Erik Forsell

Self-injury is a growing health crisis among youth, and the strongest risk factor for suicide attempts. Scalable treatments are needed but lacking. We have recently shown that a brief digital treatment, IERITA (Internet-delivered Emotion Regulation Individual Therapy for Adolescents), can be efficacious and cost-effective. However, not all patients respond sufficiently to the standard treatment procedure. Now we aim to implement and evaluate IERITA within regular health services and optimize treatment outcomes. First, we will develop and validate a classification tool to predict non-remission (continued self-injury after treatment). This tool will subsequently be used in the second step: a randomized controlled trial (N=341) between 2025 to 2028, which compares adaptable to standard IERITA. Adolescents allocated to adaptable IERITA and classified as likely non-remission in treatment week four will recieve adapted IERITA (e.g., personalized dose and treatment delivery) for the remaining eight weeks. We will (1) follow participants one- three- and twelve-month post-treatment

(2) use self-reports and blinded assessments

(3) study distal effects in national registers

(4) investigate several clinically relevant outcomes

and (5) conduct cost-effectiveness analyses. If successful, more patients could receive evidence-based treatment for self-injury, and treatment outcomes could be improved. In extension, queues to care may be reduced, and suicide attempts and suicides prevented.

Research idea and purposeSelf-injury is a growing and urgent health crisis among youth and the strongest risk factor for suicide attempts. Scalable and evidence-based treatments are needed but lacking. We have recently shown that a brief digital treatment, IERITA (Internet-delivered Emotion Regulation Individual Therapy for Adolescents), can be efficacious compared to treatment as usual only. However, not all patients respond sufficiently to the standard treatment procedure, and established efficacy does not guarantee successful uptake in regular care. This project aims to implement and evaluate IERITA in real-world settings and optimize treatment outcomes. A planning grant creates opportunities to test the project´s feasibility, an essential part of preparation for a large-scale study.Work plan, methods and project realisationFirst, a classification tool to predict continued self-injury after treatment (non-remission) will be developed and subsequently used in a randomized controlled pilot trial (N=30) comparing adaptable to standard IERITA. Adolescents allocated to adaptable IERITA and classified as likely non-remission in treatment week four will change to adapted IERITA (e.g., personalized dose and treatment delivery) for the remaining eight weeks. Feasibility will be evaluated through the number of completed treatment parts, degree of participation in data collection, satisfaction, adherence, and therapist time. Clinically relevant outcomes will also be measured, which include remission (primary clinical outcome), frequency of self-injurious behaviour, suicidality and level of functioning. Participants will be followed up one- and three months post-treatment. The project will be conducted within regular health care services in several regions which we have collaborated with previously. Patient organizations and health professionals will contribute to increasing relevance and feasibility. The budget includes salaries for the project manager and patient organization, and a smaller part for operating costs.Societal relevance and utilisationSelf-injury is rapidly increasing, posing severe risks for youths. The queue to healthcare services is long, and current treatments are costly and not widely or equally accessible. If this project is successful, more youths across the country could receive effective early intervention for self-injury, with the hope of reduced waiting times, equal care, and suicide preventive effects.