Nonsuicidal Self-Injury (NSSI) in Virtual Reality: Effect of Blood-Viewing on Affect Controlling for Pain

Empirical evidence suggests engagement with nonsuicidal self-injury (NSSI) serves to regulate emotions, though there is controversy surrounding specific mechanisms by which this occurs, partially because of limited ability to observe the behavior within a laboratory setting. Although behavioral analogues (e.g., pressure, cold) have found support for the role of pain in affect regulation, they have neglected other potential processes, including viewing one's wound and seeing blood. In a virtual reality paradigm, participants were randomly assigned to either a "see blood" (n = 35) or "no blood" (n = 29) condition following a negative mood induction to simulate the experience of self-cutting. Positive (PA) and negative affect (NA) were assessed at baseline, post-induction, and post-NSSI. Analyses failed to support differential changes in both NA and PA following engagement with NSSI between conditions, though NA increased significantly post-NSSI across conditions. Results from this study provide no evidence to suggest viewing blood alone (i.e., without pain) is an integral part of emotion regulation processes associated with NSSI. Unexpected mood worsening following virtual reality NSSI simulation raises questions about the utility of this paradigm for studying the affect regulation functions of NSSI above and beyond existing methods (e.g., EMA). However, qualitative evidence and follow-up assessments suggest it is a feasible and safe way to study NSSI within a laboratory setting. Future research is needed to adjust virtual reality procedures for NSSI to make the experience more realistic (e.g., adding pressure) and to clarify whether it can capture established affect regulation functions of NSSI.