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Published in final edited form as: J Psychiatr Res. 2021 Sep 3;144:146–150. doi: 10.1016/j.jpsychires.2021.09.005

An Experimental Examination of Interpersonal Problem-Solving in Nonsuicidal Self-Injury: A Pilot Study

Brooke A Ammerman 1, Kristen M Sorgi 2, Martha K Fahlgren 2, Alexander A Puhalla 3, Michael S McCloskey 2
PMCID: PMC8817559  NIHMSID: NIHMS1747215  PMID: 34628275

Abstract

Nonsuicidal self-injury (NSSI) typically occurs in the presence of negative emotions. Prior research has emphasized interpersonal stress as a specific context that may elevate negative emotions in this population and even increase the likelihood of NSSI behavior. However, the factors that contribute to the relationship between interpersonal stress and NSSI have received relatively limited attention. The current pilot study aimed to experimentally examine interpersonal problem-solving as a potential moderator of the interpersonal stress – NSSI risk relationship among those with a NSSI history. Eighty-six participants (52.3% with NSSI history) were randomly assigned to one of three mood induction conditions (interpersonal negative, general negative, interpersonal neutral), after which they completed an interpersonal problem-solving task and a laboratory analogue of self-injurious behavior. Results indicated that NSSI history was associated with poorer interpersonal effectiveness. Further, individuals with a history of NSSI who experienced an interpersonally-focused negative mood and produced less effective interpersonal solutions were more self-harming on a laboratory analogue of self-injurious behavior. While the present findings are preliminary in nature, they offer guidance for research moving forward and, if replicated, suggest interpersonal problem-solving as a potential treatment target among individuals engaging in NSSI.

Keywords: NSSI, self-harm, interpersonal stress, interpersonal conflict, self-aggressive paradigm

Introduction

Non-suicidal self-injury (NSSI), the deliberate, self-inflicted damage of body tissue without suicidal intent and for purposes not socially or culturally sanctioned (International Society for the Study of Self-Injury, 2020), is prevalent among undergraduates, with over 10% of students reporting engagement in NSSI during their first year of college (Kiekens et al., 2019). Given the negative sequalae associated with NSSI (Plener et al., 2015), there is a need to better understand NSSI’s associated risk factors. While numerous factors confer potential NSSI risk (e.g., Fox et al., 2015), few factors have been considered within the context that NSSI naturally occurs. As NSSI is most commonly endorsed as an emotion regulation strategy (Taylor et al., 2018), and the behavior typically occurs in response to negative thoughts or feelings (Hepp et al., 2020), understanding risk in the context of psychological stress may be most beneficial for advancing theoretical understandings of NSSI and identifying treatment targets.

Interpersonal stress, in particular, has been identified as a trigger for NSSI (Cawley et al., 2019). Negative interpersonal experiences (i.e., conflict, rejection, criticism) are associated with increased likelihood of NSSI urges and behaviors within the following hours and days (Turner et al., 2016; Victor et al., 2019). While prior research has recognized interpersonal stress as a potential key scenario leading to NSSI, little is known about why interpersonal, as opposed to other forms of, stress may be particularly salient. Thus, there is a need to understand the factors that may potentiate NSSI behavior following interpersonal stress.

Interpersonal problem-solving may play an important role in the relationship between interpersonal stress and NSSI. Given the strong relationship between NSSI and emotion dysregulation (Gratz, 2007; Hasking et al., 2017; Taylor et al., 2018), it would be expected that when individuals prone to NSSI experience negative emotion, their problem-solving might be most impaired, which in turn may facilitate engagement in NSSI. Supporting this, and related literature among those with a history of suicidality (e.g., Schotte & Clum, 1987), when experiencing nonspecific emotional stress, individuals who engage in NSSI produce fewer solutions to interpersonal problems than when not experiencing distress (Nock & Mendes, 2008). However, this has yet to be examined in the specific context of an interpersonal stressor, a scenario known to confer risk for NSSI and one when interpersonal problem-solving may be most important.

Current Study

The current experiment was a preliminary investigation of the role of interpersonal problem-solving abilities in the context of an interpersonally-focused negative mood (vs general negative or neutral mood) on a laboratory analogue of NSSI behavior among those with and without a history of NSSI. The first study aim was to evaluate the separate and combined effects of an acute interpersonally-focused negative mood and NSSI history on interpersonal problem-solving abilities. We hypothesized a mood-by-NSSI history interaction, wherein individuals with an NSSI history who experienced an acute interpersonally-focused negative mood would demonstrate the poorest interpersonal problem-solving abilities. The second study aim was to examine the impact of interpersonal problem-solving abilities on the relationship between an acute interpersonally-focused negative mood and acute self-harm. It was hypothesized that the poorer interpersonal problem-solving abilities would strengthen (i.e., moderate) the relationship between the interpersonally-focused negative mood and acute self-harm on a laboratory analogue of NSSI among individuals with a NSSI history.

Material and Methods

Participants

Participants were 86 undergraduates recruited from a large, urban university. Participants were 20.69 years old (SD = 3.76), and 81.4% identified as female (18.6% male). The majority of participants identified as White (59.3%), followed by 18.6% Asian, 12.8% Black / African-American, and 9.3% another race or multiracial. Overall, 52.3% (n = 45) of participants reported a lifetime history of repeated NSSI (i.e., 2 or more acts). Exclusion criteria were based on potential influence on laboratory task performance (i.e., impacted reaction time) and ethical concerns (i.e., elevated baseline distress), which included: history of psychosis, intellectual disabilities, or traumatic brain injury with loss of consciousness for > 60 minutes; severe past-week depression symptoms (i.e., score > 15 on the Quick Inventory of Depression Symptoms; Rush et al., 2003); current severe alcohol or substance use disorder diagnosis (determined by the Structured Clinical Interview for DSM-5; First, 2014); and failure to pass a urine screen for illicit drugs on two separate occasions.

Measures

Suicide Attempt Self-Injury Interview (SASII; Linehan et al., 2006).

The SASII is a semi-structured interview used to assess for NSSI history; only the presence and frequency of lifetime NSSI were utilized. Interrater reliability and convergent validity of the SASII are supported among self-injuring samples (Linehan et al., 2006).

Means-Ends Problem Solving Task (MEPS; Platt et al., 1975).

In the MEPS, participants are presented with hypothetical interpersonal problem scenarios and linked final resolutions. They receive 60 seconds (each) to describe: (a) most effective strategy to link the problem and resolution (outcome rated as 1 = not at all effective to 7 = very effective), (b) potential obstacles to their strategy (outcome is number of identified obstacles), and (c) alternative strategies for solving the problem (outcome is number of identified alternatives). Three scenarios were presented at Visit 1 and Visit 2 each (order randomized within session). Responses were coded via Pollock and William’s coding scheme (2004) on three outcomes (effectiveness, obstacles, alternatives) by at least two independent raters (ICCs = .82-.94). The average of each outcome across the three scenarios (within visit) are utilized in analyses.

Self-Aggressive Paradigm (SAP; Berman & Walley, 2003; McCloskey & Berman, 2003).

The SAP is a laboratory proxy for self-injurious behavior. Participants compete against a (unbeknownst to them) fictitious opponent in 32 reaction-time trials. After each losing trial, participants are asked to select a shock level to receive. Shock options range from 0 (no shock) to 10 (the participant’s predetermined threshold), or a 20 (believed to be twice their predetermined threshold; coded as 11). The dependent variable is average shock level. Construct validity (i.e., self-harm behavior) for the SAP has been demonstrated (Berman & Walley, 2003). Post-SAP, a questionnaire is administered, serving as a manipulation (i.e., deception) check.

Positive and Negative Affect Schedule (PANAS; Watson, Clark & Tellegen, 1988).

The PANAS is a self-report measure comprising 10 positive affect and 10 negative affect items assessing how participants feel “right now”. The PANAS was completed before and after the mood induction(s).

Mood Induction Procedures

Interpersonal Mood Inductions.

A valid interpersonally-focused mood induction procedure was utilized (Gratz et al., 2011; Lang & Cuthbert, 1984; Levin et al., 1982). Participants engaged in a semi-structured interview regarding a recent interpersonal interaction, either distressing (i.e., they felt “very upset or angry”) or neutral (i.e., an everyday interaction), with someone with whom they have an ongoing relationship. The interview elicits details of the interaction (i.e., others involved, environment, feelings, thoughts), which were used to create a personalized 1-minute script of the interaction. To increase the saliency and duration of the mood induction, participants also read a series of 15 negative (i.e., “I just can’t seem to connect with people.”) or neutral (i.e., “Sometimes I hate how people treat me, but I know they mean well.”) (pending on condition) Velten statements (Göritz & Moser, 2006; Hepburn et al., 2006; Velten, 1968).

General Negative Mood Induction.

The Paced Auditory Serial Addition Task-Computerized Version (PASAT-C; Lejuez, Khler, & Brown, 2003) has been supported in its use to evoke negative mood (Gratz et al., 2010). Numbers are flashed sequentially on a computer screen and participants follow specific instructions about summing the numbers, which increases in difficulty as the task progresses; upon an incorrect response (or no response), an explosive sound is played. In the present study, the PASAT-C was used to induce general emotional distress (Brown et al., 2022). To increase the saliency and duration of the mood induction, participants read a series of 15 general negative Velten statements (Göritz & Moser, 2006; Hepburn et al., 2006; Velten, 1968) following the PASAT-C.

Procedures

Prior to study procedures, all participants provided informed consent. At Visit 1, participants completed the MEPS and SASII. At Visit 2 (approximately one week later), participants were randomly assigned to one of three mood induction conditions (i.e., interpersonal negative [n = 28], interpersonal neutral [n = 31], or general negative [n = 27]). Following the mood induction, participants completed the MEPS then the SAP. Prior to exiting the laboratory, participant distress was monitored and mood enhancing strategies were utilized as needed (Linehan, 1998). The study was carried out in accordance with the Declaration of Helsinki and was approved by the University IRB.

Results

Preliminary Analyses

Among those with an NSSI history, mean number of lifetime NSSI acts was 38.18 (SD = 56.02; Median = 15; Range = 2–200). Correlations between MEPS outcomes at Visits 1 and 2 ranged from −.06 to .65. Those with and without a history of NSSI did not differ on the MEPS at Visit 1, F (77,3) = .166, Wilks = .994, p = .92, Ƞ2 = .01. Each mood induction demonstrated the desired effect. In the interpersonal neutral condition, there were no significant changes in positive (p = .06) or negative (p = .18) affect. In both the interpersonal negative and general negative conditions, there was a significant decrease in positive affect (p = .002, p = .04, d’s = .20-.41, respectively) and increase in negative affect (p < .001, p = .04, d’s = .44-.61, respectively).

Aim 1

ANCOVAs were conducted to examine the main and interactive effects of NSSI history and mood induction condition on each MEPs outcome during Visit 2, controlling for Visit 1 MEPS performance. There was a significant main effect of NSSI history on MEPS problem solving effectiveness. There were no other significant main effects or interactions for any MEPS outcome (See Table 1).

Table 1.

Examining Differences in Interpersonal Problem-Solving Outcomes based on Nonsuicidal Self-Injury History and Mood Induction Condition During Visit 2

Model Description Model Results
F statistica p-value Ƞ2
Effectiveness
 NSSI History 4.93 .03 .06
 Mood Condition .39 .68 .01
 NSSI × Mood .33 .72 .01
Obstacles
 NSSI History 1.02 .32 .01
 Mood Condition 1.11 .33 .03
 NSSI × Mood 1.31 .28 .01
Alternatives
 NSSI History .71 .40 .01
 Mood Condition .52 .60 .01
 NSSI × Mood .21 .81 .01
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Note: NSSI = nonsuicidal self-injury; Effectiveness, Obstacles, and Alternatives = Means Ends Problem Solving task outcomes; Visit 1 Means Ends Problem Solving included as a covariate in all analyses;

a

= df for all models (2, 76)

Aim 2

The PROCESS macro (model 3; Hayes, 2012) was utilized to examine the three-way interactions between NSSI history, mood condition, and each of the three MEPS outcomes in predicting average shock on the SAP (three models total). Visit 1 MEPS performance was controlled for in all analyses (Table 2).

Table 2.

Examining Differences in Average Shock based on Nonsuicidal Self-Injury History, Mood Condition, and Interpersonal Problem-Solving Outcomes During Visit 2

Model Description Model Results
Coeffienta (SE) p 95% CI
Model 1: Effectiveness
 NSSI History −24.18 (9.95) .02 −44.01, −4.36
 Mood Condition −7.32 (4.37) .09 −16.02, 1.39
 Effectiveness −2.56 (1.25) .04 −5.05, −.07
 NSSI × Mood × Effectiveness −1.98 (.94) .03 −3.84, −.11
Model 2: Obstacles
 NSSI History −4.75 (4.98) .34 −14.68, 5.17
 Mood Condition −.36 (1.57) .82 −3.49, 2.78
 Obstacles −.07 (.87) .93 −1.64, 1.50
 NSSI × Mood × Obstacles −.26 (.52) .62 −1.31, .78
Model 3: Alternatives
 NSSI History −1.67 (4.22) .69 −10.07, 6.72
 Mood Condition −.07 (1.13) .95 −2.33, 2.18
 Alternatives .17 (.86) .84 −1.55, 1.90
 NSSI × Mood × Alternatives −.31 (.58) .59 −1.47, .85
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Note: NSSI = nonsuicidal self-injury; Effectiveness, Obstacles, and Alternatives = Means Ends Problem Solving task outcomes; Visit 1 Means Ends Problem Solving included as a covariate in all analyses;

a

= unstandardized regression coefficient

There was a significant main effect of NSSI history and MEPS effectiveness on average shock. Though the main effect of mood condition was non-significant, there was a significant three-way interaction in which the NSSI (vs. no NSSI) group selected greater self-shock at high levels of effectiveness in the interpersonal neutral condition (p = .03) and at low levels of effectiveness in the interpersonal negative condition (p = .04). See Figure 1. There were no significant main effects or three-way interactions for MEPS obstacles or alternatives.

Figure 1.

Figure 1

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Three-Way Interaction between Nonsuicidal Self-Injury, Mood Condition, and Effectiveness During Visit 2

Note: AvgShk = average shock on the self-aggressive paradigm; NSSI = nonsuicidal self-injury; Effectiveness = Means Ends Problem Solving task outcomes; Visit 1 Means Ends Problem Solving included as a covariate

Discussion

The current study aimed to provide a preliminary investigation of the relationship between interpersonal stress, interpersonal problem-solving, and NSSI behavior through an experimental study. The hypotheses were partially supported, with NSSI group differences emerging for interpersonal problem-solving effectiveness and the combination of NSSI history, mood induction and interpersonal problem-solving effectiveness predicting acute self-harm on an NSSI laboratory analogue.

In the interpersonal negative mood condition, individuals with a NSSI history who produced solutions to interpersonal problems that were low on effectiveness, were more likely to select a higher level of shock on the laboratory paradigm. This finding supports the study hypothesis; it was anticipated that, when experiencing interpersonal stress, one’s ability to handle interpersonal situations may increase the propensity to engage in self-injury. While the current results must be interpreted with caution and considered preliminary given the small sample size, it is worth considering a few explanations for this finding. Specifically, as individuals report engaging in NSSI for both intrapersonal (i.e., affect regulation) and interpersonal (i.e., social communication) reasons (Klonsky & Glenn, 2009; Taylor et al., 2018), specific motivations may be activated in the context of interpersonally-focuses or a general negative mood. For example, it may be that producing less effective solutions to interpersonal problems may further elevate negative affect (due to lack of resolution of the conflict), further reinforcing the use of NSSI as an emotion regulation strategy. It could also be that as an individual has difficulty resolving an interpersonal scenario, there may be an increased need to effectively communicate their needs or distress, supporting the use of NSSI as a means of social communication (Klonsky & Glenn, 2009).

Interestingly, in the interpersonal neutral mood condition, individuals with a history of NSSI who produced highly effective interpersonal strategies were also more likely to select higher levels of shock. It is possible that this reflects a general propensity of those with a history of NSSI to select a higher level of shock. Alternatively, this finding may be interpreted as individuals without a history of NSSI being likely to select higher shocks when producing solutions that were low on effectiveness. It is possible this is driven by the frustrating, and inherently social, nature of the laboratory task, which may have differentially impacted those not in a negative mood induction condition (i.e., not already distressed) and those who had poorer interpersonal problem-solving skills. However, this latter explanation would have predicted a similar pattern among participants in the interpersonal neutral condition with a history of NSSI. It will be important for future research to disentangle this relationship between interpersonal neutral mood inductions and self-harm propensity in a larger sample.

The only significant three-way interaction emerged for the interpersonal problem-solving outcome of effectiveness. While hard to speculate based on the current design, it may be that interpersonal problem-solving effectiveness is a driving factor in the relationship between interpersonal stress and NSSI. Of the problem-solving abilities examined in this study, effectiveness may most impact an interpersonal problem in the moment. While identifying alternative solutions or potential obstacles to a problem may be beneficial in the long-term, this may not directly impact how individuals cope with an interpersonal stressor in moments of elevated distress. This finding is in contrast to prior research that found individuals with and without a history of NSSI both developed fewer solutions to an interpersonal problem following a general stressor as compared to when in a neutral state (Nock & Mendes, 2008). It is possible that the current findings highlight processes that are specific to interpersonal stressors as compared to general distress. However, as the interpersonal problem-solving outcomes examined in the present and previous studies differed slightly, it will be important to determine if these contrasting results are due to the type of stressor utilized or the outcome assessed.

The present findings should be interpreted in light of the study’s limitations. This study intends only to be preliminary in nature, serving as pilot work for future research in this arena. Thus, the overall sample size and number of participants per experimental cell were limited. Participants were also included in this study based on a repeated lifetime history of NSSI, highlighting the need to replicate findings among individuals with a more severe and recent NSSI history, such as detailed by the Diagnostic Statistical Manual – 5 for NSSI disorder (American Psychiatric Association, 2013). Finally, the present study was unable to examine important mechanisms of the found relationships, such as emotion dysregulation or pain analgesia, that may help further elucidate processes underlying NSSI behavior. It is possible that a different pattern of results may emerge if extended to a larger, more clinically severe sample.

Despite these limitations, the present study offers initial findings that shed light on the role of interpersonal stress and interpersonal problem-solving in NSSI engagement. Future studies should aim to replicate the current findings in larger, more diverse samples of individuals with a recent history of NSSI. If supported, these results point to interpersonal problem-solving abilities and skills targeting effectively navigating interpersonal situations, such as those in Dialectical Behavior Therapy, as particularly important in intervention efforts aimed to reduce NSSI behaviors.

Acknowledgements:

This project was funded by NIMH 1F311MH107156-01A1 awarded to Brooke A. Ammerman.

Footnotes

Author Statement

BAA was responsible for Conceptualization; Data curation; Formal analysis; Visualization; Writing the Original Draft; Reviewing & Editing; and Funding acquisition. KMS, MKF, and AAP were responsible for Data curation; Reviewing & Editing. MSM was responsible for Conceptualization; Reviewing & Editing; Supervision; and Funding acquisition.

Conflicts of Interest

The authors have no conflicts of interest to disclose.

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References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). [Google Scholar]
  2. Berman ME, & Walley J. (2003). Imitation of Self-Aggressive Behavior: An Experimental Test of the Contagion Hypothesis1. Journal of Applied Social Psychology, 33, 1036–1057. [Google Scholar]
  3. Brown RA, Lejuez CW, Kahler CW, & Strong D. (2002). Distress tolerance and duration of past smoking cessation attempts. Journal of Abnormal Psychology, 111, 180–185. [PubMed] [Google Scholar]
  4. Cawley R, Pontin EE, Touhey J, Sheehy K, & Taylor PJ (2019). What is the relationship between rejection and self-harm or suicidality in adulthood?. Journal of Affective Disorders, 242, 123–134. [DOI] [PubMed] [Google Scholar]
  5. First MB (2014). Structured clinical interview for the DSM (SCID). The Encyclopedia of Clinical Ssychology, 1–6. [Google Scholar]
  6. Fox KR., Franklin JC., Ribeiro JD., Kleiman EM., Bentley KH., & Nock MK. (2015). Meta-analysis of risk factors for nonsuicidal self-injury. Clinical Psychology Review, 42, 156–167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Göritz AS, & Moser K. (2006). Web-based mood induction. Cognition and Emotion, 20, 887–896. [Google Scholar]
  8. Gratz KL, Hepworth C, Tull MT, Paulson A, Clarke S, Remington B, & Lejuez CW (2011). An experimental investigation of emotional willingness and physical pain tolerance in deliberate self-harm: The moderating role of interpersonal distress. Comprehensive Psychiatry, 52, 63–74. [DOI] [PubMed] [Google Scholar]
  9. Gratz KL, Rosenthal MZ, Tull MT, Lejuez CW, & Gunderson JG (2010). An experimental investigation of emotional reactivity and delayed emotional recovery in borderline personality disorder: The role of shame. Comprehensive Psychiatry, 51, 275285. [DOI] [PubMed] [Google Scholar]
  10. Gratz KL (2007). Targeting emotion dysregulation in the treatment of self-injury. Journal of Clinical Psychology, 63, 1091–1103. [DOI] [PubMed] [Google Scholar]
  11. Hasking P., Whitlock J., Voon D., & Rose A. (2017). A cognitive-emotional model of NSSI: Using emotion regulation and cognitive processes to explain why people self-injure. Cognition and Emotion, 31, 1543–1556. [DOI] [PubMed] [Google Scholar]
  12. Hayes AF (2012). My macros and code for SPSS and SAS. URL: http://afhayes.com/spss-sas-andmplus-macros-and-code.html.
  13. Hepburn SR, Barnhofer T, & Williams JMG (2006). Effects of mood on how future events are generated and perceived. Personality and Individual Differences, 41, 801–811. [Google Scholar]
  14. Velten E Jr (1968). A laboratory task for induction of mood states. Behaviour Research and Therapy, 6, 473–482. [DOI] [PubMed] [Google Scholar]
  15. Hepp J, Carpenter RW, Störkel LM, Schmitz SE, Schmahl C, & Niedtfeld I. (2020). A systematic review of daily life studies on non-suicidal self-injury based on the four-function model. Clinical Psychology Review, 101888. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. International Society for the Study of Self-Injury (2020). About Self-Injury. Retrieved from: https://itriples.org/category/about-self-injury/.
  17. Kiekens G, Hasking P, Claes L, Boyes M, Mortier P, Auerbach RP, ... & Myin-Germeys I. (2019). Predicting the incidence of non-suicidal self-injury in college students. European psychiatry, 59, 44–51. [DOI] [PubMed] [Google Scholar]
  18. Lang PJ, & Cuthbert BN (1984). Affective information processing and the assessment of anxiety. Journal of Behavior Assessment, 6, 369–395. [DOI] [PubMed] [Google Scholar]
  19. Levin DN, Cook EW, & Lang PJ (1982). Fear imagery and fear behavior: psychophysiological analysis of clients receiving treatment for anxiety disorders. Psychophysiology, 19, 571–572. [Google Scholar]
  20. Lejuez CW, Kahler CW, & Brown RA (2003). A modified computer version of the Paced Auditory Serial Addition Task (PASAT) as a laboratory-based stressor. Behavior Therapy, 23, 290–293. [Google Scholar]
  21. Linehan MM., Comtois KA., Brown MZ., Heard HL., & Wagner A. (2006). Suicide Attempt Self-Injury Interview (SASII): development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury. Psychological Assessment, 18, 303–312. [DOI] [PubMed] [Google Scholar]
  22. Linehan MM (1998). University of Washington risk assessment protocol. Unpublished instrument. University of Washington, Seattle. [Google Scholar]
  23. McCloskey MS, & Berman ME (2003). Alcohol intoxication and self-aggressive behavior. Journal of Abnormal Psychology, 112, 306. [DOI] [PubMed] [Google Scholar]
  24. Nock MK, & Mendes WB (2008). Physiological arousal, distress tolerance, and social problem-solving deficits among adolescent self-injurers. Journal of Consulting and Clinical Psychology, 76, 28–38. [DOI] [PubMed] [Google Scholar]
  25. Platt JJ, Spivack G, & Bloom W. (1975). Manual for the Means-End Problem-Solving Procedures (MEPS) :A measure of interpersonal problem-solving skill. Hahnemann Medical College and Hospital, Department of Mental Health Sciences: Philadelphia, PA. [Google Scholar]
  26. Plener PL, Schumacher TS, Munz LM, & Groschwitz RC (2015). The longitudinal course of non-suicidal self-injury and deliberate self-harm: a systematic review of the literature. Borderline Personality Disorder and Emotion Dysregulation, 2(1), 2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Pollock LR, & Williams JMG (2004). Problem-solving in suicide attempters. Psychological Medicine, 34, 163–167 [DOI] [PubMed] [Google Scholar]
  28. Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, ... & Thase ME (2003). The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry, 54, 573–583. [DOI] [PubMed] [Google Scholar]
  29. Schotte DE, & Clum GA (1987). Problem-solving skills in suicidal psychiatric patients. Journal of Consulting and Clinical Psychology, 55(1), 49–54. [DOI] [PubMed] [Google Scholar]
  30. Taylor PJ., Jomar K., Dhingra K., Forrester R., Shahmalak U., & Dickson JM. (2018). A meta-analysis of the prevalence of different functions of non-suicidal self-injury. Journal of Affective Disorders, 227, 759–769. [DOI] [PubMed] [Google Scholar]
  31. Turner BJ, Cobb RJ, Gratz KL, & Chapman AL (2016). The role of interpersonal conflict and perceived social support in nonsuicidal self-injury in daily life. Journal of Abnormal Psychology, 125, 588. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Watson D, Clark LA, & Tellegen A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070. [DOI] [PubMed] [Google Scholar]
  33. Victor SE, Scott LN, Stepp SD, & Goldstein TR (2019). I Want You to Want Me: Interpersonal Stress and Affective Experiences as Within-Person Predictors of Nonsuicidal Self-Injury and Suicide Urges in Daily Life. Suicide and Life-Threatening Behavior, 49, 1157–1177. [DOI] [PMC free article] [PubMed] [Google Scholar]

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