Published: 13-07-2023 18:44 | Updated: 13-07-2023 18:44

Internet-based therapy effective against self-harm in adolescents

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Self-harming behaviour in young people causes suffering and increases the risk of suicide. Researchers at Karolinska Institutet and Region Stockholm have now studied if an internet-delivered emotion regulation therapy can reduce self-harm in youth. The study, which is published in JAMA Network Open, suggests that the therapy is effective.

Johan Bjureberg photo Andreas Andersson.
Johan Bjureberg. Photo: Andreas Andersson.

“The therapy is based on the expectation that if you teach young people more adaptive ways for regulating their emotions, they will have less need to harm themselves and our results indicate that this assumption is correct,” says corresponding author Johan Bjureberg, docent at the Department of Clinical Neuroscience, Karolinska Institutet.

Self-harm behaviour often serves to regulate emotions in the moment, but has many adverse consequences. The idea behind the treatment, called Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA), is to reduce self-harming behaviour by helping young people to handle and regulate their emotions in a more adaptive way.

The therapy comprises eleven modules delivered across twelve weeks. Meanwhile, parents participate in a separate six-module online course on supporting their children. During the therapy, both parties have online contact with a therapist.

82 percent reduction 

The efficacy of IERITA has now been tested by researchers at the Centre for Psychiatry Research at Karolinska Institutet and Region Stockholm. The study involved 166 young people between the ages of 13 and 17 who had harmed themselves at least five times in the past year, including once in the past month, and their parents.

The participants were randomly assigned to test IERITA as an add-on to the regular care provided by the child and adolescent psychiatry service (BUP) or primary care. A control group received regular care only, but were offered IERITA at a later date. The study was conducted between 2017 and 2020 at clinics in the Stockholm, Västra Götaland and Skåne regions in Sweden.

IERITA as add-on to regular care resulted in an 82 percent reduction in self-harm episodes and other destructive behaviour and an improved ability to regulate emotions and greater level of functioning after treatment, compared with 47 percent after treatment with regular care only. The effects of IERITA were still significant at a three-month follow-up.

More accessible therapy 

The researchers are now working to ensure that the internet format makes the therapy more accessible in more regions.

Clara Hellner.Photo: Ulf Sirborn.

“There are few scientifically evaluated therapies for self-harm, and those that do exist have long waiting times and are offered primarily in urban areas,” says last author Clara Hellner, adjunct professor at the Department of Clinical Neuroscience, Karolinska Institutet. “The aim of the project was to increase accessibility to the therapy by offering low-threshold treatment that doesn’t require physical presence at a clinic.”

The study was financed by the National Self-Harm Project, the Royal Swedish Academy of Letters, the Swedish Research Council, the Marcus and Amalia Wallenberg Memorial Foundation, the Fredrik and Ingrid Thuring Foundation, the Clas Groschinsky Memorial Foundation, the Jerring Foundation, the Foundation Kempe-Carlgren Fund, the Bror Gadelius Memorial Fund, and the Natur & Kultur Foundation. Some of the authors have reported potential conflicts of interest; see the article for a complete list.


Effect of Internet-Delivered Emotion Regulation Individual Therapy for Adolescents With Nonsuicidal Self-Injury Disorder: A Randomized Clinical Trial”. Johan Bjureberg, Olivia Ojala, Hugo Hesser, Henrike Häbel, Hanna Sahlin, Kim L. Gratz, Matthew T. Tull, Emma Claesdotter Knutsson, Erik Hedman-Lagerlöf, Brjánn Ljótsson, Clara Hellner. JAMA Network Open, online 13 July 2023, doi:10.1001/jamanetworkopen.2023.22069.