Alternatives to self-harm

This additional information makes it clear that we are dealing with impulses to self-mutilate, not with OCD. The treatment approach I'd recommend is a three-pronged one:

First, reinforce her motivation for refraining from self-harm. One way that this can be done is by examining the pros and cons of self-harm as a way of coping with anxiety and examining the pros and cons of developing better ways of coping with anxiety. When doing this it is important to identify any apparent advantages to using self-harm as a way of reducing her anxiety and the feeling of pressure and to look critically at them. It also is important to make sure she recognizes the full range of drawbacks to using self-harm as a way of reducing anxiety, and to find out what she thinks will happen is she doesn't do something to reduce the anxiety and pressure immediately.

Second, help her develop adaptive ways of coping with anxiety and the sensation of pressure in her forehead. Options to consider include: tolerating the anxiety until it passes, exercise, relaxation exercises, meditation, talking with a friend, calling her therapist, taking a hot bath or shower, etc. Have her try out the options that seem promising and record the results so that you and she can figure out which options work best.

Third, identify any issues that are eliciting the anxiety/pressure. It probably will be useful to have her record the situations, thoughts, and feelings that are present when her anxiety increases. Standard CBT for anxiety (addressing fears cognitively, improving coping skills, and in-vivo exposure) should be useful. If she is reluctant to identify the situations/cognitions/issues that elicit her anxiety, it probably will be useful to discuss her fears of what will happen if she acknowledges the triggers to her anxiety.

Replies:

Re:Alternatives to self-harm, by ANGELLA, 03/10/04

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