Hanna Sahlin

Background: Deliberate self-harm without suicidal intent is highly prevalent among adolescents and is associated with reduced quality of life and increased risk of later suicidal behaviour and mortality. Difficulties in emotion regulation appear to be a central underlying factor in self-harm, and treatments that enhance emotion regulation skills have shown promising results in both adults and adolescents. Despite substantial and increasing clinical need, access to evidence-based treatments for adolescent self-harm remains limited within child and adolescent mental health services (CAMHS). Thus, we developed a group-based treatment for adolescents (ERGT-A), which includes a parallel psychoeducational parent program to meet current needs. A feasibility study conducted 2023-2024 (Krastev & Sahlin, in prep) demonstrated promising acceptability and preliminary efficacy, supporting progression to a fully powered randomized controlled trial. Aim: The primary aim of this study is to evaluate the clinical efficacy of ERGT-A compared to an active control condition. Maintenance of treatment gains will be assessed up to 12 months post-treatment. Method: In a multi-site randomized controlled trial, with a cross-over design, 180 adolescents aged 13–17 years with recurrent self-harm will be recruited from four child and adolescent mental health services and randomized (1:1) in blocks of 4-6 to ERGT-A or an active psychoeducational control intervention. Assessments will be conducted at baseline, post-treatment, and at 1-, 6-, and 12-month follow-ups by blinded assessors. The primary outcome is self-harm frequency measured using the interview version of the Deliberate Self-Harm Inventory – Youth (DSHI-Y). Secondary outcomes include emotion regulation, psychiatric symptoms, and clinician rated functional impairment. The control group will be offered ERGT-A after the primary endpoint (one month follow-up). Data will be analysed according to intention-to-treat, using generalized and linear mixed-effects models for longitudinal and count-data. A health economic evaluation will be conducted from both healthcare provider and societal perspectives (not included in this application). Time plan: Recruitment and data collection will take place between 2026 and 2029, followed by data analyses and dissemination of findings. Objective: This study is expected to contribute important knowledge regarding the effectiveness and mechanisms of a scalable, group-based treatment for self-harming adolescents, thereby strengthening the evidence base for implementing emotion regulation–focused interventions within routine child- and adolescent mental health care.

Self-harm is a serious and growing public health concern among adolescents, strongly associated with suicide risk and mental health problems. It imposes significant societal costs through increased demand for psychiatric and emergency medical care, school absenteeism, and parental sick leave, both short- and long-term. Early interventions, including parental support and psychological treatment focused on emotion regulation may help prevent further deterioration. There is a clear need for brief, accessible treatments tailored to patients within child and adolescent psychiatry services (CAMHS), as well as for effective collaboration models between families and CAMHS. Following a promising feasibility study, we now want to assess the effectiveness of a novel group-based intervention, ERGT-A, for self-harming adolescents and their parents in a single blinded clinical randomized controlled effectiveness study including 166 adolescents (ages 13–18). The control group will receive TAU and cross over to ERGT-A treatment after the primary end-point. This study combines quantitative measures and repeated assessments to identify change processes and long-term effects. This project involves parents, and bridges the gap between research and practice, promoting early intervention and long-term health for a vulnerable and growing patient group.

Self-harm is a serious and growing public health concern among adolescents, strongly associated with suicide risk and mental health problems. It imposes significant societal costs through increased demand for psychiatric and emergency medical care, school absenteeism, and parental sick leave, both short- and long-term. Early interventions, including parental support and psychological treatment focused on emotion regulation may  help prevent further deterioration. There is a clear need for brief, accessible treatments tailored to patients within child and adolescent psychiatry services (CAPS), as well as for effective collaboration models between families and CAPS.Following a promising feasibility study, we now want to assess the effectiveness of a novel group-based intervention, ERGT-A, for self-harming adolescents and their parents in a single blinded clinical randomized controlled effectiveness study including 166 adolescents (ages 13–18). The control group will receive TAU and cross over to ERGT-A treatment after the primary end-point. This study combines quantitative measures and repeated assessments to identify change processes and long-term effects. This project involves parents, and bridges the gap between research and practice, promoting early intervention and long-term health for a vulnerable and growing patient group.

Research problem and specific questions Self-harm in adolescents is a serious and growing concern, inked to increased risk of suicide attempts, psychiatric disorders, substance use, and inpatient care. Early detection and intervention is crucial for improving long-term outcomes and well-being. Although clinical guidelines recommend treatments focusing on emotion regulation, access remains largely restricted to specialist clinics, leaving many adolescents at risk of receiving no or non-specific care. To adress this, we have developed a group-based emotion regulation treatment for self-harming adolescents, showing promising results. The group format integrates well into healthcare structures, fosters social skills training, and reduces stigma – key challenges for this patient group. Schools are primary environments in adolescents' lives and often the first to identify self-harm. However, limited knowledge of appropriate responses and concerns about contagion effects creates barriers to effective management. Strengthening collaboration between healthcare and schools is essential to enhance early detection and support. Data and Method A single-blind randomized controlled trial will be conducted to evaluate the effectiveness of this novel treatment. Adolescents (N=166) age 13–17, will be randomized to emotion regulation treatment plus treatment-as-usual (TAU) or TAU only. The content of TAU will be carefully monitored. Cost-effectiveness, mechanisms of change, and treatment effects up to 12 months post-treatment will be assessed. Focus group interviews with school health professionals will be conducted to identify collaboration needs between schools and healthcare. Societal Relevance and utilization This unique project addresses a critical scientific and clinical challenge by increasing access to treatment for self-harming adolescents. By mitigating the long-term health and social consequences associated with self-harm the project aims to improve outcomes for affected youth. Strengthening collaboration between healthcare, families and schools will enhance early detection and timely interventions. Plan for project realisation The project team consists of researchers with expertise in self-harm, emotion regulation, clinical trials, and child and adolescent psychiatry. Feasibility has been tested, infrastructure is being developed, and recruitment will be carried out through established collaboration with regional and national child and adolescent psychiatry clinics.