Self-help

If you want to stop harming yourself you need to find other ways of expressing or coping with your feelings. In order to do this you need to seriously think about why you self-harm. Many people don't know why they harm themselves so it may be useful to consider:

  • What was happening in my life when I harmed myself?
  • How do I feel just before I hurt myself?
  • Am I always in the same place or with a particular person?
  • Have I any bad memories or thoughts that I can't tell to anyone?

When you feel anxious or upset, doing something you enjoy or trying to think about other things can be a way to help you stop hurting yourself. You could try:

  • Speaking to a family member or friend
  • Phoning Breathing Space
  • Structuring your day so that you do not spend long periods on your own
  • Writing down your feelings in a diary
  • Going for a walk or a run, dancing, exercising or playing sport
  • Making time for activities that you enjoy and make you feel good about yourself, such as spending time with friends, listening to music or having a meal
  • Doing calming activities such as yoga or relaxation exercises or having a scented bath.

Self management skills

Self management skills includes a whole array of skills and techniques that individuals can employ to help themselves cope in the face of strong negative emotions or great distress. These skills and techniques include stress and anxiety management, anger management, relaxation techniques, social skills training and problem-solving skills. These skills are usually taught by trained counsellors and psychologists.

  • Anger management skills
    These help individuals recognise the trigger points that arouse unpleasant emotions in them and teach them how to deal with the emotions before they become impulsive and destructive
  • Social skills and assertive training
    These teach individuals how to be more assertive and to say "no" to negative peer pressures and influences
  • Relaxation skills
    These help individuals cope with situational stresses through the use of deep breathing exercises, imagery techniques, progressive muscle relaxation as well as distractions. Meditation, listening to music, reading, writing poems, drawing, singing and other creative methods can sometimes allow individuals to represent their feelings through other means without harming themselves.

If you still want to hurt yourself – You could try some other coping strategies that have proved useful to others such as:

  • Finding a safe "punch bag" like cushions or pillows
  • Putting your hands into a bowl of ice cubes for a short time or rubbing ice on the part of your body you feel like injuring
  • Using a red felt tip marker or lipstick to mark your body instead of cutting
  • Putting a rubber band around your wrist and flicking it
  • Putting sticking plasters on the parts of your body you want to injure.

Trying to stop yourself from self-harming can be really difficult. It will take time, patience and high levels of motivation and there are likely to be some ups and downs. Sometimes, however hard you try on your own, you just can't cope with your feelings.

You may wish to get help.

Sources of help

Deciding to get help is not an easy decision but one which only you can make. Remember, however, that you are not alone and that many other people who have experienced the same problems as you have made the same decision – and as a result many have been helped to stop self-harming.

You could start by talking to someone that you feel confident with and trust. This could be a partner, parent, other relative, friend, colleague, school nurse, teacher, social worker, school / college / university counsellor or youth worker.

Sometimes it's easier to talk to someone you don't know – especially if they've been trained to help. There are many sources of help of which the following are some:

  • Family doctor
    Your family doctor is always a good starting point and he/she may refer you to a community mental health team or to the child and adolescent mental health services as appropriate. Here you'll be able to see professionals who can help in different ways.
  • Minister/Priest
  • Community Mental Health Team [CMHT]
    A CMHT will normally include:
    • Psychologists are qualified to assist you to talk through and understand difficult problems. They can help you deal with the issues that are causing you to hurt yoursel.
    • Community psychiatric nurses can offer you support and practical advice at difficult moments as you work through the process of beginning to stop harming yourself
    • Psychiatrists are doctors who may talk to you about your problems or who can also prescribe drugs like anti-depressants which may be helpful in the short term.
  • Child and Adolescent Mental Health Services (CAMHS)
    Provide a wide range of services that offer help, support and treatment to children and young people up to the age of 18. Like Community Mental Health Teams they have different specialist staff who can help with lots of different emotional and mental health problems.

Some of these services are based in GP surgeries, health centres or hospitals. Others are based in schools, colleges and universities or in youth centres, drop-in centres for young people and counselling services. Local health services have different arrangements for the way their teams work. In some places you may be able to talk through your problems with a specially trained nurse. If your local team can't provide the help you need then ask for an assessment by a specialist service.

Traditional therapies

Counselling and psychotherapy

'Counselling and Psychotherapy are ways of responding to a wide range of human needs and provide opportunities for those seeking help to work towards living in more satisfying and resourceful ways.'

COSCA: Counselling and Psychotherapy in Scotland www.cosca.org.uk.

In making the decision to undertake counselling you are entering into a relationship which will afford you a period of non-judgmental listening when you will be heard by the counsellor who will journey with you as you attempt to unpack whatever issue or problem you feel you have to discuss. You should be able to talk freely and comfortably about problems without feeling judged.

What you will receive in counselling are qualities which are often described as the 'Core Conditions' namely Acceptance, Genuineness and Empathy. These qualities are necessary to create a safe environment for you to talk about any problems you are finding hard to resolve.

  • The counsellor, in providing acceptance or unconditional positive regard, provides an environment where your feelings, experiences and values are respected. You will not be judged or criticised because of your own attitudes or beliefs
  • In being afforded genuineness the counselor is demonstrating that they will be honest and open with you and will not present an outward appearance of one attitude while actually holding another
  • Empathy is the ability to let the person know that you have truly heard what they are saying. It is not the same as sympathy as that is about feeling sorry for a person. You will experience the counsellor as having really understood what you are putting across.

At the first meeting the counsellor will hear what you want from counselling and talk about regularity of appointments and what he or she will expect of you. You also, at this first meeting, can discuss with the counsellor what you expect from counselling. Normally you will be given one appointment per week and each session will last for one hour.

It is important for you to know that your counsellor will be bound by a Code of Practice and Ethics, normally by COSCA or The British Association of Counselling and Psychotherapy (BACP). The counsellor will also be supervised by an approved/accredited Supervisor.

For more details on Counselling and Psychotherapy contact:

COSCA: Counselling and Psychotherapy in Scotland www.cosca.org.uk

British Association of Counselling and Psychotherapy (BACP) www.bacp.co.uk

Cognitive Behaviour Therapy (CBT)

CBT is a form of counselling which involves learning to overcome distorted negative thinking patterns that can lead to depression.

Therapists may use techniques which enable the depressed person to do more things that give them pleasure; helping them to solve problems in their life; and learning better social skills.

  • How does CBT work?
    • People who are depressed have distorted thinking patterns. They see themselves and their situations more negatively than others. These thinking patterns make their depressed mood worse.
    • In CBT, distorted thinking is challenged by the therapist who teaches the person to overcome their negative thinking patterns in everyday life.
  • Is CBT effective?
    • There are studies showing that people with mild or moderate depression recover more quickly if they are treated with CBT.
    • CBT is as effective as antidepressant drugs.
    • Unlike antidepressant drugs, CBT works as well for adolescents as adults.
    • An advantage of CBT is that it helps people learn skills that may prevent them from becoming depressed in the future.
    • CBT is not suitable for severely depressed peole as they are too depressed to learn new thinking skills.
    • However, once they have begu to recover with medical treatment CBT may be helpful.

The way we think can effect how we feel!

'It is not things in themselves which trouble us, but opinions we have about these things'

Epictetus

  • Life's experience can develop our thinking habits and belief systems.
  • The meaning we place on our experiences can influence how we feel and behave.
  • Unrealistic thinking can cause and /or maintain distressing feelings.

Ten common types of thinking distortions that make coping more difficult:

 

  1. Black and white thinking –all our nothing.
  2. Setting unrealistic expectations –living by fixed rules.
  3. Selective thinking –looking on the dark side.
  4. Converting positive into negatives –being a cynic.
  5. Overgeneralising –here we go again.
  6. Magnifying unpleasantness –making mountains out of molehills.
  7. Castastrophising –whatever can go wrong will go wrong.
  8. Personalising –it is all my fault.
  9. Mistaking feelings for facts –I feel therefore I am.
  10. Jumping to negative conclusions.

 

Dialectical Behavioral Therapy (DBT)

DBT is a form of therapy that is useful for individuals who self harm repeatedly due to borderline personality disorder. Individuals undergoing DBT attend both weekly individual sessions and group therapy. DBT also explores the pros and cons of tolerating distress and in doing so, helps the individual make a decision not to harm himself. It also advocates taking measures to reduce vulnerability to negative emotions so that one is less likely to be overwhelmed by emotions. These measures include taking care of one's basic needs of nutrition and self-care, and getting enough sleep.

Other Psychotherapies


Psychodynamic therapy

This is a form of psychotherapy developed by Sigmund Freud, the "father of psychoanalysis". Believing that one's childhood has a direct effect on the person's emotional and mental health, Freud used interviewing methods to retrace and relive the person's emotional life from early infancy. Some individuals who self-harm may need more in-depth therapy to explore deeper issues such as sexual abuse and trauma that date back to early childhood.

Interpersonal group therapy

This form of therapy takes place in a group setting. There is two-sided commentary by both the therapist and individuals in the group. There is a lot of reiteration and paraphrasing of statements, reflecting on doubts and confusion, answering enquiries and offering supportive statements.

Rational-emotive behaviour therapy

The concept behind this is that thought control feelings. Individuals are thus taught how to rethink their situations and learn how to control negative feelings. Self-harmers are taught to:

  • Examine and study their beliefs, feelings and actions.
  • Come up with positive counter statements to dispute and challenge their wrong beliefs.
  • Set realistic goals.
  • Put up constructive options.
  • Review the results when the option is put into practice.

Family therapy

The intention of family therapy is to bring about a change in the attitudes of each family member and propel each member to think about what he or she can do about the problem. Very rarely would individuals who self-harm require alternative care in residential homes or hostels.

Support group

Groups enable people to share their thoughts and feelings with others who have had similar experiences and to support each other to find new ways of coping. Groups can also be very helpful in overcoming people's feelings of shame and isolation.

Creative arts therapies

These often provide a good way of expressing feelings that are too difficult or painful to talk about.

Practical help

Over matters such as benefits, accommodation, training or employment. This can be important to help people find a way out of a damaging situation (such as a relationship with an abusive partner) or get back on their feet.

CG16 Self-harm – Quick reference guide

Medical help

Medical help for those who self-harm will normally be related to the underlying mental health condition of the individual. Whilst the focus here is on anti-depressant medication, other drugs may be prescribed.

Selective Serotonin Reuptake Inhibitors (SSRIs) affect chemicals in the brain that may become unbalanced and cause depression, panic or anxiety, or obsessive or compulsive symptoms. SSRIs are used to treat depression, obsessive-compulsive disorder, panic disorder, generalised anxiety disorder, social anxiety disorder (social phobia), post traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD). SSRIs may also be used for purposes other than those listed in this medication guide. These include:

  • Paxil (paroxetine)
  • Prozac (fluoxetine)
  • Zoloft (sertraline)
  • Celexa (citalopram)
  • Lexapro (escitalopram oxalate)
  • Luvox (fluvoxamine).

Tricyclic anti-depressants affect chemicals in the brain that may become unbalanced and cause depression. Tricyclic anti-depressants are used to relieve symptoms of depression and anxiety such as feelings of sadness, worthlessness, guilt; loss of interest in daily activities, changes in appetite, tiredness, insomnia/hypersomnia, and thoughts of death and suicide. These include:

  • Adapin (doxepin)
  • Anafranil (clomipramine)
  • Elavil (amitriptyline)
  • Endep (amitriptyline)
  • Ludiomil (maprotiline)
  • Norpramin (desipramine)
  • Pamelor (nortryptyline)
  • Pertofrane (desipramine)
  • Sinequan (doxepin)
  • Surmontil (trimipramine)
  • Tofranil (imipramine)
  • Vivactil (protriptyline).

Monoamine Oxidase Inhibitors (MAOIs) are used to relieve certain types of mental depression. They work by blocking the action of a chemical substance known as monoamine oxidase. Although these medicines are very effective for certain patients, they may also cause some unwanted reactions if not taken in the right way. It is very important to avoid certain foods, beverages, and medicines while you are being treated with an MAOI. Your health care professional will help you obtain a list to carry in your wallet or purse as a reminder of which products you should avoid. These include:

  • Nardil (phenelzine)
  • Parnate (tranylcypromine).

New anti-depressants

  • Effexor (venlafaxine)
  • Cymbalta (duloxetine)
  • Desyrel (trazodone)
  • Buspar (buspirone)
  • Edronax, Vestra (reboxetine)
  • Remeron (mirtazapine)
  • Serzone (nefazodone)
  • Wellbutrin (bupropion).

Note: Effexor is one of the "newer" antidepressants which likewise SSRI's have much less side effects than TCA's or MOAI's (not as sedating, less anticholinergic side effects, safe in overdose).

First aid

If you do not wish anyone to find out about your self-harming, knowledge of first aid can be useful. The purpose of giving this information is to promote safety rather than encouraging self-harming behaviour to continue. This section is aimed to keep people as safe as possible until they want to/are able to stop.

Self-harm can take different forms therefore there are different aspects of first aid to be covered. The treatment for burns is different to that of abrasions, cuts and scratches.

Cuts and scratches

Cutting is a common form of self-injury and taking care of cuts so that they don't become infected is important.

  • Clean the area thoroughly with warm water and soap
  • Carefully wash away any dirt that could be present
  • Apply pressure directly onto the wound until it stops bleeding
  • Bandage up the wound using clean, dry bandages
  • If the cut is very deep medical advice may be needed and it will be necessary to get assistance as quickly as possible.

Scratching is also a common means of self-harm.

  • Wash the area thoroughly with soap and warm water, washing away any dirt present
  • If it bleeds or oozes, bandage it. This is to protect it from infection.

Infected wounds

The following signs around the wound are an indication that it has become infected:

  • Pain
  • Redness
  • Swelling.

If this happens it is important that medical assistance is obtained as soon as possible.

Bleeding from a cut

It is important to stop the bleeding as soon as possible as too much blood loss can be dangerous.

  1. Apply Pressure
    • Apply direct pressure onto the wound
    • Use a clean cloth to apply this pressure
    • If blood soaks through the cloth do not remove it, but add another cloth on top of it
    • Continue to apply pressure for 7-10 minutes until the bleeding stops.
  2. Elevate the injured part
    • Elevate the injured part if possible so that it is above heart level, and continue applying pressure.
  3. Use pressure points
    • In the event that steps 1 and 2 do not work then apply pressure to the pressure points nearest the injury

      Arm: it is located on the upper part of the arm

      Leg: it is located in the creases in the upper leg

      Apply pressure to the artery between the bone directly behind it and your finger (or the palm of your hand if it is on the leg).

Burns

There are different degrees of burns and these each need to be treated in their own way. They also each have their own characteristics as to how they look and feel. However, there are some things that are valid for all types of burns:

Never put butter or any greasy ointments or creams onto a burn. These seal the heat into the wound and may cause infection to occur.

If the area of the burn is extensive and covers more than one part of the body seek medical attention.

First degree burns

First degree burns damage the outer layer of the skin. The characteristics of first degree burns are as follows:

  • Redness to the area burned
  • A mild pain on the area
  • Swelling around and on the burned area.
Treating first degree burns

 

  • Cover the whole of the affected area in cold water. Keep it under cold running water if possible.

OR

  • Place cold, wet, clean, clothes on it until the pain goes down.
  • Cover the burn with a clean, dry gauze dressing to protect it.
  • Do remember to change the dressing to keep the wound clean and free of infection.

 

Second degree burns

Second degree burns are burns, which go through the second layer of skin. The characteristics of second degree burns are as follows:

  • Blisters
  • Rough, red skin
  • Swelling
  • Extremely painful.
Treating second degree burns
  • Cover the whole of the affected area in cold water
  • Place cold, wet, clean, towels or clothes on it
  • Gently dry the area by dabbing not rubbing
  • Cover the wound with a dry, clean bandage
  • If the burn is on an arm or leg, keep it elevated as much as is possible.

Second degree burns should heal within a few weeks. If there are any complications such as infection or a failure to heal get medical assistance as soon as possible.

Third degree burns

Whilst third degree burns are less painful due to nerve cell damage the burns are deeper and more serious.

The characteristic of a third degree burn is as follows:

  • A white or charred appearance over the burned area.
Treating third degree burns
  • DON'T remove any clothing near or on the burn
  • DON'T apply cold water or medication to the burn
  • Cover the affected area with clean, dry cloths (e.g. strips of a clean sheet)
  • If burns are on arms or legs, keep the limbs elevated above the level of the heart.

Get medical help immediately

Don't worry about questions as their main concern is getting the burn treated properly. They will have seen burns similar before and they know how to treat it correctly, which is very important with such burns so that infection does not occur. If it is left untreated serious problems WILL occur, which will in turn cause more problems.

Contacts

Use the contacts below for help or to find out more information. Alternatively, if you need someone to talk to about how you're feeling, call Breathing Space on 0800 83 85 87 between 6pm and 2am. Remember your call is confidential and free.

  • Samaritans To speak to a Samaritan volunteer call 08457 90 90 90 anytime day or night. Calls on this number are automatically sent to the nearest free line, which could be your local branch or another branch in Scotland. jo@samaritans.org
    www.samaritans.org
  • Childline Childline is the free helpline for children and young people in the UK. Children and young people can call on 0800 1111 to talk about any problem – counsellors are always there to help you sort it out. www.childline.org.uk
  • NHS 24 You're not feeling well, it's the middle of the night, you can't wait until your GP's surgery opens in the morning – what can you do? Call NHS 24 on 08454 24 24 24. www.nhs24.com
  • Young People and Self-harm The Young People and Self-harm website provides information for young people who self-harm or self-injure. It includes sources of help, support, advice, local services, organisations, publications, research projects and professional training. www.selfharm.org.uk
  • Depression Alliance Scotland The Depression Alliance Scotland provide useful information and advice regarding all aspects of depression. They can be reached on their website. www.depressionalliancescotland.org

If you need help right now, visit the Immediate Help page.

Anyone can get depressed - Want to turn things around? Phone Breathing Space - 0800 83 85 87