(PS9-D80) Examining the Moderating Role of Shame and Stigma in the Relationship Between Cognitive Flexibility and Self-injury

Research has found deficits in cognitive flexibility—defined as the ability to change perspectives and find new ways to problem solve – among individuals who engage in self-injury compared to healthy individuals (Nilsson et al., 2021). Conversely, higher levels of cognitive flexibility have been related to increased distressed tolerance (Arici-Ozcan et al., 2019), a mechanism known to play a critical role in NSSI outcomes (Slabbert et al., 2018). However, there is a gap in literature as to how distinct, specific types of distress affect cognitive flexibility’s role in outcomes for individuals who engage in NSSI. Prior research has established internalized shame and self-stigma as two forms of distress associated with increased severity of NSSI behaviors (Piccirillo et al., 2020; Staniland et al., 2021). Thus, we explored if and how shame and self-stigma moderate the effect of cognitive flexibility on NSSI outcomes.

Participant were 1,240 college students (Mage = 19.25, SD = 1.11; 74.6% White; 61.7% female; 41.4% with NSSI history) who completed assessment of NSSI history (Klonsky et al., 2009), cognitive flexibility, (CF; Dennis et al., 2010), internalized shame (Cook, 1988) and NSSI self-stigma (O’Loughlin et al., 2021). We used linear regression to examine the effect of CF on NSSI presence and, among those with NSSI history, lifetime NSSI features: 1) NSSI frequency (categorized), 2) NSSI versatility (continuous), 3) NSSI medical attention (dichotomous), 4) NSSI intrapersonal functionality (continuous), and 5) NSSI social functionality (continuous). We examined internalized shame and self-stigma as potential moderators of the CF - NSSI relationship.

Increased CF predicted decreased likelihood of NSSI presence within the entire sample (b = -.004, S.E. = .001, p < .001). Neither internalized shame nor NSSI self-stigma significantly moderated the relationship between CF and NSSI presence. 

Among participants with an NSSI history, increased CF predicted 1) decreased NSSI versatility (b = -.02, S.E. =.01, p = .016), 2) decreased odds of NSSI medical attention (b = -.001, S.E. = .00, p = .032), 3) decreased intrapersonal functionality (b = -.09, S.E. = .02, p < .001), and 4) decreased social functionality (b = -.05, S.E. = .01, p < .001). CF did not significantly predict NSSI frequency. 

Internalized shame was a significant moderator of the CF - NSSI intrapersonal functionality relationship (b = -.02, S.E. = .01, p = .011). At low levels of internalized shame (<2.25 SD below mean), increased CF predicted increased intrapersonal functionality. Internalized shame did not moderate any other outcomes.

NSSI self-stigma was a significant moderator of the CF - medical attention relationship (b = .004, S.E. = .002, p = .032). Specifically, higher levels of self-stigma (>4.63 SD above the mean) weaken the relationship between CF and medical attention. NSSI self-stigma did not moderate any other outcomes.

These findings suggest that clinical populations with low levels of internalized shame and high CF may have higher intrapersonal motivation for NSSI. Other implications are that decreasing self-stigma may increase the beneficial effect of CF for medical severity.