Key Takeaways
- Self-harm, or nonsuicidal self-injury (NSSI), occurs when someone deliberately injures themselves — like cutting or burning — to try to cope with tough emotions, relieve tension, or regain a sense of control.
- While self-harm can affect anyone, it’s most common in teens and young adults. It’s not a mental health condition itself but rather a symptom of underlying issues like depression, anxiety, eating disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
- Research estimates that up to 6% of people engage in self-harm at some point in their lives.
Some people engage in self-harm* to temporarily cope with emotional pain or try to manage intense feelings like sadness, anger, or self-hate. Through self-injury, they can activate a response known as pain-relief offset, in which the end of physical pain brings a fleeting sense of emotional relief.
Relying on self-harm as a coping mechanism may offer temporary relief, but it often leads to feelings of shame and guilt. This emotional distress can trigger another episode, creating a cycle that can become difficult to break.
If you or someone you love is experiencing self-harm and wants to stop but isn’t sure how to begin, support is available. Therapy can be a valuable tool in addressing the underlying causes of self-injury, helping to identify triggers, and developing healthier coping strategies.
*If you or a loved one is experiencing suicidal thoughts or thoughts about harming themself or others, please call or text 988 on any phone for the Suicide & Crisis lifeline, contact a local crisis line, or head to the emergency room immediately. If you’re experiencing a life-threatening emergency or you need immediate help, please call 911.
Which types of therapy are best for self-harm?
Therapy provides a safe and supportive space to explore the emotions behind self-harm and develop healthier coping strategies. Various evidence-based therapeutic approaches can help address self-injurious thoughts and behaviors (SITBs), including:
1. Cognitive behavioral therapy (CBT)
This type of talk therapy helps people identify and change negative thought patterns that contribute to self-harm. It teaches healthier coping skills while addressing underlying issues that drive self-injury. CBT is widely used for conditions like generalized anxiety disorder (GAD), eating disorders, major depressive disorder (MDD), substance use, bipolar disorder, and post-traumatic stress disorder (PTSD).
2. Dialectical behavioral therapy (DBT)
Initially designed to treat borderline personality disorder (BPD) and self-injurious thoughts and behaviors (SITBs), DBT teaches essential skills like distress tolerance, emotional regulation, mindfulness, and effective communication. Research has shown that DBT can significantly reduce self-harm, depression, and anxiety.
3. Mindfulness-based cognitive therapy (MBCT)
This approach combines CBT with mindfulness techniques to help people recognize and manage distressing thoughts and emotions without resorting to self-injury. It’s particularly effective for people experiencing recurrent self-harming thoughts. It does this by promoting self-compassion and reducing emotional sensitivity.
4. Affirmative therapy
People who identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual, and more (LGBTQIA+) face nearly three times the risk of self-injury compared to others. LGBTQIA+-affirming therapists provide a safe supportive space to discuss identity-related stress, discrimination, family conflicts, and other factors contributing to self-harm.
5. Compassion-focused therapy
This approach fosters self-compassion while reducing self-criticism, a key trigger for self-harm. It’s particularly helpful for people who struggle with self-blame, perfectionism, eating disorders, borderline personality traits, chronic stress, or PTSD.
6. Psychodynamic therapy
This therapy delves into the underlying emotional conflicts and past trauma that contribute to self-harm. By exploring the root causes of distress, people can gain insight, develop better coping strategies, and improve their relationships.
7. Mentalization-based treatment for adolescents (MBT-A)
This type of therapy is designed for teens experiencing intense emotions, self-harm, and interpersonal difficulties. MBT-A helps teens improve emotional awareness and self-reflection, develop healthier ways of relating to others, and reduce impulsivity and depression.
8. Interpersonal psychotherapy for depressed adolescents (IPT-A)
Because self-harm often arises from relationship struggles, unresolved grief, life transitions, or interpersonal conflicts, IPT-A helps teens recognize how their relationships impact their emotions and behaviors. This therapy teaches effective coping skills, problem-solving, and direct communication techniques. It may be especially helpful for teens struggling with anxiety and depression.
9. Trauma-informed therapy
When self-harm is linked to past trauma, this type of therapy offers a path to healing. Approaches like exposure therapy, trauma-focused cognitive behavioral therapy (TF-CBT), and eye movement desensitization and reprocessing (EMDR) help people process traumatic experiences. Key elements include emotional regulation and addressing feelings like sadness, grief, guilt, shame, and anger.
10. Group-based psychotherapy
Incorporating techniques from CBT, DBT-A, MBT-A, and group therapy provides children and teens with a supportive environment to share their experiences, feel understood, and reduce feelings of isolation. Structured programs usually run for 12 to 16 weeks and may be more effective than individual therapy for some young people, but research has shown mixed results about its effectiveness.
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Finding the right self-harm therapist for you
If you’re considering therapy for self-harm, asking the right questions can help you find a therapist who meets your individual needs.
Here are some questions to consider asking:
- How do you create a safe and nonjudgmental space for your clients?
- What’s your experience with helping clients who self-harm?
- Do you believe in harm reduction?
- Do you have experience working with people with my diagnosis (eating disorder, trauma, etc.)?
- How often do you suggest meeting for therapy?
- How will we track my progress in therapy?
- What strategies do you use to help clients reduce urges to self-harm?
Pre-screening a therapist is an important step in finding the right fit for effective treatment.
How to open up to your therapist about self-harm
You may feel nervous about bringing up the topic of self-harm with your therapist, but it’s an important step toward healing.
Here are some ways to make it easier:
- Write it down. If talking feels too difficult, consider writing a journal entry to share with your therapist.
- Plan what to say. Think about how much you’re comfortable revealing. You can take therapy at your own pace and don’t have to reveal everything all at once.
- Remember your therapist’s role. Therapists are trained to help, not judge. Their goal is to support you, not punish or shame you.
Therapy can help you understand the reasons why you self-harm. This insight can help you foster more understanding and compassion for yourself, which may allow you to release some of that isolating shame and guilt.
Find care with Rula
If you or someone you care about is using self-harm to release emotional pain or express feelings you can’t put into words, help is available. Therapy can provide a safe space to explore emotions, understand triggers for self-harm, and learn alternative ways to manage distress.
At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best.
Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.
About the author
Linda Childers
Linda is an award-winning medical writer with experience writing for major media outlets, health companies, hospitals, and both consumer and trade print and digital outlets.
Her articles have appeared in the Washington Post, USA Today, WebMD, AARP, Brain+Life, HealthyWomen.org, The Rheumatologist, California Health Report, Everyday Health, HealthCentral, and many other media outlets.
While juggling the responsibilities of being part of the “sandwich generation” and caring for both her toddler son and terminally ill mother, a nurse friend encouraged her to seek therapy, which helped her to learn coping strategies and manage her depression. Linda hopes her work will help to destigmatize mental health conditions and encourage others to get the help they need.
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Members of Rula’s clinical leadership team and other expert providers contribute to all published content, offering guidance on themes and insights based on their firsthand experience in the field. Every piece of content is thoroughly reviewed by a clinician before publishing.
