Table 4

Cultural adaptation of an intervention for self-harm using consumer explanatory style in youth self-harm

Findings related to consumer explanatory style and treatment experience
Contextual factors, formulation and current feelingsPerceived supports and help-seekingTreatment related experiences, barriersCoping strategies
Key findings informing PI
  1. Emotional regulation difficulties.

  2. Interpersonal conflict resolution difficulties.

  3. Lack of supports and confiding relationships.

  4. Sense of problems being extreme and circumstances exceptional.

  5. Self-harm an option to deal with problems.

  6. Significant stigma related to people who self-harm and difficulty in accepting self as part of that group.

  1. Family members and friends main support.

  2. Parental concern and familial relationships as deterrent towards future attempts.

  1. In-patient treatment less helpful.

  2. Empathic professionals with perceived understanding of problems most helpful.

  3. Professional support by doctor more useful than by counsellor.

  4. Counselling useful if tailored to needs.

  5. Beliefs about people who self-harm a barrier.

  6. Talking to a stranger a barrier.

  1. Socialising with friends.

  2. Distraction strategies.

  3. Exercise physical and breathing.

  4. Religious beliefs.

  5. Substance use.

PIs for self-harm that can be adapted to South Asia, goals and content of PIPIs with inherent emotion regulation skills, problem solving and interpersonal conflict resolution skills training such as dialectical behaviour therapy, problem solving therapy, interpersonal therapy.
PIs should explore meaning of self-harm, address stigma related to it, help in reflection of attempt and triggers to promote help-seeking for better outcomes. Psycho-education about self-harm, and how improvement in emotional regulation, conflict resolution and problem solving skills may improve symptoms. Social network enhancement techniques could be particularly useful for females.
PIs with flexibility for an individualised therapy involving supports identified by client. It should take into account interpersonal triggers, help in conflict resolution, and optimise crisis support. Culturally appropriate materials and illustrations can be used to depict common interpersonal conflicts and stressful social situations relevant to the local community, for example, pictorial representation of spousal conflict/sibling conflict with possible resolution options.PIs with emphasis on rapport building, personalised approach with involvement of family members such as interpersonal therapy.
PIs should be delivered by counsellors with understanding of social and cultural context of patients.
Problem solving approach to resolve conflicts should be practiced in sessions.
There could be a peripheral involvement of medical professional to supervise treatment and increase trust.
PIs can include distraction strategies, relaxation exercises, behavioural activation including religious activities when found helpful, psycho-education to the patient and family, crisis plan.
  • PI, psychological intervention