(PS9-C61) Measuring the Effect of NSSI Urge Disclosure via Ecological Momentary Assessment

Introduction: Non-suicidal self-injury (NSSI) is the deliberate destruction of bodily tissue for reasons not socially sanctioned and without suicidal intent (Nock & Favazza, 2009). Those who engage in NSSI often report significant interpersonal deficits across a variety of domains associated with social support (Muehlenkamp et al., 2013). Further, as many as half of individuals who engage in NSSI report being motivated by desired interpersonal consequences, such as communicating distress (Taylor et al., 2018). Despite this, there is a relative dearth of research surrounding the interpersonal context of NSSI (Turner et al., 2016). Specifically, there is little research examining the direct interpersonal consequences of disclosing NSSI thoughts and behaviors to trusted confidants (Simone & Hamza et al., 2020). Prior research indicates that disclosure of stigmatized statuses is associated with increased social support (Chaudoir & Fisher, 2010). Additionally, disclosure of NSSI acts is associated with next-day increases in perceived social support (Turner et al., 2016). The present study hypothesized that disclosure of NSSI urges will be associated with similar increases in perceived social support during an ecological momentary assessment study.

Participants and Procedures: Participants (N = 95) were 18-34 year-olds (M = 23.71, SD = 4.26) living in the United States, and they reported NSSI thoughts or behaviors within the past month. EMA surveys were completed at 6 pseudo-random intervals within each participant’s provided wake and bed times for 7 days.

Measures: NSSI urges were assessed during each EMA survey via a single dichotomous item inquiring “Since the last survey you completed…Did you have the urge to hurt yourself on purpose, but NOT to kill yourself?” NSSI urge disclosure was assessed during each time point for which participants reported NSSI urges via a single, dichotomous item inquiring “Did you tell anyone about your urges to self-injure?” Perceived social support was assessed during each EMA survey via two items adapted from the emotional support index of the NIH Toolbox Adult Social Relationships Scale (Cyranowski et al., 2013).

Analyses: Analyses were conducted using two-level, fixed effects models in Mplus version 8.8, employing Bayesian Markov Chain Monte Carlo (MCMC) estimation and Dynamic Structural Equation Modeling. Within-person associations were evaluated between NSSI urge disclosure (coded as present or absent) at time t (e.g., the index timepoint) and social support at time t+1, controlling for social support at time t.

Results: Results indicated NSSI urge disclosure was significantly associated with increased perceived social support during the next time point (B = .30; Credibility Interval = 0.14, 0.46).

Discussion, Conclusions, and Clinical Implications: Results indicate that disclosure of NSSI urges may be an effective strategy for achieving desired interpersonal outcomes without engaging in NSSI behaviors when specific circumstances are met (e.g., when disclosure is met with a positive reaction). Additionally, results may support the use of phone-coaching protocols in DBT as a harm reduction technique for NSSI behaviors.