Cognitive Behavioral Therapy and Self-Injury by Lauren Appel

People who self-injure tend to experience a significant amount of negative thinking. The concept behind Cognitive Behavioral Techniques is that if the negative thinking can be changed into something more productive, then the urge to self-injure will be minimized. Self-Injury comes from emotional pain and as most CBT practitioners believe, our emotions are tied closely to our thoughts. 

There are two key components for overcoming negative thinking. The first is “awareness” or recognizing that you are having a negative thought or a “thinking trap.” The second is “changing the thought” into something more useful.  Cognitive Behavioral techniques can help transform thoughts, which can, in turn, create a better mindset and reduce self-injury urges. Below are examples of typical thinking traps, which can facilitate awareness, along with additional strategies for dealing with negative thoughts.

Cognitive Distortions or “Thinking Traps” (Based on Trails’ Thinking Traps: Unhelpful Thinking Styles)

All or Nothing Thinking– Thinking in extremes without a middle ground. For example, “I’ve got to be the fastest on the track team, otherwise I’m no good.”

Jumping to Conclusions– Developing an opinion on something with little to no evidence.  This can look like “mind reading” (assuming you know what the other person is thinking) or “fortune telling” (predicting the future.) For example, “Everyone is going to laugh at me when I present my project.”

Emotional Reasoning– Using your feelings as the basis for facts. For example, “I feel miserable; therefore, I’m worthless.”

Overgeneralization– Creating a pattern based on a single event or episode. For example, “I stumbled over my words, so I must be awkward.”

Ignoring the Good– Focusing on the negative parts and leaving out the good things. For example, “I can’t do anything right.” Ignoring the good maybe omitting that they did make the football team, therefore something went right.

Creating awareness of these thinking traps makes a good start in halting negative thinking once the student realizes that the thoughts in their head are not true.

Strategies for Overcoming Thinking Traps

Be your own friend– This strategy is great for transforming negative thoughts into positive or encouraging thoughts. The concept is also simple enough for even elementary school children to understand.  Basically, you frame the scenario by asking what the student would say if their friend said a negative statement (i.e. I have no friends; I’m worthless, etc.) Most students who self-injure are much kinder to their friends than to themselves and teaching them in the context of becoming their own friend can help alter their way of thinking. The juxtaposition between how they talk to their friends versus how they talk to themselves can also help them become aware of the intensity of their own negative thinking.

Prove the thought wrong– Often our negative thoughts involve a scathing statement about ourselves, usually about something we have concluded based on a single event or an assumption of how we think other people view us. The key is to challenge the thought by coming up with evidence that proves the statement wrong.  For instance,  if I were to say, “I’m a terrible student,”  then I should challenge myself to come up with times where I was a good student.  Examples may include getting an A on a project or taking notes every class. The idea is that if you can come up with at least one example, then it contradicts the extreme of “I’m a terrible student.” This creates a new thought, “Well, I’m actually a pretty good student, I just made a bad grade,” to replace the old one. Help can also be given by providing these examples with the student to get them on the right track.

Write a positive reminder list– This strategy piggybacks off of the “prove the thought wrong” strategy. During emotional moments where things seem the bleakest, it feels impossible to think of anything good about yourself. It’s beneficial, when the student is feeling stable and reasonably well, to have them come up with reminder lists about their positive traits, what their talents are, etc. This can be tailored to the negative thoughts they have the most. For instance, if the thought is “I have no friends,” then have them come up with a list of friends. These friends can even participate by asking them to write down what the student means to them. These affirmations can be kept on a phone where it can be easily accessed and when the student feels down, they can read all the positive evidence that proves the thought wrong.

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