Understanding Distress and Self-Harm


Catherine Lau, M.ADS, RP, BCBA

12/5/20233 min read

gray stones
gray stones

Behaviour Chain: Identifying the Links

It can be helpful to identify the links between this behaviour and see the chain of events and behaviours. For instance, what did I do before, during, and after our distress? How did my body feel? What thoughts came up? What was happening in my environment? How did I feel? By identifying the links in this chain, we can gain a deeper understanding of how our thoughts, emotions, and behaviours are interconnected.

Distress tolerance is to the ability to withstand and manage emotional distress and get through a storm. It can be an essential skill for someone who engages in self-harm behaviours. There can be many reasons why someone engages in self-harm, including communicating distress, emotional regulation, distress and tension reduction (Miller et al, 2021). Psychotherapy and psychosocial interventions with experienced mental health professionals are found to be effective treatments for reducing self harm and suicide attempts (Bettis et al, 2000; Briggs, 2019). A focus on skills development (emotional regulation, interpersonal skills) and incorporating family support.

Let's explore some steps that may be taken with a mental health profession to understand and develop skills around managing distress.

Assessing Behaviour: What Happened?

It is important to understand the self-harm behaviour. Is this a pattern of behaviour? Is there something that happened before the behaviour? What happened in the situation? It can be difficult to examine a distressing situation, but a mental health professional can support you through this important step. By identifying the specific events, thoughts, or emotions that led to our distress, we can gain valuable insights into ourselves and the ways in which we respond.

selective focus photography of thunder
selective focus photography of thunder

Skills Development

The therapist and client will work together on strengthening skills to help cope in times of distress. The skills targeted to strengthen will really depend on the client's individualized treatment plan. Here are some examples of areas of focus:

  • Grounding and mindfulness: Engaging our senses to be mindful and in the here-and-now. For example, splashing cold water on our face activates the vagus nerve, activating the mammalian dive reflex, calming down the body.

  • Focus on a valued activity: Engaging in a valued activity can be better than simply trying to find a distraction because a valued activity not only helps us focus on something else, but it is also meaningful. Create something, exercise, call a friend and socialize, watch a funny show - whatever it is that you value, seek it out and do it.

  • Communication skills and relationships: Communicating our needs in a healthy way and seeking (and be open to receiving) social support can be an important component of a treatment plan

Function of Behaviour: Why?

All behaviour serves us in some way. A mental health professional can help understand how the self-harm behaviour serves an individual. Does it communicate a need? Is it decreasing emotional pain? Does it help us cope? Understanding why we do what we do can be a big step in healing and strengthening healthy coping skills that help fulfill the same need.


Bettis AH, Liu RT, Walsh BW, Klonsky ED. Treatments for Self-Injurious Thoughts and Behaviors in Youth: Progress and Challenges. Evid Based Pract Child Adolesc Ment Health. 2020;5(3):354-364. doi: 10.1080/23794925.2020.1806759. Epub 2020 Aug 26. PMID: 32923664; PMCID: PMC7480822.

Briggs, S., Netuveli, G., Gould, N., Gkaravella, A., Gluckman, N., Kangogyere, P., . . . Lindner, R. (2019). The effectiveness of psychoanalytic/psychodynamic psychotherapy for reducing suicide attempts and self-harm: Systematic review and meta-analysis. The British Journal of Psychiatry, 214(6), 320-328. doi:10.1192/bjp.2019.33

Miller M, Redley M, Wilkinson PO. A Qualitative Study of Understanding Reasons for Self-Harm in Adolescent Girls. Int J Environ Res Public Health. 2021 Mar 24;18(7):3361. doi: 10.3390/ijerph18073361. PMID: 33805082; PMCID: PMC8037877.

Get Support

Self-harm can be scary and difficult to understand. Stigma around mental health can be a barrier for seeking treatment. If you or someone you love is experiencing self-harm, I encourage you to consider finding a therapist who helps you feel comfortable.

It is scary to find oneself stuck within a storm. You are not alone. I hope you find a safe haven in which you can find shelter on your journey.