The Experience of Goals and Rewards in Young People Who Self-Harm: A Qualitative Exploration

Background/Objectives. Self-harm is a heterogeneous behaviour with a lifetime prevalence of around 20% in young people aged 16-25 years old. Recent neurocognitive evidence suggests that, for some individuals, self-harm is associated with motivational processes similar to addiction, including maladaptive mental imagery, reward anticipation, and goal pursuit. However, our knowledge of young people's subjective experiences of rewards and goals in relation to self-harm behaviour remains limited. Our study aimed to investigate how young people who self-harm experience enjoying and wanting rewards and pursuing goals in daily life and whether this experience changes during periods of self-harm. We also explored their use of mental imagery as a key cognitive process to support motivation. Methods. We conducted two parallel focus groups online (total of N = 12) with young people (mean age = 12.2, SD = 3; nine women, two men, and one non-binary) with a past-year history of self-harm behaviour. Qualitative data was analysed using inductive thematic analysis. Two young people with lived experience of self-harm informed the topic guide and data interpretation. Examples of questions were "Do you think your experiences of enjoying and/or looking forward to pleasant things are related in any way to self-harm, or not?" and "Do you visualise things you enjoy or may look forward to? If you do, how is that experience?". Results. There were six themes: rewards need deserving, high self-standards, keeping control, trapped into long-term goals, unhelpful mental imagery, and self-harm alters the experience and anticipation of rewards and goal attainment. Most young people reported enjoying conditional rewards and working towards long-term goals that tend to be unattainable and beyond their control. Imagining these goals was experienced as unhelpful by most. For all young people, periods of self-harm thwarted enjoyment and goal achievement, shifted the preference to short-term immediate gratification, including from self-harm behaviour, and devalued long-term goals. However, our data cannot determine if these experiences are specific to young people who self-harm. Conclusions. Our findings indicate that the reciprocal relationship between motivational processes and self-harm behaviour in young people warrants further investigation. Helping individuals develop more adaptive rewards and goals, including appreciation of short-term goals and use of motivational mental imagery, could represent valued support for young people with self-harm.