Psychiatry · Medical Literature
The effect of mindfulness-based cognitive therapy on non-suicidal self-injury in hospitalized adolescents with depressive disorders: a randomized controlled trial.
Abstract
Nonsuicidal self-injury (NSSI) in adolescents with depressive disorder is characterized by recurrent impulsivity and is a predictor of future suicidal behavior, necessitating effective and feasible interventions. Mindfulness-based cognitive therapy for adolescents (MBCT-A), a first-line treatment for depression, was evaluated in this trial for its efficacy in reducing NSSI in this population. In this randomized, single-blind, controlled trial, 94 hospitalized adolescents diagnosed with depressive disorder and engaging in NSSI were allocated to either MBCT-A plus treatment-as-usual (TAU) or TAU alone. The primary outcome was the severity of NSSI, measured by the Adolescent Self-Harm Scale (ASHS) at baseline, post treatment (4 weeks), and at 1-month follow-up. Secondary outcomes encompassed symptoms of anxiety, depression, emotion regulation, risk behaviors, life satisfaction, resilience, rumination, coping styles, and mindfulness. Both intention-to-treat (ITT) and per-protocol (PP) analyses were conducted. Both ITT and PP analyses revealed significant between-group differences in NSSI severity at 4 weeks. Compared to the control group, the MBCT-A group showed significant improvements in mindfulness awareness, nonreactivity, emotional awareness, depressive symptoms, emotion regulation, and rumination (all P < 0.05). At the 1-month follow-up, the intervention group maintained a significant reduction in NSSI severity (interaction effect: F = 9.454, P < 0.001). MBCT-A is effective in reducing NSSI behavior and improving mindfulness, emotion regulation, and depressive symptoms among adolescents with depressive disorder and NSSI. These findings support the clinical application of MBCT-A for this high-risk population.
Clinical relevance
Nonsuicidal self-injury (NSSI) in adolescents with depressive disorder represents a high-risk, recurrent behavioral pattern and a well-established predictor of future suicidal behavior, yet evidence-based inpatient interventions remain limited. This RCT directly addresses this gap by evaluating Mindfulness-Based Cognitive Therapy for Adolescents (MBCT-A) as an adjunct to treatment-as-usual (TAU) in a hospitalized psychiatric population—a setting where feasible, structured psychotherapeutic options are critically needed. Clinicians managing inpatient adolescent psychiatry should attend to these findings given the dual burden of depressive disorder and NSSI and the current scarcity of validated intervention protocols for this cohort.
Key findings
1. Study design: 94 hospitalized adolescents with depressive disorder and active NSSI were randomized (single-blind RCT) to MBCT-A plus TAU versus TAU alone, with assessments at baseline, 4 weeks (post-treatment), and 1-month follow-up. 2. Primary outcome — NSSI severity: Both intention-to-treat (ITT) and per-protocol (PP) analyses demonstrated statistically significant between-group reductions in NSSI severity (measured by the Adolescent Self-Harm Scale, ASHS) at 4 weeks in favor of MBCT-A plus TAU. 3. Durability of NSSI reduction: The reduction in NSSI severity was maintained at 1-month follow-up, with a significant time-by-group interaction effect (F = 9.454, P < 0.001), indicating sustained benefit beyond the active treatment period. 4. Mindfulness and emotional outcomes: The MBCT-A group showed significant improvements in mindfulness awareness and nonreactivity, and emotional awareness compared to controls (all P < 0.05). 5. Psychiatric symptom outcomes: Significant between-group improvements were observed in depressive symptoms, emotion regulation, and rumination in the MBCT-A group versus TAU alone (all P < 0.05). 6. Limitation — effect sizes not reported: Precise effect sizes (Cohen's d), confidence intervals, NNT, or NNH were not provided in the abstract, limiting quantitative benchmarking against existing interventions.
Practice implications
Inpatient adolescent psychiatry units should consider integrating a structured 4-week MBCT-A protocol as an adjunct to TAU for hospitalized adolescents diagnosed with depressive disorder who present with active NSSI, given demonstrated efficacy on both self-injury severity and key mechanistic targets (emotion regulation, rumination, mindfulness). Patient selection should prioritize this intervention for adolescents with recurrent NSSI in the context of depressive disorder, with particular attention to post-discharge follow-up, as the 1-month maintenance of benefit suggests MBCT-A may confer protective effects into the transition period. Clinicians should monitor NSSI frequency and severity, depressive symptoms, and emotion regulation capacity as outcome benchmarks, and advocate for training of inpatient therapy staff in MBCT-A delivery to support programmatic implementation.