Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Internet-delivered emotion regulation for adolescents (IERITA) used in combination with treatment as usual (TAU) produces larger reductions in nonsuicidal self-injury (NSSI) frequency and improves emotion dysregulation.

Evidence Rating Level: 1 (Excellent)

NSSI, affecting 3% to 7% of adolescents, refers to deliberate harm to one’s body without suicidal intent and is a significant risk factor for suicide attempts. There are limited empirically supported and accessible treatments for NSSI in adolescence. Emotional dysregulation has been identified as a key mechanism underlying NSSI, therefore IERITA has been proposed as a treatment for NSSI. This 3-site, single-masked, randomized superiority clinical trial aimed to investigate the effectiveness of therapist-guided IERITA as an adjunct to treatment as usual (TAU) compared to TAU alone. Therapist-guided IERITA comprised 11 modules for adolescents and 6 modules for parents delivered over 12 weeks, with a dedicated therapist providing online support via a message function. TAU typically involved supportive therapy sessions every 2 weeks with community clinicians. A total of 166 participants (mean [SD] age, 15.0 [1.2] years; 92.8% female) were recruited between November 2017 and April 2020, and were randomly allocated to receive therapist-guided IERITA plus TAU (84 participants) or TAU alone (82 participants). There was a significantly larger reduction in both self-reported and masked assessor-rated NSSI frequency in the IERITA plus TAU vs TAU only group, at both the 1-month and 3-month post-treatment mark. Furthermore, compared to the TAU only group, adolescents in IERITA plus TAU group demonstrated significantly larger improvements in self-reported emotion dysregulation (1-month posttreatment p<0.01, 3-month posttreatment p=0.01), self-reported self-destructive behaviors (p<0.001, p<0.001), and assessor-rated global functioning (p=0.02, p=0.009) at both 1-and 3-month posttreatment. Mediation analysis revealed week-to-week improvements in emotion dysregulation mediated week-to-week reductions in NSSI frequency in IERITA. Overall, these findings support therapist-guided IERITA delivered adjunctive to TAU over 12 weeks as an effective treatment for NSSI, by targeting emotion dysregulation.

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