School psychologists and counselors are uniquely equipped to support students within the school setting by addressing one of the most significant challenges underlying NSSI—difficulty tolerating uncomfortable emotions. Within this context, they can use strategies grounded in Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) to help students recognize and label their emotions, and to develop adaptive coping skills. These might include techniques such as deep breathing, grounding strategies, and mindfulness, among others. Such in-school support builds students’ self-regulation skills and complements outside clinical treatment, which parents should be encouraged to pursue with qualified mental health professionals.
Practical strategies school staff can reinforce:
- Deep breathing exercises (e.g., “box breathing”) to manage acute stress
- Grounding techniques (5-4-3-2-1 senses check, holding an object, orienting to surroundings)
- Mindfulness practices (brief guided meditation, noticing thoughts without judgment)
- Emotion labeling and reframing (helping students name what they feel and identify helpful responses)
- Coping skills planning (building a personal “toolbox” of adaptive strategies students can use at school)
Both therapy orientations have robust research demonstrating their effectiveness with a wide variety of concerns, including emotion regulation difficulties and nonsuicidal self-injury (NSSI). While schools cannot replace clinical treatment, these approaches can provide valuable tools to help students feel safer and more supported in their daily environment.
Manual-Based Therapy Resources:
- Safe Alternatives School Resources (scroll down for NSSI materials for school based mental health professionals)
- Cutting Down by Lucy Taylor
It is also important to remember that because of the contagion factor, self-injuring students should not be seen in homogeneous groups. They may be included in a group addressing a relevant skill such as those listed above, but should not be aggregated into a single group of self-injurers.
Richard Lieberman, school psychologist and consultant for Los Angeles County, provides the following information regarding contagion in a pamphlet developed for his district:
- Each student should be assessed and triaged individually. If the activity involves a group “rite of togetherness,” the peer group should be identified and each student interviewed separately.
- When numerous students within a peer group are referred, assessment of every student will often identify an “alpha” student whose behaviors have set the others off. The “alpha” student should be assessed for more serious emotional disturbance. While most students participating in a group event will be assessed at low-risk, identifying moderate and high-risk students and targeting them for follow-up is critical
- Respond individually, but try to identify friends who engage in SI.
- School mental health professionals should refrain from running specific groups that focus on cutting rather than focusing on themes of empowerment, exercise/tension relief, and grief resolution.
- Health educators should reconsider the classroom presentation of certain books, popular movies, and music videos that glamorize such behaviors and instead seek appropriate messages in the work of popular artists.
- Monitor the internet chat and websites.
- SI should not be discussed in detail in school newspapers or other student venues. This can serve as a “trigger” for individuals who SI.
- Those who SI should be discouraged from revealing their scars because of issues of contagion. This should be discussed, explained, and enforced.
- Educators must refrain from school-wide communications in the form of general assemblies or intercom announcements that address self-injury.
- In general, a designated person should be clear with the student that although the fact of SI can be shared, the details of what is done and how, should not be shared as it can be detrimental to the well-being of the student’s friends.
*Adapted from: Lieberman, R., Toste, J.R., & Heath, N.L. (2008). Prevention and intervention in the schools. In M.K. Nixon & N. Heath (Eds.), Self injury in youth: The essential guide to assessment and intervention. New York, NY: Routledge.