BCACC Blog

A conversation with Dan Siegel: Interview by Fiona Douglas-Crampton

For any adult who supports the development of children and teens — counsellors, parents, teachers, mentors — finding ways to build capacity for resilience, compassion, and creativity is of utmost importance.  When faced with challenges or unpleasant tasks, children often shut down and move to a state of reactivity. This is what Dr. Dan Siegel, clinical professor of psychiatry at the UCLA School of Medicine and founding co-director of the Mindful Awareness Research Center, calls the “No Brain” response. How do we get children to move out of this state? According to Siegel, this can be changed when children develop a “Yes Brain,” which helps them embrace life in a different way, with openness, curiosity, compassion, and creativity.

In his new book published this January, The Yes Brain: How to cultivate courage, curiosity, and resilience in your child, Siegel explores practical strategies for parents and caregivers to better support children and teens on the path to a positive way of living in the world.

Dalai Lama Center for Peace and Education’s President Fiona Douglas-Crampton has asked Dan Siegel to share a few insights on what it actually takes to engage in yes brain parenting.

Fiona Douglas-Crampton: In your new book, you provide caregivers with tools to help children develop a “Yes Brain.” Tell us briefly what is the Yes Brain?

Dan Siegel: Our brains have two fundamental states: a receptive state and a reactive state.  In my workshops, if I say the word “no” harshly several times, participants experience the reactive state as if they were being threatened. This is a survival state the brain creates of fight, flight, freeze, or faint.  When we are in this reactive state, we can’t learn well and we can’t connect well with others, or with our inner mental experience.

In contrast, saying “yes” repeatedly and in a soothing way evokes a very different state. A feeling of openness and safety emerges, one that reflects the brain’s state of being receptive.  The scientist Steven Porges describes the turning on of a social engagement system, a neural set of circuits that enables us to reach out to others and even be more open to our own self-awareness, engage in learning, and be more flexible and at ease. This is the “Yes-Brain” state of receptivity.

With parenting, it is possible to provide a strategy that intentionally cultivates this receptive Yes Brain state in a child.  With repeated activation of a state, the process of neuroplasticity is engaged which can transform a temporary neural firing pattern, a state, into a long-term structural change in the brain, making the propensity of that way of being a trait in a person’s life.  Yes Brain parenting is about creating the balance, resilience, insight and empathy at the heart of a positive way of living in the world.

FD-C: What work do we need to do ourselves as caregivers before we can start nurturing these special qualities in our children?

DS: Research on parenting suggests that the best gift parents can offer their children is of self-understanding. This self-awareness means making sense of how the past has shaped us into the present time and how we can be aware of our current state and learn to be as open and receptive as possible in connecting with our kids.  Coherent self-understanding is possible to attain through an inside-out approach that builds the capacity for mental time-travel, to connect the past with the present, and to free ourselves up for living in the future in a positive way.

When we learn how to recognize our own Yes Brain or No Brain state in the moment, we begin the important steps of self-awareness that enable us to then change from a reactive state to a more receptive one. This capacity is the basis of our own resilience and enables us to role model this skill for our children.

When we are open in the Yes Brain state we can play the important PART we need to play as parents and be 1) Present—open and receptive to the child’s experience, and our own; 2) Attuned—focusing our attention on the inner experience of our child’s beneath behavior—doing this for ourselves as well; 3) Resonating—feeling the feelings of our child but not becoming them or over-identifying with their experience; and cultivating 4) Trust—a state of receptivity and reliance on another, and even on ourselves.  A Yes Brain is essential in ourselves to provide these core aspects of a loving relationship in the PART we play with our children.

FD-C: Can you give us an example of the difference it makes in children’s lives when they are able to develop a Yes Brain.

DS: Children who are prone to entering the No Brain state and haven’t been offered the tools enabling them to maintain a Yes Brain state, or to move toward this receptive state if they’ve left it, are at a disadvantage in many aspects of their lives.  Feeling threatened shuts down learning, decreases compassion, alters how we connect with others, and leaves an individual prone to feeling insufficient and continually comparing him or herself to others.

In contrast, a Yes Brain trait can be cultivated in a child that parallels Carol Dweck’s notion of a growth mindset in which a child can experience challenges as an opportunity to grow and learn more, to try harder and in a different way, rather than as a failure or sign of weakness.  Having the persistence in the face of difficulties draws on the Yes Brain qualities of having balance internally, resilience to move back to receptivity, insight into one’s own inner experience, and empathy to embrace the reality of our interconnectedness.  These are all strengths that support courage, creativity, and living life guided by an internal compass, rather than simply the expectations of others.  A Yes Brain way of parenting helps us redefine what “success” means, giving meaning and connection to a child supporting their growth of an internal compass in their lives.  Yes Brain parenting is a gift that keeps on giving.

Fiona Douglas-Crampton is the president and CEO of the Dalai Lama Center for Peace and Education, a charitable organization focused on “.” 

Resources

Books

• Gabor Mate: When the Body Says No
• Karen Salmansohn: Think Happy
• Carol Dweck: Mindset: The New Psychology of Success
• Brene Brown: Daring Greatly
• Dan Harris: 10% Happier

Websites

• Gratitude 365: http://gratitude365app.com/
• Calm (meditation techniques for stress reduction): https://www.calm.com
• Self compassion: http://selfcompassion.org/
• Left Buddha Brain: The modern mindful life: http://leftbrainbuddha.com/
• Tiny Buddha: 45 simple self-care practices for a healthy mind, body and soul: https://tinybuddha.com/blog/45-simple-self-care-practices-for-a-healthy-mind-body-and-soul/

by Elaine Pelletier, RCC

The Skytrain doors open and I move quickly to grab a seat. Directly across from my seat by the door, my suitcase anchored between my legs I see two, very tall women with suitcases much larger than mine. Athletes travelling home? One of the women leans with her back against the wall, feet firmly planted to the floor, while the other stands upright holding her large suitcase with her legs and pelvis. She and the suitcase seem symbiotic as her lower body stabilizes allowing animated upper body expression and discussion with her friend. A man wheels his bicycle onto the train. These ladies are in the spot for bikes, he pauses a brief second as all his intention of movement holds, but as he quickly waves and smiles to the women, who to offer to move, he turns his bike into the area that connects this car to the next. Parking his bike against the wall, still holding onto the frame, he grounds in his lower body, one leg before the other, seeking stability, and his entire torso leans forward in the space between his hips and his bike, also shaping to his environment, meeting his immediate need of rest. Looking diagonally across the aisle from me I see a person sitting heavily into the seat, wrapped thoroughly with winter coat, scarf, and hat such that no face can be seen, body inert, no breath visible. Sleeping? Maybe, but her hands firmly grasp a large shopping bag from a downtown store. Exhausted perhaps. No movement. As the train begins to fill, a youth maybe in the mid-teens now stands off to the left of me, near the support pillar, but not holding on. The train doors close and the train’s force of momentum carries us. The youth nearly stumbles and I wonder if he is trying out his core-support and adaptive flexibility? He is lithe and carries his centre of weight high in his body. He continues to be unstable, having to grab the bar multiple times, re-establish his footing and try again. I briefly watch his breath, high and shallow. Seeking grounding, with or without intentional goal, perhaps exploring the option of playful awareness. I continue to wonder about the boy’s spatial intent and resulting spatial tension.

I am returning from a workshop on Bartenieff Fundamentals (BF) observing myself and those around me. BF stems from the Laban Movement Analysis System and is a somatic, body-based practice, founded in developmental movement patterns, efficient movement functioning and personal expression, with the goal to help people “…discover and pattern inner connective pathways in the neuromuscular system which leads to full body integration and connectivity” (p. 1).¹ Filled with internal sensing, a lively awareness of my own body, my spatial shaping and spatial intentions, I feel connected to this environment of the train which moves and shapes internally as it speeds toward its destination. And then there is my breath, that all important first tool of self-awareness. The process of breathing grows or shrinks the shapes we hold with our bodies, while spatial shaping occurs with a bodily initiated spatial intent toward an ‘object’; the object embraced or repelled being the beginning of a spatial tension². The study of movement developed by pioneers such as Rudolph Laban and Irmgard Bartenieff has a long and deep history. This body of knowledge is foundational to the fields of movement analysis and dance movement therapy, both of which have much to provide in the rediscovery of the importance of the body in psychological health.

Currently, sensorimotor focused psychotherapy and the research supporting is a fast developing field of work with clients who have experienced trauma. Different than the psychodynamic approach of talking about the trauma, somatically focused methods work directly with the body, the location of the first impact of trauma and where the cascade of physical and physiological effects are held³. This view suggests that “…traditionally trained therapists can increase the depth and efficacy of their clinical work by adding body-oriented interventions to their repertoire.”(p. xxviii )⁴ This evolving body of knowledge and the resulting methods of helping clients through their bodies⁵ are being researched and validated.⁶ Exploration and practice with mindfulness, a skill developed through meditative awareness, has contributed to the foundations of the this new field of psychotherapy.^{7, 8, 9} There seems to be a coalescing of diversity, a coming together of distant relatives, a gathering of souls, while at the same time an expanding of awareness and a recognition of the role of variability and the emergence of self-organized properties in what makes for a healthy person.¹⁰

“We can only observe behaviour, but we can also develop the skills to better intuit what a client’s behaviour in the moment is telling us about the state of their nervous system and what they have learned to do in order to survive. A client’s physical posture is one component of this — how does the client carry his/her body, is there evidence of “bracing”, do we see “collapse” or a lengthened spine?”(p. 11)¹¹ I attended the BF workshop to re-establish my grounding in movement work, the roots of my therapeutic skill. While body and movement awareness are only some of the skills required to work therapeutically with the mind~body relationship of traumatized people, being aware and working with my own embodiment and mindfulness is instrumental, and as important as is the need to understand my own attachment patterns.¹² BF, along with related and extended methods¹³, are an experiential system of movement analysis for the integration of skills and knowledge that can then be used to observe, evaluate, and interpret a client’s movement expressions. Other skills helpful to working with the body in therapy are to be able to tolerate, perhaps even be comfortable with, uncertainty,¹⁴ to understand the empathy inherent in nonverbal communication, bodily movement, and verbal communication, and to be aware of one’s own movement, inner sensations, and feelings.¹⁵ While these studies can become extensive, an initial exploration of the BF by a therapist begins the process of developing a deep comprehension of how people emerge through their embodied selves. This skill contributes to both therapeutic alliance and therapeutic response. I especially like how Bonnie Cohen expressed this: “I see the body as being like sand. It is difficult to study the wind, but if you watch the way sand patterns form and disappear and re-emerge, then you can follow the pattern of the wind or, in this case, the mind” (p. 11)¹⁶.

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References

¹ Redlick, D (2008). Who was Irmgard Bartenieff. Introduction to Bartenieff Fundamentals Workshop handout.
² Bartenieff B, Lewis, D (1980/1997). Body movement: Coping with the environment (8th edition). Neatherlands: Gordon and Breach Publishers.
³ Buczynski R, Ogden P (2016). How to Help Clients Build Their Body’s Resources to Heal from Trauma. Transcript of Webinar: Why the Body Holds the Key to the Treatment of Trauma. The National Institute for the Clinical Application of Behavioral Medicine. www.nicabm.com
⁴ Ogden P, Minton K, Pain C (2006). Trauma and the body: a sensorimotor approach to psychotherapy. New York: W.W.Norton.
⁵ Fisher J (2017). Changing Roles for Client and Therapist. In Healing the Fragmented Selves of Trauma Survivors Overcoming Internal Self-Alienation. New York: Routledge, Taylor & Francis Group.
⁶ Ogden P, Fisher J (2015). Sensorimotor psychotherapy: Interventions for trauma and attachment. New York, NY: W. W. Norton & Company.
⁷; Buczynski R, Siegel D, van der Kolk B, Ogden P, Porges S, Lanius R, Borysenko J, Schore A,Levine P, O’Hanlon B (2017). Transcripts of Webinar Treating Trauma Master Series. Connecticut: National Institute of the Clinical Application of Behavioral Medicine.
⁸ Kabat-Zinn, J (2011). Some reflections on the origins of MBSR, skillful means, and the trouble with maps. Contemporary Buddhism, 12(1), 281-306.
⁹ Bien, T (2006). Mindful therapy: A guide for therapists and helping professionals. Somerville: Wisdom Publications, Inc.
¹⁰ la Torre-Luque A, Bornas X, Balle M, Fiol-Veny A (2016). Complexity and nonlinear biomarkers in emotional disorders: A meta-analytic study. Neuroscience & Biobehavioral Reviews, June. DOI: 10.1016/j.neubiorev.2016.05.023
¹¹ Manley R (2016). Attachment, Trauma, and the Therapeutic Relationship. BC Psychologist, Summer, 10-12.
¹² Manley R (2016). Attachment, Trauma, and the Therapeutic Relationship. BC Psychologist, Summer, 10-12.
¹³ Kestenberg Amighi, J & Loman, S (1999). The Kestenberg movement profile explained. In Kestenberg Amighi, J, Loman, S, Lewis, P & Sossin, KM (Eds). The meaning of movement. Developmental and clinical perspectives of the Kestenberg Movement Profile. Amsterdam: Gordon and Breach Publishers.
¹⁴ Wengrower, H (2009). Chapter 2: The creative–artistic process in dance/movement therapy. In Sharon Chaiklin and Hilda Wengrower (Eds.). The Art and Science of Dance/Movement Therapy: Life is Dance. New York: Routledge.
¹⁵Fischman, D (2009). Chapter 3: Therapeutic relationships and kinesthetic empathy. In Sharon Chaiklin and Hilda Wengrower (Eds.). The Art and Science of Dance/Movement Therapy: Life is Dance. New York:Routledge.

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An art therapist and clinical counsellor, Elaine Pelletier BFA MSc DVATI RCC, works for a not for profit agency in the Okanagan helping children, youth and women who have experienced sexual abuse or assault. Elaine also has a private practice Art|Mind|Movement Therapy providing individual and group therapy and workshops. This practice is primarily focused on the integration of, and recovery from, traumatic experiences for children, youth and adults. Elaine has extensive background with healthcare system critical incidents and can help people heal from the trauma experienced from other areas of complex system failures.

By Tracey Block

Research has long proven the positive mental and physical effects of adding green to our lives. Yet, it seems we need to be reminded of it every now and then.

Whether we are bringing the green inside with plants and flowers in home or office–or making a physical connection to the green outdoors by gardening or otherwise engaging with nature—the affirmative effects on our psyches are boundless.

Brian Minter, gardening columnist for Canada’s Vancouver Sun newspaper, sees the influence of greenery worthy of a new year’s resolution. “As we’re about to enter a new year, it’s a great time to consider a few ways of adding greater value to our lives. Engaging the world of plants will improve our sense of well-being, happiness and health,” he wrote in last week’s column.

A 2016 report by the World Health Organization called Urban Green Spaces and Health cites early exposure to greenery as an important support to children’s overall mental health Minter explained. “Increasing children’s exposure to green spaces influenced their cognitive ability in a positive way, improved their social inclusiveness and behaviour and lowered the risk of ADHD.”

Minter referred to biophilia, a term meaning a “connection to plants and nature”, recently conceived by Arizona State University’s (ASU) adjunct faculty members Sonja Bochart and Joe Zazzera. Encouraging an interaction with nature and greenery “by bringing the outdoors inside is the latest trend in interiorscapes,” he added. “Using water, living walls, larger indoor plants, and other natural elements boost people’s mood, productivity and health.”

In his article for the university’s publication, ASU Now, writer Scott Seckel explained Bochart’s perspective. “Bochart called biophilia a balance between art and science, and it’s something science has plenty of evidence to support,” Seckel wrote. “Views of nature . . . lower blood pressure and heart rate. Morning sun reduces hospital stays of bipolar patients 26 to 30 percent.”

Bochart’s colleague, Joe Zazzera, cautioned that biophilic design is “not just bringing plants indoors”. Instead, it encourages an overlap between the worlds of nature and humans. “Hopefully, in the future there won’t be a difference,” Zazzera said. “Corporations are waking up to this.” In an increasing technical world where crowded spaces, concrete structures and computer chips ever make up a larger part of our collective existence, the role of simple nature in positive mental health outcomes will only be increase over time.

In an October article for PsychCentral.com, writer Traci Pedersen discussed an analysis from the journal Open Agriculture. Based on the affirmative emotional influence plants have on people’s mental health, University of Florida researchers believe greenery may work to boost the mental wellness of “space crews”.

“Long periods of space travel can lead to sleep problems, reduced energy, inattentiveness, difficulty in problem-solving, and even memory loss,” Pedersen wrote. “It can also increase hostility, impulsivity and, despite the danger and excitement, it can be quite boring.”

Based on their literary review of “plant-people interactions”, Pedersen explained, the university researchers determined that the benefits of plants to humans on Earth are equally applicable to astronauts in outer space. Their conclusions, Pedersen added, suggest that “plants can help reduce both social and cognitive problems related to space travel, and . . . should be part of the design of future space missions for both nutritional and psychological reasons”.

While most of us spend our working hours with feet planted firmly on the Earth, even a subtle change in our access to a greenspace gives a notable lift to our moods. Too many offices provide workers with concrete walls and lifeless dividers to look at 6-8 hours each day. But the opportunity to look out a window onto a greenspace can be a gamechanger.

Rebecca Clay, in an article for the American Psychological Association, described the stunning change of perspective University of Michigan psychologist Rachel Kaplan, Ph.D., experienced when, after 17 years she moved into a university office that provided a “tree-top view” instead of the “barren” courtyard wall she had looked onto for so long.

For many years, Kaplan and her husband studied the effects of greenery on human psyches, but her own experience provided first-hand evidence that their conclusion is correct: “Green is good for you”.

According to Clay, the Kaplans’ research encompasses an area they describe as restorative environments. With other psychologists, they examine “nature’s impact on people’s mental functioning, social relationships and even physical well-being,” she wrote. “Others are putting that research into practice by working with interior designers, architects and city planners to create psychologically healthy buildings and cities.”

Kaplan’s change of work venue underscored what a lot of people encounter every day. “My previous office was harder on me than I realized,” she said. “I have to admit I was more convinced of my own work after I changed offices. I realized that all of our results were right.”

Clay explained that from the research Kaplan and her husband had done, as well as from her own encounters–Kaplan concluded that the “restorative effects” of nature do not have to be sought out with daily hikes in the woods. “Even a glimpse of nature from a window helps,” Kaplan explained.

In one recognized experiment, continued Clay, “Rachel Kaplan found that office workers with a view of nature liked their jobs more, enjoyed better health and reported greater life satisfaction.”

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References

Clay, R.A., (April 2001). American Psychological Association. Green is good for you. http://www.apa.org/monitor/apr01/greengood.aspx

Minter, B., (December 29, 2017). Vancouver Sun. Improve your health, well-being and happiness with plants. http://vancouversun.com/homes/gardening/brian-minter-improve-your-health-well-being-and-happiness-with-plants

Pedersen, T., (October 20, 2017). PsychCentral.com. Plants May Help Maintain Mental Health of Astronauts. https://psychcentral.com/news/2017/10/20/plants-may-help-maintain-mental-health-of-astronauts/127703.html

Seckel, S., (February 2, 2017). ASU Now. ASU adjunct faculty says bringing nature into design has physical, mental health benefits. https://asunow.asu.edu/20170202-solutions-biophilic-design-doesnt-just-look-good-–%C2%A0it-makes-us-feel-good-too

Waters, E., (March 6, 2017). PsychCentral.com. Top 6 Bedroom Plants that Promote Better Sleep. https://psychcentral.com/blog/archives/2017/03/06/top-6-bedroom-plants-that-promote-better-sleep/

Seasonal Affective Disorder. (n.d.). Retrieved from https://www.theravive.com/therapedia/seasonal-affective-disorder.

by Sarah E. Victor, PhD

Reprinted with permission from “Young People: Self-Injury” issue of Visions: BC’s Mental Health and Addictions Journal, 13(2), produced by the Canadian Mental Health Association’s BC Division on behalf of BC Partners for Mental Health and Addictions Information. To access other helpful articles in the issue, visit www.heretohelp.bc.ca/visions. There, you can also sign up to receive the quarterly magazine free of charge by email or hard copy. Visions is written to be accessible to members of the public and providers alike.

Many teens who self-injure do not get the help they need, even when they reach out to others. A recent study of high school students found that 83% of self-injuring teens asked for help for an emotional or behavioural problem, but only 59% told someone about their self-injury, and less than 10% talked about self-injury with an adult.¹

This means that no news is not good news when it comes to a youth who may be struggling! If you’re worried that a teen or young adult in your life may be self-injuring, the best thing to do is ask him or her directly.

Some people worry that asking about self-injury will “make” people start self-injuring. Thankfully, research shows that asking about self-injury doesn’t cause an individual to self-injure, nor does it make an existing situation worse.^2,3 The same is true when it comes to talking about suicidal thoughts and actions: asking about a possible behaviour doesn’t cause someone to engage in the behaviour.⁴

But how can you start a conversation with someone about such a difficult topic? You might feel awkward, uneasy or nervous about having this kind of discussion. That’s normal. This article outlines some important things to think about when discussing self-injury, as well as providing some tips that might help make the conversation go more smoothly.

When and where to have the conversation

Self-injury is often associated with uncomfortable emotions, like shame and guilt.⁵ Because of this, it’s important to ask about self-injury in a way that makes the person feel comfortable instead of making the individual feel more ashamed or guilty. Ask about self-injury in private, away from other people. Make sure you have plenty of time, and avoid discussing the topic at a time when one or the other of you is already upset.

How to start the conversation

Before you start asking questions, tell the person that you’ve noticed that he or she is having a hard time, that you care and that you want to help. For example, you might say, “I’ve noticed that you’ve been really down the last few times we’ve met, and I’m concerned. Can we talk about how you’ve been doing?” If the person seems nervous, you might even say, “I know it can be tough to talk about these things, but I think it’s important enough that we should talk anyway, even if it’s awkward.”

What questions you should ask first

It’s important to be clear and direct. Avoid using generic phrases like “hurting yourself,” because these can mean different things to different people. You could start with something like “Sometimes when people are struggling, they do things like cutting or burning themselves, not as a way to die, but to try to feel better or to get help from other people. Have you ever done anything like that?”

Then, if the person is self-injuring, there are lots of different aspects of the self-injury that you may want to ask about. For starters, it’s important to know the severity of the self-injury, and the motivation (or function) of the self-injury.

How to ask about severity

Knowing the severity of someone’s self-injury will help you to help the person stay physically safe. Most self-injury causes minimal physical harm, but some self-injury can cause major health problems or even accidental death. Here are some good questions to ask:

What specific methods of self-injury have you used?

How often have you been self-injuring?

Have you ever needed medical attention for self-injury?

Have you ever thought you needed medical care for self-injury, but didn’t get it?

Have you had thoughts about other kinds of self-injury methods? If so, which ones?

These questions can help you understand whether the self-injury may be medically dangerous. If you’re not sure, you can always refer the person to a physician or the nearest emergency room for more assessment. We know that those who self-injure are more likely to report a suicide attempt.⁶ Even if the person is not currently in need of medical attention, it is important to know about self-injury severity because people who self-injure are more likely to also experience suicidal thoughts and behaviours, and self-injuring more often or with more methods of self-injury can be related to a greater risk of suicide attempts.

How to ask about motivation

We all have reasons for doing the things we do. This is true for self-injury, too. Even if others can’t understand the person’s reasoning, everyone who self-injures does so because it seems like the best option at the time—even if it causes problems later. Knowing why someone self-injures will help you understand and support the person. Your knowledge may also help mental health professionals provide the best care possible.

People usually self-injure for two types of reasons: they wish to change something within themselves (most common), or they wish to change something about their relationship with another person (less common).⁷ Most people who self-injure say that self-injury helps them feel less sad, scared or angry immediately afterward, even though they may continue to have those feelings (or worse feelings) later. Many describe self-injury as a way to punish themselves. Less often, people use self-injury as a way to reach out to others for help, or to avoid interacting with other people.⁸ Here are some good questions to ask:

What usually happens right before you self-injure?

How do you feel before you self-injure? How do you feel right after?

What does self-injury do for you?

What about your self-injury is helpful to you? What isn’t as helpful?

Do you want to stop self-injuring? Why (or why not)?

These questions let the person know that you care, and that you won’t dismiss the self-injury as “attention-seeking” or “irrational.” Knowing what self-injury means to someone is the first step to helping him or her find other coping strategies to use instead.

Where to go from here

Once you’ve talked to someone about self-injury, what’s the next step? Here are a few options to consider:

• Let the person know there’s help available 24/7 if he or she is struggling. In British Columbia, the Crisis Centre offers phone and chat counselling specifically for youth; you can find information about the centre at crisiscentre.bc.ca.
• Develop a safety plan. What can the person do instead of self-injuring? Who can the person call or text? What else could help when he or she is upset? Some ideas for coping with self-injury urges can be found at sioutreach.org.
• Find a school counsellor, physician, therapist, psychologist or another professional who can help. In British Columbia, you can call 811 to get free, non-emergency health information, including information about mental health concerns.

Asking someone about self-injury can feel intimidating and distressing, but it can also be a very important step to getting someone the help they need. By being respectful, genuine and compassionate, you can provide support and resources to someone who might otherwise feel alone and hopeless. For more information about assessing self-injury, see the sidebar panel.

Where can I learn more about self-injury assessment?

Depending on the setting, your training and other factors, you may want to use a more structured method to ask about self-injury in more detail. Here are a few useful assessment tools:

• Inventory of Statements About Self-Injury

This questionnaire asks about self-injury methods and motivations or functions for self-injury. It is very brief and frequently used, although it does not cover some aspects of self-injury, such as medical severity. You can find the questionnaire at www2.psych.ubc.ca/~klonsky/publications/ISASmeasure.pdf.

• Ottawa Self-Injury Inventory

This questionnaire asks about self-injury methods, motivations and characteristics. It is very thorough and includes many items, but it does take longer to complete than others. You can find this questionnaire at www.insync-group.ca/publications/OSI-2015-English-v3.1.pdf.

• Self-Injurious Thoughts and Behaviors Interview

This interview asks about nonsuicidal self-injury and suicidal thoughts and behaviours. It gives the user information about different kinds of self-injury, both suicidal and nonsuicidal, but does require that someone ask questions in an interview format rather than allowing the interviewee to self-report. You can find the interview at projects.iq.harvard.edu/files/nocklab/files/sitbi_longform.doc.

• Nonsuicidal Self-Injury Disorder Scale

This questionnaire is meant to go along with other measures of self-injury methods, to assess whether the person meets diagnostic criteria for Nonsuicidal Self-Injury Disorder in the DSM-5. You can find the questionnaire at www2.psych.ubc.ca/~klonsky/publications/NSSIDS_measure.pdf.

Have more questions about supporting someone around self-injury? Join a Q&A in early November!

Visions contributor experts will be available for a discussion panel on twitter, a tweet chat. The tweet chat will take place on November 9, 11-12 Pacific Time, using #nssichat. Follow them now on Twitter at @HeretoHelpBC.

Footnotes

1. Hasking, P., Rees, C.S., Martin, G. & Quigley, J. (2015). What happens when you tell someone you self-injure? The effects of disclosing NSSI to adults and peers. BMC Public Health, 15, 1039. doi:10.1186/s12889-015-2383-0.

2. Bjärehed, J., Pettersson, K., Wångby-Lundh, M. & Lundh, L.G. (2013). Examining the acceptability, attractiveness, and effects of a school-based validating interview for adolescents who self-injure. The Journal of School Nursing, 29(3), 225-234. doi:10.1177/105984051245852.

3. Muehlenkamp, J.J., Swenson, L.P., Batejan, K.L. & Jarvi, S.M. (2015). Emotional and behavioral effects of participating in an online study of nonsuicidal self-injury: An experimental analysis. Clinical Psychological Science, 3(1), 26-37. doi:10.1177/2167702614531579.

4. Dazzi, T., Gribble, R., Wessely, S. & Fear, N.T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361-3363. doi:10.1017/S003329171400129.

5. Victor, S.E. & Klonsky, E.D. (2014a). Daily emotion in non-suicidal self-injury. Journal of Clinical Psychology, 70(4), 364-375. doi:10.1002/jclp.2203.

6. Victor, S.E. & Klonsky, E.D. (2014b). Correlates of suicide attempts among self-injurers: A meta-analysis. Clinical Psychology Review, 34(4), 282-297. doi:10.1016/j.cpr.2014.03.00.

7. Klonsky, E.D., Glenn, C.R., Styer, D.M., Olino, T.M. & Washburn, J.J. (2015). The functions of nonsuicidal self-injury: Converging evidence for a two-factor structure. Child and Adolescent Psychiatry and Mental Health, 9(44). doi: 10.1186/s13034-015-0073-4.

8. Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27(2), 226-239. doi:10.1016/j.cpr.2006.08.002.

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Sarah E. Victor, PhD studied clinical psychology at the University of British Columbia and is now a postdoctoral scholar at the University of Pittsburgh School of Medicine. Her research and clinical work focuses on understanding nonsuicidal self-injury, suicidal behaviours and the relationship between the two, particularly in adolescence and young adulthood.

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