title: A brief mobile app reduces nonsuicidal and suicidal self-injury: Evidence from three randomized controlled trials.
abstract: OBJECTIVE
  Self-injurious thoughts and behaviors (SITBs) are a major public health problem that traditional interventions have been unable to address on a large scale. The goal of this series of studies was to take initial steps toward developing an effective SITB treatment that can be easily delivered on a very large scale.
  
  
  METHODS
  We created a brief (1-2 min), game-like app called Therapeutic Evaluative Conditioning (TEC), designed to increase aversion to SITBs and decrease aversion to the self. In 3 separate studies, we recruited participants with recent and severe histories of SITBs from web forums focused on self-injury and psychopathology (Ns = 114, 131, and 163) and randomly assigned them to receive access to the mobile treatment TEC app or a control app for 1 month. We tested the effect of TEC on the frequency of self-cutting, nonsuicidal self-injury more generally, suicide ideation, suicide plans, and suicidal behaviors.
  
  
  RESULTS
  Analyses showed that, compared with the control app, TEC produced moderate reductions for all SITBs except suicide ideation. Across studies, the largest and most consistent reductions were for self-cutting episodes (32%-40%), suicide plans (21%-59%), and suicidal behaviors (33%-77%). Two of the 3 studies showed that TEC impacted its intended treatment targets and that greater change in these targets was associated with greater SITB reductions. TEC effects were not maintained at the 1-month posttreatment follow-up.
  
  
  CONCLUSIONS
  Future versions of brief, mobile interventions like that tested here may have the potential to reduce SITBs and related behaviors on a large scale. (PsycINFO Database Record
authors.affiliation: Department of Psychology, Harvard University.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Franklin
authors.affiliation: Department of Psychology, Harvard University.
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Fox
authors.affiliation: Department of Psychology, Harvard University.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Franklin
authors.affiliation: Department of Psychology, Harvard University.
authors.forename: Evan M
authors.initials: EM
authors.lastname: Kleiman
authors.affiliation: Department of Psychology, Harvard University.
authors.forename: Jessica D
authors.initials: JD
authors.lastname: Ribeiro
authors.affiliation: Department of Psychology, Harvard University.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Jaroszewski
authors.affiliation: Department of Psychology, Harvard University.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Hooley
authors.affiliation: Department of Psychology, Harvard University.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Nock
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D063731:Mobile Applications; D016728:Self-Injurious Behavior / Q000517:prevention & control*; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult