SELF-HARM IN CHILDREN & ADOLESCENTS: UNDERSTANDING AND INTERVENING THIS PRESENTATION WILL HELP YOU TO:

 BUILD CONCEPTUAL, THEORETICAL & PRACTICAL KNOWLEDGE  GAIN INSIGHT INTO MENTAL HEALTH & ALLIED PROFESSIONAL INTERVENTION  IDENTIFY RISK FACTORS  DEVELOP STRATEGIES FOR INTERVENTION  CONSIDER GUIDELINES FOR YOUR SCHOOL/ PRACTICE  ACCESS USEFUL RESOURCES  ENHANCE LEARNING THROUGH CLINICAL CASE PRESENTATIONS OUR INDIVIDUAL RESPONSES TO SELF-HARM OUR CURRENT CONTEXT: INVOLUNTARY CONFINEMENT IN A WORLD OF COVID 19

 SOCIAL ISOLATION & FEAR  FAMILIES UNDER STRESS  15 – 24 = 63.3% UNEMPLOYED  LACK OF ACCESS TO SUPPORT  LIVING ‘ON-LINE’(OR OFF)  IMPACT OF SOCIAL MEDIA SECTION 1: CONCEPTUAL & THEORETICAL INPUT

“THE BODY KEEPS THE SCORE” Bessel van der Kolk MYTHS ABOUT SELF-HARM

 ALWAYS A SUICIDE ATTEMPT VS INCREASES RISK  “FREAK DISCOURSE”  ATTENTION SEEKING  RETALIATION OR MANIPULATION  CUTTING IS THE ONLY FORM OF SELF-HARM  ONLY ADOLESCENTS ENGAGE IN SELF-HARM MYTHS …  SELF-HARM IS UNCOMMON & ‘ONLY GIRLS’ DO IT  ALL PEOPLE WHO SELF-HARM HAVE BEEN ABUSED VS RISK  “ITS JUST A PHASE”  PEOPLE WHO SELF-HARM DON’T FEEL PAIN  IT’S A COPING SKILL = RATIONALISATION  IT CAN’T BE TREATED CLINICAL CASE CASE 1: The girl with PRESENTATION trichotillomania

FORMS OF SELF-HARM FORMS OF SELF-HARM

 CUTTING, CARVING,  BURNING, ABRASIONS GOUGING & STABBING  HEAD BANGING  SCRATCHING, BRANDING &  STRANGULATION, BREATH ‘TATTOOS’ HOLDING  PICKING & PULLING SKIN,  EXCESS BODY PIERCING HAIR, SCABS & STITCHES  MISUSE OF MEDICATION,  BITING, BRUISING & HITTING SUBSTANCES & INHALANTS PREVALENCE

USA – 2020

1 IN 4 GIRLS 1 IN 10 BOYS (?) APPROXIMATELY 17% 1ST INCIDENT: 13 (12 – 25) 45% = CUTTING 10% HELP-SEEKING RATE S.A. STATISTICS

 UNDERSTANDING OF SELF-HARM = BASED ON NORTHERN HEMISPHERE  S.A STUDY OF REPORTS & RECORDS (74 STUDIES) OF ADOLESCENTS 10 – 25 IN SUB-SAHARAN AFRICA: LIFE TIME PREVALENCE: 10.3 % 12 MONTH PREVALENCE: 16.9% 6 MONTH PREVALENCE: 18.2% DSM 5

 DSM 5: NON-SUICIDAL SELF-INJURY (NSSI)

OTHER TERMS:

 DELIBERATE SELF-HARM (DSH)  SELF-INJURIOUS BEHAVIOUR (SIB)  SELF-MUTILATION  PARASUICIDE  SELF-ABUSE & SELF-INFLICTED VIOLENCE DSM 5

 NONSUICIDAL SELF-INJURY (NSSI) RECOGNISED BY APA AS A CONDITION FOR FURTHER STUDY – IE: AS A SEPARATE DIAGNOSTIC ENTITY  ESSENTIAL FEATURES: “THE INDIVIDUAL REPEATEDLY INFLICTS SHALLOW, YET PAINFUL INJURIES TO THE SURFACE OF HIS OR HER BODY” VS  “A PREOCCUPATION WITH DELIBERATELY HURTING ONE SELF WITHOUT CONSCIOUS SUICIDAL INTENT, OFTEN RESULTING IN DAMAGE TO BODY TISSUE” DSM 5: DIAGNOSTIC CRITERIA

 IN THE LAST YEAR ON 5 OR MORE DAYS THE INDIVIDUAL HAS ENGAGED IN INTENTIONAL SELF-INFLICTED DAMAGE TO THE SURFACE OF THE BODY OF A SORT LIKELY TO INDUCE BLEEDING, BRUISING OR PAIN WITH THE EXPECTATION THAT THIS INJURY WILL LEAD TO MINOR OR MODERATE PHYSICAL HARM (NO SUICIDAL INTENT)  VS SUICIDAL BEHAVIOUR DISORDER (NEW CONDITION FOR FURTHER STUDY)  INDIVIDUAL ENGAGES IN SELF-HARM WITH ONE OR MORE OF THE FOLLOWING EXPECTATIONS: A. TO OBTAIN RELIEF FROM A NEGATIVE FEELING OR COGNITIVE STATE B. TO RESOLVE AN INTERPERSONAL DIFFICULTY C. TO INDUCE A POSITIVE FEELING STATE PROPOSED CRITERIA …

 THERE MAY BE DEPENDENCE ON THE RELIEF AFFORDED  INTENTIONAL SELF-INJURY ASSOCIATED WITH INTERPERSONAL DIFFICULTIES, NEGATIVE FEELINGS OR THOUGHTS, SUCH AS DEPRESSION, ANXIETY, TENSION, ANGER, DISTRESS, OR SELF-CRITICISM OCCURRING IN THE PERIOD IMMEDIATELY PRIOR TO THE SELF-HARM ACTIVITY  A PERIOD OF PREOCCUPATION WITH THE INTENDED BEHAVIOUR PRIOR TO THE ACT THAT IS DIFFICULT TO CONTROL (OCD?)  THINKING ABOUT SELF-INJURY FREQUENTLY EVEN WHEN NOT ACTED ON AND …

 BEHAVIOUR NOT SOCIALLY SANCTIONED  BEHAVIOUR OR ITS CONSEQUENCES CAUSE CLINICALLY SIGNIFICANT DISTRESS OR INTERFERENCE WITH INTERPERSONAL, ACADEMIC OR OTHER IMPORTANT AREAS OF FUNCTIONING  THE BEHAVIOUR DOES NOT OCCUR EXCLUSIVELY DURING PSYCHOTIC EPISODES, DELIRIUM, INTOXICATION, WITHDRAWAL  BEHAVIOUR IS NOT PART OF STEREOTYPY IN AUTISM SPECTRUM DISORDER, INTELLECTUAL DISABILITY, TRICHOTILLOMANIA OR EXCORIATION DISORDER THE RELATIONSHIP BETWEEN SUICIDAL & NON- SUICIDAL BEHAVIOURS

❖ HIGHLY CONTESTED ❖ SELF-HARM IS NOT A SUICIDE ATTEMPT BUT CAN LEAD TO ONE ❖ PARTLY DEPENDENT ON CO-MORBID PSYCHOPATHOLOGY & PSYCHIATRIC DISORDERS ❖ DELAYED OR NON-INTERVENTION INCREASES RISK ❖ THEREFORE EVERY YOUNG PERSON WHO SELF-HARMS SHOULD BE ASSESSED FOR SUICIDE RISK BY A PROFESSIONAL THE RELATIONSHIP BETWEEN SUICIDAL & NON- SUICIDAL BEHAVIOURS

❖ INCREASED SUICIDE RISK WHEN SELF-HARM CEASES TO ‘OFFSET’ FEELINGS OF STRESS OR TRAUMA ❖ IN A CRISIS SITUATION INDIVIDUALS WHO SELF-HARM WHO HAVE BECOME DESENSITISED TO PAIN (DISSOCIATION?) MAY VIEW A SUICIDE ATTEMPT AS LESS FRIGHTENING ❖ THE MORE CLANDESTINE THE SELF-HARM THE GREATER THE SUICIDE RISK ❖ THE LONGER THE SELF-HARM PERSISTS THE GREATER THE SUICIDE RISK 2 MECHANISMS PROPOSED

A. THE SPRING PATH MECHANISM: A BUILD-UP OF TENSION & DISTRESS GOES BEYOND THE PERSON’S COPING THRESHOLD

B. THE SWITCH PATH MECHANISM: AN UNCONTROLLABLE URGE OR IMPULSE TO SELF HARM IS SWITCHED ON (NEUROLOGICAL/ OCD) SELF-HARM & SUICIDE ATTEMPTS DIFFER

SELF-HARM SUICIDE ATTEMPTS INCIDENTS FREQUENT OCCUR LESS FREQUENTLY CUTTING/BURNING/HITTING SELF-POISONING LESS SEVERE SEVERE, CAN BE LETHAL DONE TO AVOID SUICIDAL DONE WITH INTENT TO DIE IMPULSES (?) CONCLUDING THOUGHTS:

❖ THE DIFFERENCE BETWEEN WANTING TO BE DEAD AND WANTING TO NOT BE ALIVE TO THE PAIN? ❖ SELF-HARM ON A CONTINUUM OF SUICIDALITY? ❖ LIMITED RESEARCH – WE DON’T KNOW HOW MANY PEOPLE WHO SELF-HARM GO ON TO ATTEMPT SUICIDE AETIOLOGY OF SELF-HARM

❖ IS IT A DISCREET DISORDER OR A SYMPTOM OF OTHER DISORDERS/ A PRE-DISORDER THAN CAN BECOME A FULL DISORDER? ❖ SET OF COMPLEX BEHAVIOURS, SIGNS & SYMPTOMS ❖ MULTIFACTORIAL ❖ UNIQUE CONFIGURATION OF EXTERNAL, INTERNAL AND ACCELERATING OR COMPOUNDING FACTORS IN EACH INDIVIDUAL ❖ CLINICAL LITERATURE & RESEARCH PROPOSES: AN ALMOST ENDLESS LIST OF CAUSES & REASONS AN ALMOST ENDLESS LIST OF INTERPRETATIONS OF SELF- HARMING BEHAVIOUR AETIOLOGY AND/ OR CO-MORBIDITIES

INTERNAL FACTORS  ANXIETY & DEPRESSION  ATTACHMENT DISORDERS  SUBSTANCE USE  PSYCHOTIC DISORDERS  EVOLVING PERSONALITY ‘DISORDERS’ (PERSONALITY ORGANISATION) – ESPECIALLY BORDERLINE PERSONALITY DISORDER CLINICAL CASE CASE 2: PRESENTATION The boy with eczema

AETIOLOGY AND/OR CO-MORBIDITIES

INTERNAL FACTORS  POST TRAUMATIC STRESS DISORDER  COMPLEX POST-TRAUMATIC STRESS DISORDER  ADJUSTMENT DISORDER  ATTENTION DEFICIT & HYPERACTIVITY DISORDERS  OBSESSIVE COMPULSIVE DISORDER  EATING DISORDERS  NEURODEVELOPMENTAL DISORDERS EXTERNAL FACTORS

❖ABUSE, NEGLECT & TRAUMA ❖CHILDHOOD ILLNESS OR SURGERY (?) ❖FAMILY/ HOUSEHOLD/ ENVIRONMENTAL VIOLENCE ❖ABANDONMENT / MULTIPLE CAREGIVERS (DISRUPTIONS TO ATTACHMENT) ❖LOSS OF A PARENT / DIVORCE EXTERNAL FACTORS

❖SOCIAL REJECTION & BULLYING ❖FAMILY PATHOLOGY – SUBSTANCE ABUSE, PSYCHIATRIC ISSUES ❖PARENTAL PRESSURE & EMOTIONAL DETACHMENT ❖ISOLATION ❖SOCIAL MEDIA ACCELERATING FACTORS

❖ IMPULSIVITY ❖ EMOTIONAL DYSREGULATION ❖ REDUCED MENTALISATION ❖ NEGATIVE BODY IMAGE ❖ HYPER-PERFECTIONISM ❖ GLAMOURISATION & POPULARISATION OF SELF- HARM ❖ ACCEPTANCE BY OTHER ‘CUTTERS’ - MEMBERSHIP ❖ CYBERBULLYING &“CANCEL CULTURE” THE DEVELOPMENTAL & IDENTITY CONTEXT 1. ADOLESCENT BRAIN DEVELOPMENT Jensen & Nutt

❖ SEX HORMONES TRIGGER PHYSICAL CHANGES ❖ CONCENTRATION OF THESE HORMONES IN BRAIN ❖ HORMONES LINKED TO NEUROCHEMICALS THAT CONTROL MOOD ❖ HORMONES ACTIVE IN LIMBIC SYSTEM (EMOTIONAL CENTRE OF THE BRAIN) = EMOTIONALLY VOLATILE & SEEK OUT EMOTIONALLY CHARGED EXPERIENCES - RISKS ❖ NEURAL CONNECTIONS BEING PRUNED & NEW ONES BUILT = BRAIN IN FLUX A BRAIN UNDER CONSTRUCTION …

FRONTAL LOBE DEVELOPMENT COMPLETE AT 25 – RESPONSIBLE FOR HIGHER ORDER COGNITIVE FUNCTION - MEMORY, EMOTIONS, IMPULSE CONTROL, PROBLEM SOLVING, SELF-REGULATION & SELF-MONITORING!

INCREASED SELF-CONSCIOUSNESS FEAR OF NOT BEING AS GOOD AS OTHERS MORE FEAR THAT “SOMETHING IS WRONG WITH ME WHEN MY FEELINGS ARE HURT” MORE INTENSE NEED TO BELONG & BE ACCEPTED A BRAIN UNDER CONSTRUCTION …

STRONG MIXED FEELINGS OF LIKING & DISLIKING THE SAME PERSON INCREASED RISK TAKING – PERCEPTION IS KEY SOME RESEARCH SUGGESTS SELF-HARM RELEASES ENDORPHINS = MILD RUSH OR HIGH = ADDICTIVE REDUCED TOLERANCE FOR STRESS MOODINESS, IRRITABILITY, EXCESS SLEEP “YOUR BRAIN AND YOUR PHONE” *

 CONTINUOUS ONLINE CONNECTEDNESS & CONSTANT CHECKING  ONLINE TEACHING  678 MILLION SMARTPHONE CONNECTIONS IN SUB-SAHARAN AFRICA BY 2025 = 65% ‘ADOPTION’ RATE  REPEATED CONTEXT SWITCHES & ‘MULTI-TASKING’ = DISTRACTION & POOR TASK COMPLETION  BRAIN CONTINUOUSLY MONITORS ENVIRONMENT FOR CUES – GOOD & BAD  BRAIN CAN’T FILTER OUT - REDUCED COGNITIVE CONTROL?  TIME FOR THINKING, PROCESSING & REFLECTING? * D Le Roux – Stellenbosch University 5 June 2021 “DIGITAL INVASION OF THE TEENAGE BRAIN” Jensen & Nutt

 A PRIVATE BUT PUBLIC WORLD = SIMULTANEOUS ISOLATION & EXPOSURE  ‘SHARE’ OR ‘COMPARE DESPAIR’  ‘CANCEL CULTURE’  SOME MORE VULNERABLE THAN OTHERS 2. NEURODEVELOPMENTAL DISORDERS

A. INTELLECTUAL DISABILITY  SELF-HARM COMMON – DIFFICULT TO UNDERSTAND & MANAGE  CAN BE PART OF AGGRESSIVE BEHAVIOUR DIRECTED AT SELF OR OTHERS  CAN BE TRIGGERED BY CHANGE IN ROUTINE, EXCESS DEMANDS, PRESENTATION OF DIFFICULT TASKS  CAN BE RELATED TO SPECIFIC MEDICATIONS  IMPAIRED COMMUNICATION A FACTOR  POTENTIAL FOR SUICIDAL THOUGHTS & SUICIDE  UNDERSTANDING & MANAGEMENT IS SPECIALISED B. AUTISM SPECTRUM DISORDER(S)

 CONTINUUM OF IMPAIRMENT  INCREASED RISK FOR ANXIETY, DEPRESSION & OCD THEREFORE INCREASED RISK FOR SELF-HARM  CAN BE LINKED TO SENSORY PROFILE  CAN BE PART OF STEREOTYPY  EARLY DIAGNOSIS OF SPECTRUM FEATURES FACILITATES BETTER INTERVENTION AND MANAGEMENT  SPECIALISED UNDERSTANDING & MANAGEMENT REQUIRED 3. IDENTITY DEVELOPMENT

 WHO AM I?  WHO IS MY ‘SELF’?  GENERALISED BODY DISSATISFACTION  GENDER VARIANCE / GENDER DIVERSE GENDER DYSPHORIA BODY DYSPHORIA CLINICAL CASE CASE 3: The boy with the PRESENTATION mask

PRE-PUBERTY CHILDREN: 6 - 12 (?)

 EARLIER ONSET OF PUBERTY  REPORTEDLY MORE LIKELY TO BE SCRATCHING & BITING  MAY BE GREATER VERBALISATION OF SELF-HARM THOUGHTS & FEELINGS  SOME RESEARCH SUGGESTS THAT CHILDREN WITH EITHER INTERNALISING (ANXIETY, DEPRESSION, SOMATIC COMPLAINTS, WITHDRAWAL), OR EXTERNALISING (RULE BREAKING & AGGRESSION) CHARACTERISTICS AT GREATER RISK  DISSOCIATION RELATED TO ATTACHMENT DISORDERS AND TRAUMA SEEMS CLINICALLY SIGNIFICANT  POSSIBLY LESS LIKELY OR LESS ABLE TO CONCEAL CASE 4 & 5: CLINICAL CASE The boy who cut PRESENTATION The girl with the scarf

SECTION 2: ASSESSMENT & INTERVENTION

“THE SKIN IS THE CRADLE OF THE SOUL’ Didier Anzieu 1. ASSESSMENT IDENTIFYING SIGNS OF SELF-HARM

CONFIRMED OR SUSPECTED PSYCHIATRIC DIAGNOSIS AWARENESS OF PRESENCE OF INTERNAL, EXTERNAL & ACCELERATING FACTORS HEIGHTENED STRESS PERIODS – DIVORCE, EXAMS, BREAK UPS

 UNEXPLAINED INJURIES  IMPLAUSIBLE EXPLANATIONS (VS ABUSE)  WEARING HEAVY/ CONCEALING CLOTHING  AVOIDING PHYSICAL EDUCATION CLASSES/ REFUSING TO CHANGE CLOTHES  ISOLATION, AVOIDANCE IDENTIFYING SIGNS

OBVIOUS DISTRESS RISK TAKING BEHAVIOUR DECLINE IN SCHOLASTIC PERFORMANCE SCHOOL YARD GOSSIP REDUCED SCHOOL ATTENDANCE TALKING WITH CHILDREN & YOUNG PEOPLE ABOUT SELF-HARM  PRIVATE & CALM  CONFIDENTIALITY (WITHIN REASONABLE LIMITS – SAFETY FIRST)  RAISE EVIDENCE OF SELF-HARM OR CONCERNS ABOUT CLEARLY, SIMPLY AND DIRECTLY  NON-JUDGEMENTAL & NON-ACCUSATORY  ACKNOWLEDGE STRESS & OTHER FACTORS  IDENTIFY HELP & PROCEDURE  EXPLAIN YOUR ETHICAL DUTY OF CARE  SPEAKING WITH PARENTS OR CAREGIVERS  CONFIRM FOLLOW UP CONTACT IF THE CUTS COULD TALK …

IF THE CUTS COULD TALK WHAT WOULD THEY SAY? WHAT WOULD THEY WANT TO TELL US? THE PSYCHODYNAMICS OF SELF-HARM ❖ DON’T THREATEN, REBUKE OR FORCE STOPPING ❖ RECOGNISE MIXED FEELINGS ABOUT THE SELF-HARM & ABOUT RECEIVING HELP ❖ SELF-HARM WILL NOT BE GIVEN UP UNLESS THERE ARE USEFUL ALTERNATIVES ❖ CONSIDER THE BENEFITS & BARRIERS ❖ AFFECT-REGULATION FUNCTION OF SELF-HARM – RELIEF AND CONTROL ❖ TO REPRESENT UNACCEPTED/ABLE FEELINGS ❖ TO EXPRESS FEELINGS THAT HAVE NO WORDS ❖ TO CONVEY PREVERBAL AND UN-MENTALISED LOSS (TRAUMATIC ABANDONMENT) THE PSYCHODYNAMICS OF SELF-HARM

 IDENTIFICATION WITH OTHERS/ ATTEMPTS TO CONNECT

 ATTEMPTS AT SEPARATION & INDIVIDUATION – A WAY OF HANDLING DEVELOPMENTAL CHALLENGES IN AUTONOMY & IDENTITY FORMATION: THE POWER OF SECRETS BOUNDARY BETWEEN INSIDE & OUTSIDE, SELF & OTHERS ITS MY BODY! I HAVE A ‘ME’ TO HATE 2. INTERVENTION CRISIS INTERVENTION & REFERRALS

 FIRST AID OR DOCTOR/ HOSPITAL  YOUNG CHILD – CALL PARENTS IMMEDIATELY  NEGOTIATE WITH OLDER CHILDREN  FOLLOW YOUR SETTING’S PROTOCOLS  IN-HOUSE PSYCHOLOGIST, SOCIAL WORKER OR COUNSELLOR  EXTERNAL REFERRAL TO THERAPIST/ PSYCHIATRIST  FOLLOW UP METHODS OF TREATMENT

 PSYCHOTHERAPY  PSYCHIATRY & MEDICATION  ADMISSION – IN-PATIENT  GROUP THERAPY – OUT-PATIENT  SELF-HELP  BUDDY SYSTEM  MONITOR & CHECK-IN  CONTRACTS ASSESSMENT TOOLS and a word of caution

THE SELF-HARM RISK THE INVENTORY OF ASSESSMENT FOR STATEMENTS ABOUT CHILDREN (SHRAC) SELF-INJURY (ISAS) •PIONEERED BY •KLONSKY & GLENN ANNE ANGELKOVSKA PSYCHOTHERAPEUTIC APPROACHES – DEMYSTIFYING THERAPY

 GOOD RESEARCH HAS CONSISTENTLY DEMONSTRATED THAT NO ONE THERAPEUTIC MODALITY IS SUPERIOR – DESPITE TERRITORIALISM & CLAIMS TO THE CONTRARY  THE GOODNESS OF FIT BETWEEN THERAPIST & CLIENT & THE QUALITY OF THE THERAPEUTIC RELATIONSHIP ARE ACKNOWLEDGED AS KEY OUTCOME DETERMINING FACTORS  THERAPY MUST BE TAILORED TO THE UNIQUE INDIVIDUAL  CURRENT THINKING: A COMBINATION OF PSYCHOTHERAPY & MEDICATION IS MOST EFFECTIVE PSYCHOTHERAPEUTIC APPROACHES

APPROACHES CAN BE LOOSELY GROUPED INTO 1. DEPTH PSYCHOLOGIES: (E.G. PSYCHODYNAMIC PSYCHOTHERAPY – LONGER TERM, INSIGHT-ORIENTED, ADDRESSES CONSCIOUS & UNCONSCIOUS PROCESSES, PSYCHOPATHOLOGY & DEVELOPMENTAL ISSUES) 2. COGNITIVE-BEHAVIOURAL PSYCHOLOGIES: VERY SOPHISTICATED VERSIONS SUCH AS DIALECTICAL BEHAVIOUR THERAPY (DBT) 3. HYBRIDS: SUCH AS MENTALISATION BASED THERAPY (MBT)

❖ CONTEMPORARY APPROACHES: TARGETED THERAPIES SUCH AS ACCEPTANCE AND COMMITMENT THERAPY© (ACT) DBT

 MARSHA LINEHAN – EVIDENCE SKILLS BASED THERAPY (see online)  ASSERTING NEEDS - ASKING FOR  GROUP, INDIVIDUAL & PHONE WHAT YOU NEED THERAPY  TAKING STEPS TO ACHIEVE THIS  DEVELOPS SKILLS &  DEALING WITH CONFLICT KNOWLEDGE  BUILDING SELF-RESPECT  DIALECTICAL = MULTIPLE  SOOTHING & DISTRACTING PERSPECTIVES  IMPROVING STRESSFUL  MAIN GOALS: MINDFULNESS, SITUATIONS DISTRESS TOLERANCE, INTERPERSONAL  SEEING PROS & CONS EFFECTIVENESS, EMOTION REGULATION MBT - PSYCHOANALYSIS, ATTACHMENT THEORY COGNITIVE NEUROSCIENCE

 FONAGY & BATEMAN (see SKILLS online)  UNDERSTAND OUR  MENTALISATION – THE ABILITY CONTRIBUTION TO PROBLEMS & TO THINK ABOUT ONE’S CONFLICT THINKING  CHANGE BEHAVIOUR, CALM  TO MAKE SENSE OF  EMPATHY & COMPASSION THOUGHTS, BELIEFS, EMOTIONS  AND HOW THESE (MENTAL  IMPULSE CONTROL STATE) INFLUENCE OUR  UNDERSTAND RELATIONAL STYLE BEHAVIOUR ACCEPTANCE AND COMMITMENT THERAPY © ACT  RUSS HARRIS – DOWNLOAD HANDOUTS & WORKSHEETS  INTERVENTION PSYCHOTHERAPY – USES ACCEPTANCE & MINDFULNESS STRATEGIES, TOGETHER WITH COMMITMENT & BEHAVIOUR CHANGE STRATEGIES TO INCREASE PSYCHOLOGICAL FLEXIBILITY  EMBRACE THOUGHTS & FEELINGS VS FIGHTING WITH THEM OR FEELING GUILTY FOCUS:  VALUES, PROBLEM ANALYSIS, VITALITY VS SUFFERING, BREATHING SKILLS, DEALING WITH FEAR, CONFIDENCE, THE ‘HAPPINESS TRAP’, ETC. SMART PHONE APPS FOR TEENS

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❖ POLICY ON SELF-HARM ❖ CAN BE PART OF SCHOOL SAFE GUARDING PLAN ❖ MANY EXAMPLES ON LINE ❖ POLICY MUST BE PUBLISHED/ ACCESSIBLE ❖ INTEGRATE INTO LIFE ORIENTATION ETC. ❖ ACCOUNTABILITY PARTNERS ❖ USE YOUR SUPPORT NETWORKS