Overview
The overall purpose of the study is to implement and evaluate IERITA (Internet-delivered Emotion Regulation Individual Therapy for Adolescents) within child and adolescent mental health services for adolescents engaging in nonsuicidal self-injury (NSSI) and to optimize treatment outcomes for those adolescents at risk of insufficient effects. The specific purpose of this pilot trial is to investigate feasibility in preparation for a larger trial.
Description
Self-injury without the intention to die is a growing and urgent global health crisis among youth. It is associated with substantial individual and societal costs, including increased risk of suicide attempts. Scalable and evidence-based treatments are needed but lacking. Digital interventions can be one promising solution. A recent study shows that a novel brief digital treatment, IERITA, can be efficacious compared to treatment as usual only. However, not all respond sufficiently to standardized treatment, such as IERITA, and continued self-injury entails risks and suffering.
In this randomized controlled pilot trial, participants will be randomly allocated (1:1) to standard IERITA or adaptable IERITA. All participants will first receive standard IERITA for four weeks. In treatment week four, non-remission will be predicted. Adolescents allocated to adaptable IERITA and classified as likely non-remission, will change to adapted IERITA for the remaining eight weeks while all other participants will continue standard IERITA. Data will be collected pre-treatment, during treatment, post-treatment, one- three- and twelve-month post-treatment. The primary endpoint is one-month post-treatment.
The main objective is to investigate the project's feasibility and test key components. The specific objectives are:
- Examine the feasibility of the project (treatment satisfaction and adherence, degree of participation in data collection, and level of resources).
- Explore the utility of adapted IERITA compared to standard IERITA for adolescents at risk of non-remission.
- Evaluate the performance of the algorithm predicting treatment non-remission.
This project is sponsored by the Swedish Research Council for Health, Working life, and Welfare (number 2024-01916)
Eligibility
Inclusion Criteria:
- 13-17 years old
- At least one self-injury episode in the past three months
- A parent willing to engage in the parent program
Exclusion Criteria:
- Immediate suicide risk
- Global functioning corresponding to a rating ≤40 of the Children's Global Assessment Scale (CGAS)
- Social problems needing immediate intervention (e.g., violence within the family)
- Ongoing dialectical behavior therapy for adolescents