" and #5 in their "20 Best Clinical Psychology Podcasts." It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

  2. Aug 28

    Lived Experience: Brittany's Story of Self-Injury & Faith (Re-Release)

    In this episode, Brittany details her experience of engaging in nonsuicidal self-injury (NSSI), how it started, and how she makes sense of self-injury and her faith in God. She explains two starkly different responses she received from church leaders and shares insights about how youth pastors in particular can provide supportive responses to students who engage in self-injury and self-harm.  Purchase Brittany's new book Stories Our Scars Tell: Hope, Healing, and Honesty about the Wounds We Carry here. Follow her on Instagram at @brittanytinsleywrites and read her blog at https://brittanytinsley.com/.  Follow Dr. Westers on Instagram @DocWesters. To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS). The Psychology of Self-Injury podcast has been rated #1 by Feedspot  in their list of "10 Best Self Harm Podcasts" and #5 in their "20 Best Clinical Psychology Podcasts." It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

  3. Jul 31

    The Psychology of Self-Injury Pain (Re-Release)

    What is the relationship between nonsuicidal self-injury (NSSI) and pain? Are individuals who self-injure less sensitive to pain than those who don’t self-injure? What are the ethics involved in conducting research on pain? In this episode, Dr. Julian Koenig describes the research on the experience of pain among those who self-harm. Learn more about Dr. Koenig and his research lab at www.koeniglab.de. Below are links to some of the research referenced in this episode: Koenig, J., Thayer, J. F., & Kaess, M. (2016). A meta-analysis on pain sensitivity in self-injury. Psychological Medicine, 46(8), 1597-1612. Koenig, J., Klier, J., Parzer, P., Santangelo, P., Resch, F., Ebner-Priemer, U., & Kaess, M. (2021). High-frequency ecological momentary assessment of emotional and interpersonal states preceding and following self-injury in female adolescents. European Child & Adolescent Psychiatry, 30(8), 1299-1308. Kaess, M., Hooley, J. M., Klimes-Dougan, B., Koenig, J., Plener, P. L., Reichl, C., Robinson, K., Schmahl, C., Sicorello, M., Schreiner, M. W., & Cullen, K. R. (2021). Advancing a temporal framework for understanding the biology of nonsuicidal self-injury: An expert review. Neuroscience and Biobehavioral Reviews, 130, 228-239. Störkel, L. M., Karabatsiakis, A., Hepp, J., Kolassa, I.-T., Schmahl, C., & Niedtfeld, I. (2021). Salivary beta-endorphin in nonsuicidal self-injury: an ambulatory assessment study. Neuropsychopharmacology, 46(7), 1357-1363. Sigrist, C., Kaess, M., & Koenig, J. (2023). Autonomic nervous system function in nonsuicidal self-injury—A Research Domain Criteria perspective on the arousal/regulatory systems. In E. E. Lloyd-Richardson, I. Baetens, & J. Whitlock (Eds.), The Oxford handbook of nonsuicidal self-injury (pp. C18S1–C18S23). Oxford University Press. Naoum, J., Reitz, S., Krause-Utz, A., Kleindienst, N., Willis, F., Kuniss, S., Baumgärtner, U., Mancke, F., Treede, R.-D., & Schmahl, C. (2016). The role of seeing blood in non-suicidal self-injury in female patients with borderline personality disorder. Psychiatry Research, 246, 676-682. Follow Dr. Westers on Instagram @DocWesters. To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS). The Psychology of Self-Injury podcast has been rated #1 by Feedspot  in their list of "10 Best Self Harm Podcasts" and #5 in their "20 Best Clinical Psychology Podcasts." It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

  4. Jun 26

    The Neurobiology of Self-Injury (in Layman's Terms) [Re-Release]

    What goes on at the neurobiological level that makes someone more vulnerable to self-injure or self-harm? What biological risk factors are at play? What roles do the vagus nerve, cortisol levels, and hypothalamic-pituitary-adrenal (HPA) axis have? We hope to discuss the psychology of self-injury pain in a future episode, but in this episode, Dr. Michael Kaess from the University of Bern in Switzerland explains the neurobiology of self-injury in simple terms, or what we hope can be considered simple layman's terms.  Learn more about Dr. Kaess and his research team at the Universitäre Psychiatrische Dienste (UPD) in Bern here. To participate in Dr. Kaess' research study of an online intervention for self-injury (in German), visit the STAR (Self-injury Treatment Assessment Recovery) Project at https://star-projekt.de/. Below are links to some of the research referenced in this episode: Kaess, M., Hooley, J. M., Klimes-Dougan, B., Koenig, J., Plener, P. L., Reichl, C., Robinson, K., Schmahl, C., Sicorello, M., Schreiner, M. W., & Cullen, K. R. (2021). Advancing a temporal framework for understanding the biology of nonsuicidal self-injury: An expert review. Neuroscience and Biobehavioral Reviews, 130, 228-239. Reichl, C., Heyer, A., Brunner, R., Parzer, P., Völker, J. M., Resch, R., & Kaess, M. (2016). Hypothalamic-pituitary-adrenal axis, childhood adversity and adolescent nonsuicidal self-injury. Psychoneuroendocrinology, 74, 203-211. Plener, P. L., Bubalo, N., Fladung, A. K., Ludolph, A. G., & Lulé, D. (2012). Prone to excitement: Adolescent females with non-suicidal self-injury (NSSI) show altered cortical pattern to emotional and NSS-related material. Psychiatry Research, 203(2-3), 146-152. Follow Dr. Westers on Instagram @DocWesters. To join ISSS, visit itriples.org and follow ISSS on Facebook and X/Twitter (@ITripleS). The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."

  5. May 29

    The Psychology of Self-Injury Scarring (Re-Release)

    How are scars from nonsuicidal self-injury (NSSI) different than physical scars that are unintentional or result from non-self-inflicted wounds ? What psychological effects can result from daily reminders of one's own decision to self-harm? Is there an association between NSSI scars and suicidal thoughts and behaviors? In this episode, Dr. Burke discusses the mixed relationship that many people who self-injure have with the scars they bear from NSSI and how some may feel the need to hide their scars even from themselves.  Learn more about Dr. Burke and her work by clicking here or visiting the Mood & Behavior Lab (MABL) at www.moodandbehaviorlab.org. Follow her on Twitter @TaylorABurkePhD.  Below are some of her publications and papers referenced in this episode: Burke, T. A., Ammerman, B. A., Hamilton, J. L., Stange, J. P., & Piccirillo, M. (2020). Nonsuicidal self-injury scar concealment from the self and others. Journal of Psychiatric Research, 130, 313-320. Burke, T. A., Olino, T. M., & Alloy, L. B. (2017). Initial psychometric validation of the nonsuicidal self-injury scar cognition scale. Journal of Psychopathology and Behavioral Assessment, 39, 546–562. Burke, T. A., Hamilton, J. L., Cohen, J. N., Stange, J. P., & Alloy, L. B. (2016). Identifying a physical indicator of suicide risk: non-suicidal self-injury scars predict suicidal ideation and suicide attempts. Comprehensive Psychiatry, 65, 79–87. Bachtelle, S. E., & Pepper, C. M. (2015). The physical results of nonsuicidal self-injury: The meaning behind the scars. The Journal of Nervous and Mental Disease, 203(12), 927-933. Follow Dr. Westers on Instagram @DocWesters. To join ISSS, visit itriples.org and follow ISSS on Facebook and X/Twitter (@ITripleS). The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."

  6. Apr 28

    Eating Disorders & Self-Harm (Re-Release)

    The term "self-harm" is an umbrella term, encompassing a broad range of behaviors, under which is included substance abuse and misuse, suicide, nonsuicidal self-injury (NSSI), and even eating disorders. In this episode, Dr. Katie Gordon, a Licensed Clinical Psychologist in Fargo, North Dakota, discusses the prevalence of self-injury among individuals with eating disorders and the prevalence of eating disorders among those who self-injure. She explains the relationship between the two behaviors, including common risk factors.  You can purchase Dr. Gordon's book The Suicidal Thoughts Workbook: CBT Skills to Reduce Emotional Pain, Increase Hope, and Prevent Suicide on Amazon here.  Below are links to some of Dr. Gordon's research as well as resources referenced in this episode: Kiekens, G., & Claes, L. (2020). Non-suicidal self-injury and eating disordered behaviors: An update on what we do and do not know. Current Psychiatry Reports, 22(68). Fox, K. R., Wang, S. B., Boccagno, C., Haynos, A. F., Kleiman, E., & Hooley, J. M. (2019). Comparing self-harming intentions underlying eating disordered behaviors and NSSI: Evidence that distinctions are less clear than assumed. International Journal of Eating Disorders, 52(5), 564-575. Smith, A. R., et al. (2013). Exercise caution: Over-exercise is associated with suicidality among individuals with disordered eating. Psychiatry Research, 206(2-3), 246-255. Gordon, K. H., Perez, M., & Joiner, T. E. (2002). The impact of racial stereotypes on eating disorder recognition. International Journal of Eating Disorders, 32(2), 219-224. Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS). The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."

  7. Mar 27

    Emotion Regulation Individual Therapy for Adolescents (ERITA) Who Self-Harm (Re-Release)

    Emotion Regulation Individual Therapy for Adolescents (ERITA) and its internet-delivered version (IERITA) is just one of a couple of treatments developed specifically to address nonsuicidal self-injury (NSSI) among adolescents. In this episode, Dr. Johan Bjureberg from the Karolinska Institute in Stockholm, Sweden walks us through in detail each of the 11 sessions of IERITA and IERITA's 6 parallel sessions for parents. Learn more about Dr. Bjureberg's work here, and follow his research lab and their projects and publications at Emotion regulation, Self-injury, Suicide, and Intervention (ESSI) here. Below are links to his research on ERITA/IERITA referenced in this episode: Bjureberg, J., Ojala, O., Hesser, H., Häbel, H., Sahlin, H., Gratz, K. L., Tull, M. T., Knutsson, E. C., Hedman-Lagerlöf, E., Ljótsson, B., & Hellner, C. (2023). Effect of internet-delivered Emotion Regulation Individual Therapy for Adolescents with Nonsuicidal Self-Injury Disorder: A randomized clinical trial. JAMA Network Open, 6(7), e2322069. Bjureberg, J., Sahlin, H., Hedman-Lagerlof, E., Gratz, K. L., Tull, M. T., Jokinen, J., Hellner, C., & Ljotsson, B. (2018). Extending research on emotion regulation individual therapy for adolescents (ERITA) with nonsuicidal self-injury disorder: Open pilot trial and mediation analysis of a novel online version. BMC Psychiatry, 18, 326. Bjureberg, J., Sahlin, H., Hellner, C., Hedman-Lagerlof, E., Gratz, K. L., Bjarehed, J., Jokinen, J., Tull, M. T., & Ljotsson, B. (2017). Emotion regulation individual therapy for adolescents with nonsuicidal self-injury disorder: A feasibility study. BMC Psychiatry, 17, 411. Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS). The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."

  8. Feb 27

    Emotion Regulation Group Therapy (ERGT) for Self-Harm (Re-Release)

    A lot of therapies address the context in which nonsuicidal self-injury (NSSI) and self-harm may occur, but only a few treatments have been designed to address NSSI specifically. In this episode, we dive into one of these treatments: Emotion Regulation Group Therapy (ERGT). Drs. Kim Gratz and Matthew Tull from the University of Toledo in Ohio walk us through in significant detail each of the 90-minute 14 sessions of ERGT. You can purchase their book "Acceptance-based emotion regulation therapy: A clinician’s guide to treating emotion dysregulation and self-destructive behaviors using an evidence-based therapy drawn from ACT and DBT" on Amazon here or at New Harbinger Publications here.  Connect with Dr. Gratz on LinkedIn here and Dr. Tull here. Below are links to their research on ERGT referenced in this episode: Gratz, K. L., & Gunderson, J. G. (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with Borderline Personality Disorder. Behavior Therapy, 37(1), 25-35. Gratz, K. L., & Tull, M. T. (2011). Extending research on the utility of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality pathology. Personality Disorders: Theory, Research, and Treatment, 2(4), 316–326. Gratz, K. L., Tull, M. T., & Levy, R. (2014). Randomized controlled trial and uncontrolled 9-month follow-up of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. Psychological Medicine, 44, 2099–2112. Gratz, K. L., Bardeen, J. R., Levy, R., Dixon-Gordon, K., L., & Tull, M. T. (2015). Mechanisms of change in an emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. Behaviour Research and Therapy, 65, 29-35. Sahlin, H., Bjureberg, J., Gratz, K. L., Tull, M. T., Hedman, E., Bjarehed, J., Jokinen, J., Lundh, L., Ljotsson, B., & Hellner, C. (2017). Emotion regulation group therapy for deliberate self-harm: A multi-site evaluation in routine care using an uncontrolled open trial design. BMJ Open, 7(10), e016220. Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS). The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."

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Why do people self-injure? And what is the best way to respond when someone tells us they self-injure? Dr. Nicholas Westers, a clinical psychologist at Children's Health and Professor at the University of Texas Southwestern Medical Center, collaborates with the International Society for the Study of Self-Injury (ISSS) to interview the leading experts in the field of self-injury and self-harm as well as individuals with lived experience of self-injury and parents and family members of those who have self-injured. This podcast is meant to be a resource for parents, professionals, and people with lived experience.

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