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

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.

1. 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.
2. 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.
3. 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.
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.
5. 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.
6. 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.
7. 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.
8. 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."

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."

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:

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."

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:

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."

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:

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."

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:

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."

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:

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."

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:

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."

How can schools appropriately respond to students who engage in nonsuicidal self-injury (NSSI), whether the behavior occurs at home, on school grounds, or elsewhere? What protocols exist to support schools to better respond to students who self-injure? What role does liability play? In this episode, Dr. Nancy Heath of McGill University in Montreal, Canada explains how schools can support students who engage in self-injury and self-harm.

Learn more about Dr. Heath's work here, and learn more about her work with the Development and Intrapersonal Resilience (DAIR) Research Team here. Learn more about the International Consortium on Self-Injury in Educational Settings (ICSES) at http://icsesgroup.org/.

Self-injury Outreach & Support (SiOS) offers resources for schools here and a list of do's and don'ts here. Visit SiOS at http://sioutreach.org and follow them on Facebook (www.facebook.com/sioutreach) and Twitter (https://twitter.com/sioutreach).

Below are links to some of Dr. Heath's research as well as resources referenced in this episode:

1. Hasking, P. A., Bloom, E., Lewis, S. P., & Baetens, I. (2020). Developing a policy, and professional development for school staff, to address and respond to nonsuicidal self-injury in schools. International Perspectives in Psychology: Research, Practice, Consultation, 9(3), 176.
2. Berger, E., Hasking, P., & Reupert, A. (2015). Developing a policy to address nonsuicidal self-injury in schools. Journal of School Health, 85(9), 629-647.
3. Lloyd-Richardson, E. E., Hasking, P., Lewis, S.P., Hamza, C., McAllister, M., Baetens, I., & Muehlenkamp, J. (2020). Addressing self-injury in schools, part 1: understanding nonsuicidal self-injury and the importance of respectful curiosity in supporting youth who engage in self-injury. NASN School Nurse, 35(2), 92-98.
4. Lloyd-Richardson, E. E., Hasking, P., Lewis, S.P., Hamza, C., McAllister, M., Baetens, I., & Muehlenkamp, J. (2020). Addressing self-injury in schools, part 2: how school nurses can help with supporting assessment, ongoing care, and referral for treatment. NASN School Nurse, 35(2), 99-103.
5. Lewis, S. P., Heath, N. L., Hasking, P. A., Hamza, C. A., Bloom, E. L., Lloyd-Richardson, E. E., & Whitlock, J. (2019). Advocacy for improved response to self-injury in schools: A call to action for school psychologists. Psychological Services, 17(S1), 86–92.
6. De Riggi, M. E., Moumne, S., Heath, N. L., & Lewis, S. P. (2017). Non-suicidal self-injury in our schools: a review and research-informed guidelines for school mental health professionals. Canadian Journal of School Psychology, 32(2), 122-143.
7. Whitlock, J. L., Baetens, I., Lloyd-Richardson, E., Hasking, P., Hamza, C., Lewis, S., Franz, P., & Robinson, K. (2018). Helping schools support caregivers of youth who self-injure: Considerations and recommendations. School Psychology International, 39(3), 312-328.
8. Hasking, P. A., Heath, N. L., Kaess, M., Lewis, S. P., Plener, P. L., Walsh, B. W., .Whitlock, J., & Wilson, M. S. (2016). Position paper for guiding response to non-suicidal self-injury in schools. School Psychology International, 37(6), 644-663. Open access here.
9. Book: Self-Injury in Youth: The Essential Guide to Assessment and Intervention (2008) by Drs. Mary Nixon & Nancy Heath

Follow Dr. Westers on Instagram and Twitter/X (@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 as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot  and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

In this episode, Dr. Christian Schmahl from Heidelberg University and Mannheim, Germany, answers a listener's question and talks about his experimental research assessing how seeing blood affects heart rate and arousal among both those who engage in nonsuicidal self-injury (NSSI) and those who don't. He also shares insights into the role of self and blood in ritual and nonritual self-injury, including examples from different cultures about how they may interpret blood differently in the context of self-harm and even trance-like states.

To learn more about Dr. Schmahl and his work, visit here. To stay up-to-date on next year's ISSS conference in Stockholm, Sweden (Wed-Fri June 24-26, 2026), visit https://www.itriples.org/conferences. Below are a few papers referenced in today's episode:

1. Glenn, C. R., & Klonsky, E. D. (2010). The role of seeing blood in non-suicidal self-injury. Journal of Clinical Psychology, 66(4), 466-473.
2. Naoum, J., Reitz, S., Krause-Utz, A., Kleindienst, N., Willis, F., Kuniss, S., Baumgartner, Ulf, 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.
3. Stacy, S. E., Pepper, C. M., Clapp, J. D., & Reyna, A. H. (2022). The effects of blood in self-injurious cutting: Positive and negative affect regulation. Journal of Clinical Psychology, 78(5), 926-937.
4. Hornbacher, A., Sax, W., Naoum, J., & Schmahl, C. (2023). The role of self and blood in ritual and nonritual self-injury. In E.E. Lloyd-Richardson, I. Baetens, & J. Whitlock (Eds.), The Oxford handbook of nonsuicidal self-injury (pp. 468-480). Oxford University Press.

Follow Dr. Westers on Instagram and Twitter/X (@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 as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot  and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."