Emotion Regulation Dysfunctions in NSSI Adolescents in Naturalistic Contexts

Study Overview
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Brief Summary
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Nonsuicidal self-injury (NSSI) is defined as direct, deliberate bodily harm without suicidal intention. Recent studies indicate that prevalence rates are increasing worldwide, in particular under adolescents, indicating a growing public health issue. An impaired ability to regulate negative emotion has been suggested to play a potential role in NSSI behavior. Some recent interventions aim at improving dysfunctional emotion regulation via 'acceptance'. Acceptance represents an objective, nonreactive, nonjudgmental, and calming emotion regulation strategy, partly based on the philosophy of dialectical behavior therapy (DBT) that has been widely used in the clinical treatment of NSSI behaviors. The aim of the present functional magnetic resonance imaging (fMRI) study is to examine whether adolescents with NSSI can implement the acceptance strategy in naturalistic emotional contexts (immersive video clips) and whether they differ from healthy controls in terms of behavioral and neural effects. To this end, the investigators recruit one group of NSSI adolescents (n=40) and one healthy control group (n=40), to compare the subjective emotional experience as well as underlying neural activity as measured by blood oxygenation level-dependent (BOLD) fMRI. The investigators hypothesize that compared to HC, NSSI adolescents will experience stronger negative emotions and show dysregulated neural recruitment of brain systems engaged in emotional reactivity and regulations (e.g. limbic regions, default mode network, and frontal regions).

Official Title
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Altered Neural Activation Patterns During Emotion Regulation in Adolescents With Nonsuicidal Self-Injury Under Naturalistic Immersive Emotional Engagement

Conditions
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Nonsuicidal Self Injury, Emotion Regulation

Intervention / Treatment
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* Behavioral: Acceptance mindset


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 15-18 years right-handed normal or corrected normal visual acuity meet the proposed DSM-5 frequency criteria (e.g., ≥5 days of NSSI behaviors in the past year) Exclusion Criteria: diagnosis of borderline personality disorder, major depressive disorder, other psychiatric disorders, etc. high suicidal risk recent use of medications that can affect neural activity have received or are receiving Dialectical Behavior Therapy (DBT) other treatment for emotional problems within the past 6 months have a contraindication to MRI scanning (e.g., metal implants, claustrophobia or other conditions that make them inappropriate for MRI scanning)

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| NSSI<br> | Behavioral: Acceptance mindset<br>* Brief training of acceptance versus emotional reactivity as emotion regulation strategy.<br>|
| HC<br> | Behavioral: Acceptance mindset<br>* Brief training of acceptance versus emotional reactivity as emotion regulation strategy.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Negative subjective emotional experience as indexed by self-report | Subjects will rate their negative affect on a scale ranging from 1-9 in response to neutral and negative emotional stimuli during normal experience or acceptance. Alterations in the patients will be determined by using ANOVA models with the group (NSSI vs. HC) as a between-subject factor and emotion regulation condition as a within-subject factor. | About 30 minutes | 
| Neural activity as indexed by BOLD fMRI | Brain activity will be monitored by task-based fMRI. Alterations in the patients will be determined by the experimental groups (NSSI vs. HC) with respect to the emotion regulation conditions. | About 30 minutes |