Acceptance-Based and ACT-Informed Interventions for Non-Suicidal Self-Injury in Adolescents: A Systematic Review and...

Area of Science:

• Psychiatry and Mental Health
• Clinical Psychology
• Adolescent Behavioral Health

Background:

• Non-suicidal self-injury (NSSI) in adolescents is linked to emotion dysregulation, experiential avoidance, psychiatric issues, and increased suicidal risk.
• Interventions like Acceptance and Commitment Therapy (ACT) focus on psychological flexibility, while ERITA and IERITA target emotion dysregulation with ACT-consistent components.

Purpose of the Study:

• To systematically review and conduct an exploratory meta-analysis of ACT, ACT-informed, acceptance-based, ERITA, and IERITA interventions for adolescent NSSI.
• To evaluate the efficacy and certainty of evidence for these interventions in reducing NSSI and improving related outcomes.

Main Methods:

• A systematic review and meta-analysis following PRISMA 2020 guidelines.
• Searches conducted on PubMed, Scopus, Web of Science, and EBSCO.
• Included studies focused on adolescents with NSSI as a primary target, evaluating ACT, ERITA, or IERITA interventions; quantitative synthesis restricted to controlled studies.

Main Results:

• Six studies met inclusion criteria: two ACT, one ERITA feasibility, two uncontrolled ERITA, and one IERITA trial.
• Therapist-guided internet-delivered ERITA (IERITA) showed the strongest evidence, significantly reducing NSSI frequency (IRR 0.34).
• Exploratory syntheses indicated potential benefits for continuous NSSI and process outcomes (Hedges' g = -0.45 and 1.25, respectively), but these were imprecise and based on only two heterogeneous studies.

Conclusions:

• Primarily ACT, ERITA, and IERITA interventions appear promising for adolescent NSSI, but current evidence is preliminary and of very low certainty.
• The strongest evidence supports therapist-guided IERITA (moderate certainty), while evidence for ACT and pooled process outcomes is very low.
• Larger, preregistered randomized trials with standardized outcomes, longer follow-up, active comparators, and process measures are needed to confirm efficacy.