Emotion Regulation Strategy Choices Following Aversive Self-Awareness in People Who Engage in Nonsuicidal Self-Injury or Indirect Self-Injury

Emotion regulation difficulties are implicated prominently in self-injury. Yet it is unclear how people who engage in different forms of self-injury attempt to regulate negative affect when multiple strategies are available to them. This laboratory-based study examined emotion regulation strategy choices in individuals who engage in non-suicidal self-injury (n=40), indirect forms of self-injury (disordered eating and substance abuse; n=46), and controls (n=48). Following a self-relevant stressor (negative autobiographical memory recall), participants selected one of six regulation strategies based on what they believed would most effectively alter their affect. Strategies spanned behavioral (physical pain, a snack, word activity) and non-behavioral (rumination, reappraisal, doing nothing) domains. Compared to controls, individuals who engage in NSSI and indirect self-injury were more likely to select behavioral strategies. In addition, those with NSSI and indirect self-injury were more likely than controls to choose physical pain and less likely to ruminate. Findings indicate that people with direct and indirect forms of self-injury alike are more likely to take action than to engage in further thought when experiencing aversive self-awareness, even when cognitive strategies are made salient. Results illuminate intervention targets for these clinical populations.