Optimizing outcome and improving accessibility to psychological treatment for adolescent self-injury: randomized controlled trial

Self-injury is a growing health crisis among youth, and the strongest risk factor for suicide attempts. Scalable treatments are needed but lacking.

We have recently shown that a brief digital treatment, IERITA (Internet-delivered Emotion Regulation Individual Therapy for Adolescents), can be efficacious and cost-effective. However, not all patients respond sufficiently to the standard treatment procedure. Now we aim to implement and evaluate IERITA within regular health services and optimize treatment outcomes.

First, we will develop and validate a classification tool to predict non-remission (continued self-injury after treatment).

This tool will subsequently be used in the second step: a randomized controlled trial (N=341) between 2025 to 2028, which compares adaptable to standard IERITA.

Adolescents allocated to adaptable IERITA and classified as likely non-remission in treatment week four will recieve adapted IERITA (e.g., personalized dose and treatment delivery) for the remaining eight weeks.

We will (1) follow participants one- three- and twelve-month post-treatment; (2) use self-reports and blinded assessments; (3) study distal effects in national registers; (4) investigate several clinically relevant outcomes; and (5) conduct cost-effectiveness analyses.

If successful, more patients could receive evidence-based treatment for self-injury, and treatment outcomes could be improved. In extension, queues to care may be reduced, and suicide attempts and suicides prevented.