Double Trouble: New Developments in Understanding, Managing, Treating Suicidal Behavior and Non-Suicidal Self-Injury

Friday, May 13, 2022, 9:00 AM-4:00 PM-
$199 including CEUs
Double Trouble: New Developments in Understanding, Managing,
Treating Suicidal Behavior and Non-Suicidal Self-Injury
Barent Walsh, Ph.D.

Suicide and non-suicidal self-injury remain major public health problems in the United States. Suicide is the 10th leading cause of death and the second for young people. Suicide rates continue to increase and are now 14.5 per 100,000 in population (AAS, 2021).

Non-suicidal self-injury (NSSI; e.g. cutting, self-hitting, skin picking, and burning) is a separate (but related) problem and is a major public health challenge in its own right. Data from a recent large sample study found that 17.6% of high schoolers from 8 states self-injured during the previous year (Monto et al. 2018). In Massachusetts, the most recent data are that 14.5 % of high school students and 16.8% of middle schoolers self-injured during the previous year (Mass. DOE, 2017). There is no denying an epidemic of NSSI is in our midst.

Given the intensity of these problems, the distress and misery involved, and the complexity of providing help, it is crucial to keep our knowledge up-to-date and to employ the most state-of-the-art interventions available. This training will focus on what is most current and effective.

The workshop will begin with an emphasis on suicide prevention. The best tool available to assess imminent risk clinically is Thomas Joiner’s Acute Suicidal Affective Disturbance (ASAD;Joiner, 2015).It is evidence-based and offers four specific dimensions that are predictive of acute suicide risk. These are: 1) a geometric increase of suicidal intent and planning in the short-term, 2) marked social and/ or self-alienation, 3) perception of hopelessness, and 4) two or more manifestation of overarousal (insomnia, nightmares, agitation, irritability). The ASAD will be explored with real world clinical examples re: managing such risk.

For those who are found to be at risk using the ASAD, the logical next step is to move to Safety Planning. The training will next focus on Stanley and Brown’s evidence-based Safety Plan. It is a tool that identifies warning signs, coping skills, both personal and professional supports, restriction of means, and reasons for living. This Safety Plan also has phone app versions.

The presentation will then move to Thomas Joiner’s Interpersonal Theory of Suicide. It is the most researched formulation about suicide in the world. The workshop will explore the three major components of the theory: acquired fearlessness, thwarted belongingness, and perceived burdensomeness. The theory will be employed to explain the suicide trajectories of real-world individuals.

The treatments of choice for suicidality appear to be three: Dialectical Behavior Therapy (DBT), the Collaborative Assessment and Management of Suicidality.(CAMS), and Cognitive-Behavioral Therapy (CBT). Aspects of these treatments will be briefly reviewed with practical applications emphasized.

The second half of the training will focus on NSSI. The content addressed will be:

  • Differentiating suicide from self-injury
  • Exploring the link between recurrent NSSI and suicide attempts
  • Providing a thorough assessment of NSSI
  • Teaching replacement skills including innovative approaches such phone apps that address NSSI
  • Discussing the brain science that explains why NSSI “works” in reducing emotional distress
  • Reviewing the social contagion of NSSI and how to prevent it
  • Concluding with a discussion of self-care in relation to working with these challenging problems
Following this training, participants will:
  • Understand the full spectrum of self-destructive behavior.
  • Understand how NSSI is distinct from suicidal behavior yet, if sustained, is also a predictor of suicide attempts
  • Learn the four components of Joiner’s Acute Suicidal Affective Disturbance (ASAD)
  • Learn to employ Joiner’s Interpersonal Theory of Suicide
  • Learn to provide a thorough assessment of NSSI
  • Learn how to teach replacement skills designed to reduce NSSI
  • Learn to understand and manage social contagion of NSSI


Barent Walsh, Ph.D. has written extensively and presented internationally on the topic of self-destructive behavior. He is the author of three books on non-suicidal self-injury, including Treating Self-Injury: A Practical Guide 2nd edition, Guilford Press, (2014). This volume has been translated into Japanese, Korean, Dutch and Polish.

Dr. Walsh is Executive Director Emeritus and Senior Clinical Consultant at Open Sky Community Services, a human service agency headquartered in Worcester, MA. Dr. Walsh is also a Lecturer on Psychiatry, Harvard Medical School at Cambridge Health Alliance, Cambridge, MA.

Dr. Walsh received the following recognition in 2021:

“On behalf of the International Society for the Study of Self-Injury (ISSS) Board of Directors, we would like to honour your extensive contributions to the field by inviting you to be an Invited Fellow of ISSS. This invitation reflects the highest recognition of your many contributions to the field, notably your seminal work and publications in the areas of assessment and treatment of self-injury.”

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