Double Trouble: New Developments in Understanding, Managing, and Treating Suicidal Behavior and Non-Suicidal Self-Injury


Friday, November 22, 2019, 9:00 AM—4:00 PM

Double Trouble: New Developments in Understanding, Managing, and Treating Suicidal Behavior and Non-Suicidal Self-Injury
Barent Walsh, Ph.D.

Suicide and non-suicidal self-injury remain major public health problems in the United States. Suicide is the 10th leading cause of death and the second for young people. Suicide rates continue to increase and are now 14.5 per 100,000 in population (AAS, 2019).

Non-suicidal self-injury (NSSI; e.g. cutting, self-hitting, skin picking, and burning) is a separate (but related) problem and is a major public health challenge in its own right. Data from a recent large sample study found that 17.6% of high schoolers from 8 states self-injured during the previous year (Monto et al. 2018). In Massachusetts, the most recent data are that 14.5 % of high school students and 16.8% of middle schoolers self-injured during the previous year (Mass. DOE, 2017). There is no denying an epidemic of NSSI is in our midst.

Given the intensity of these problems, the distress and misery involved, and the complexity of providing help, it is crucial to keep our knowledge up-to-date and to employ the most state-of-the-art interventions available. This training will focus on what is most current and effective.

The workshop will begin with an emphasis on suicide prevention. The best tool available to assess imminent risk clinically is Thomas Joiner’s Acute Suicidal Affective Disturbance (ASAD; Joiner, 2015). It is evidence-based and offers four specific dimensions that are predictive of acute suicide risk. These are: 1) a geometric increase of suicidal intent and planning in the short-term, 2) marked social and/ or self-alienation, 3) perception of hopelessness, and 4) two or more manifestation of overarousal (insomnia, nightmares, agitation, irritability). The ASAD will be explored with real world clinical examples re: managing such risk.

For those who are found to be at risk using the ASAD, the logical next step is to move to Safety Planning. The training will next focus on Stanley and Brown’s evidence-based Safety Plan. It is a tool that identifies warning signs, coping skills, both personal and professional supports, restriction of means, and reasons for living. This Safety Plan also has phone app versions.

The presentation will then move to Thomas Joiner’s Interpersonal Theory of Suicide. It is the most researched formulation about suicide in the world. The workshop will explore the three major components of the theory: acquired fearlessness, thwarted belongingness, and perceived burdensomeness. The theory will be employed to explain the suicide trajectories of real-world individuals.

The treatments of choice for suicidality appear to be three: Dialectical Behavior Therapy (DBT), the Collaborative Assessment and Management of Suicidality.(CAMS), and Cognitive-Behavioral Therapy (CBT). Aspects of these treatments will be briefly reviewed with practical applications emphasized.

The second half of the training will focus on NSSI. The content addressed will be:

  • Differentiating suicide from self-injury
  • Exploring the link between recurrent NSSI and suicide attempts
  • Providing a thorough assessment of NSSI
  • Teaching replacement skills including innovative approaches such phone apps and videogames that address NSSI
  • Discussing the brain science that explains why NSSI “works” to reduce emotional distress
  • Reviewing the social contagion of NSSI and how to prevent it
  • Concluding with a discussion of self-care in relation to working with these challenging problems

Barent Walsh, Ph.D. has written extensively and presented internationally on the topic of self-destructive behavior. He is the author of Treating Self-Injury: A Practical Guide 2nd edition, Guilford Press, (2014). This volume has been translated into Polish and Japanese. In addition, Dr. Walsh is co-developer (with Screening for Mental Health of Wellesley, MA) of “Act to Prevent Self-Injury,” a prevention program with DVD for high schools. Dr. Walsh has presented on self-injury in London, Edinburg, Vienna, Stuttgart, Ulm, Oslo, Dubai, Tokyo, Beijing, Montevideo, Mexico City, Montreal, Toronto, Winnipeg, and throughout the United States.

Dr. Walsh is the Executive Director Emeritus and Senior Clinical Consultant at The Bridge, a human service agency headquartered in Worcester, MA. Dr. Walsh is a Lecturer on Psychiatry, Harvard Medical School at Cambridge Health Alliance, Cambridge, MA.

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