In this blog I am going to explain a 3-step approach to cope with Self-Harm.

Self-harm is a discrete episode where someone intentionally harms themselves when distressed and that harm reduces the distress. The urge to self-harm is usually impossible to resist and those that harm themselves are frequently unable to tell anyone and if they do people are often unable to listen or understand.

Self-harm is both a serious and complex issue and so needs a short-term, medium-term and long-term plan to tackle it.

1. Short term Plan

The first step is to develop some short-term alternatives to self-harm which provide similar relief but do not cause you harm. The basic idea is to find things that create a sensory experience that is potent enough to distract from your distress and give you a sense of being in control of what you are experiencing. For example:

  • Take a freezing cold shower
  • Eat a very hot chilli pepper
  • Run as fast as you can for as long as you can
  • Hold your breath until your lungs feel like they are going to burst
  • Hang upside down (e.g. headstand, back bend or hang backwards off your bed) and allow all the blood to rush to your head. Be careful not to stand straight back up again after this as you will feel dizzy

These activities will not be as ‘effective’ as your self-harm in the beginning but over time if you continue to use them you will find that they are sufficient to enable you to resist the urge to self-harm.

2. Medium-Term Plan

If you are going to reduce, and eventually eliminate, your self-harm over the medium-term you need to work out why you self-harm. The reason(s) that people self-harm is not always immediately obvious so don’t worry if you can’t work it out straight away. Just take your time and follow the steps below.

(ii) Self-harm is usually a way of either coping with distress or trying to alert others to the fact that you need help, so start by working out which of these feels most like you. If it is the latter contact one of the organisations below. The people that you will talk to are very familiar with and understanding of self-harm and will be able to help you to think about how to get the help you need from family and friends:

If you decide that your self-harm is a way of coping with distress move on to step (ii).

(ii) Our behaviour is determined by how we feel and how we feel is determined by what we are thinking. So, if we want to work out why we are doing something we need to track backwards from our behaviour to our feeling and finally to our thoughts. So the next time that you feel the urge to self-harm try to identify what your are feeling (e.g. angry, anxious or sad) and then what you were thinking that made you feel this way. To start with you may have to guess, but you are the best person to guess so whatever you come up with is likely to be pretty accurate. An example of a thought that could make you feel anxious enough to want to self-harm is ‘I am completely alone, no one cares about me or understands what I am going through’.

(iii) Once you have hold of your thought look at how accurate that thought is by looking at the evidence that supports it and the evidence against it. Also look at how helpful your thought is for example, if you are trying to escape from the top floor of a burning building it is accurate to think ‘I might die trying to doing this’ but this is not a very helpful focus.

(iv) If you discover that your thought is not accurate and/or helpful, try and replace it with a thought that is accurate and helpful. Doing this every time your thoughts are inaccurate and unhelpful will gradually reduce your negative feelings and in turn your urge to self-harm.

As I mentioned at the beginning of this section, identifying the reasons for self-harm is not always a straight forward process, so if you are struggling to come up with anything it is worth considering getting some professional help in the form of therapy, ideally Cognitive Behavioural Therapy (CBT).

3. Long-Term Plan

Once you have eliminated your self-harm, to ensure that your urges don’t return, it is important that you identify the factors that have made you vulnerable to self-harm in the first place. This is likely to be past experiences that have shaped the way that you think about yourself, others and the world. This piece of work is most easily done with the help of a psychologists or another type of therapist, but a good self-help starting point is this book:

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