Abstract
Although nonsuicidal self-injury (NSSI)—deliberate damaging of body tissue without suicidal intent—is a behavior that occurs in interaction with real-world contexts, studying NSSI in the natural environment has historically been impossible. Recent advances in real-time monitoring technologies have revolutionized our ability to do exactly that, providing myriad research and clinical practice opportunities. In this viewpoint paper, we review new research pathways to improve our ability to understand, predict, and prevent NSSI, and provide critical perspectives on the responsibilities inherent to conducting real-time monitoring studies on NSSI. Real-time monitoring brings unique opportunities to advance scientific understanding about (1) the dynamic course of NSSI, (2) the real-time predictors thereof and ability to detect acute risk, (3) the ecological validity of theoretical models, (4) the functional mechanisms and outcomes of NSSI, and (5) the promotion of person-centered care and novel technology-based interventions. By considering the opportunities of real-time monitoring research in the context of the accompanying responsibilities (eg, inclusive recruitment, sound and transparent research practices, participant safety and engagement, measurement reactivity, researcher well-being and training), we provide novel insights and resources to open the black box of daily life in the next decade(s) of NSSI research.
Highlights
Nonsuicidal self-injury (NSSI), defined as the direct and deliberate damage of one’s body tissue without suicidal intent [1], is a behavior seemingly at odds with the principles of minimizing pain and maximizing pleasure, which guide most human behaviors
Some considerations are universally applicable to real-time monitoring research, here we focus on seven issues that have particular relevance in the context of nonsuicidal self-injury (NSSI) and point to open questions in these domains for future research
Good quality training in working with individuals who engage in NSSI and suicidal behaviors is essential when conducting real-time monitoring research
Summary
Nonsuicidal self-injury (NSSI), defined as the direct and deliberate damage of one’s body tissue without suicidal intent (eg, cutting and hitting oneself) [1], is a behavior seemingly at odds with the principles of minimizing pain and maximizing pleasure, which guide most human behaviors. Future research is needed to clarify the relative importance of these situational, emotional, and cognitive factors at each stage of the NSSI process and their specificity in predicting NSSI compared to co-occurring behaviors (eg, eating disorder behaviors, suicidal thoughts) [27,41] Worth mentioning in this context is that real-time monitoring provides a unique opportunity to clarify the relationship with these comorbid behaviors in daily life [42], thereby offering meaningful information to further diagnostic understanding of NSSI. Building upon this, randomized controlled trials are needed to determine how, when (eg, unguided in the moment or guided during a clinical session), and which type of feedback (eg, overall functioning, activities, social interactions, or NSSI-specific triggers and risk processes) should be offered Codeveloping answers to these open questions with all stakeholders involved (ie, people with lived experience, researchers, clinicians, software developers) represents a critical step to harness the potential of real-time monitoring for NSSI treatment. The use of JITAIs is already emerging in suicide research [86], with similar efforts needed to develop, evaluate, and integrate these new treatment methods into a stepped care model for NSSI
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