Evaluating the Role of Social Interactions and Shame in Self-Injurious Behaviors using Ecological Momentary Assessment: Feasibility and Preliminary Evaluation

Abstract

Self-injurious thoughts and behaviors (SITBs) are increasingly prevalent in the United States. The transactional model of emotion dysregulation provides a framework for understanding the development and maintenance of these and related behaviors and suggests that shame and self-invalidation following invalidation from others contribute to their development and recurrence. A comprehensive evaluation of this model would include real-time, in-vivo assessment. Ecological momentary assessment (EMA) can be used to assess the moment-to-moment social responses and subsequent private experiences (emotions, thoughts and sensations) that may contribute to SITBs. The present study evaluated the feasibility and acceptability of using EMA methods to test the relationship among antecedent social invalidation and subsequent shame, self-invalidation, and SITBs. Results suggest that procedures were generally acceptable and feasible, though EMA procedures had somewhat low compliance. Preliminary analyses suggest that social invalidation was significantly associated with subsequent self-invalidation and shame. Social invalidation, self-invalidation and shame were also significantly associated with NSSI urges, but not suicide urges. Shame partially mediated the relationship between social invalidation and NSSI, but self-invalidation did not, and neither was a significant direct predictor of suicide urges. This study is a first step at examining the inter- and intra-personal links among social invalidation, self-invalidation, shame and SITBs in real time.