DBT and CBT-based therapies show signals for reducing adolescent self-harm in network meta-analysis

Psychosocial therapies such as dialectical behaviour therapy and cognitive behavioural therapy may lower the risk or severity of non-suicidal self-injury and self-harm among adolescents, according to a systematic review and network meta-analysis published in BMC Psychology. The authors caution, however, that the evidence base is sparse and the findings should be read as comparative signals rather than a definitive ranking of treatments.

Non-suicidal self-injury and self-harm are common during adolescence and are associated with later suicidal behaviour, psychiatric morbidity, and functional impairment. Earlier evidence syntheses, the researchers note, often combined psychosocial and pharmacological treatments or pooled conceptually distinct self-harm outcomes, making it harder to isolate what psychosocial care alone achieves.

To address this, the team searched PubMed, Embase, Web of Science, the Cochrane Library/CENTRAL, Scopus, and three Chinese databases for randomised controlled trials of psychosocial interventions in adolescents or young people reporting NSSI or self-harm outcomes. The quantitative evidence base comprised 30 randomised controlled trials. The review was registered in PROSPERO (CRD420261442260).

Unlike previous syntheses, the analysis separated three outcome domains: dichotomous NSSI/self-harm occurrence, continuous NSSI/self-harm severity, and broader self-harm events. Continuous outcomes were summarised as standardized mean differences and dichotomous outcomes as odds ratios, using a random-effects frequentist network meta-analysis with treatment as usual or usual care as the reference. Risk of bias was assessed separately for each outcome and time point, and disconnected or insufficiently populated networks were not forced into the analysis.

In the dichotomous network, which included 10 studies and 10 treatment nodes, three interventions were associated with lower NSSI/self-harm risk compared with usual care: a culturally adapted cognitive behavioural therapy or problem-solving intervention (odds ratio 0.19, 95% CI 0.04 to 0.99), DBT or DBT-A (odds ratio 0.32, 95% CI 0.11 to 0.93), and group therapy or psychosocial intervention (odds ratio 0.14, 95% CI 0.02 to 0.96). Because several confidence intervals approach or cross near the null, these estimates carry considerable uncertainty.

For continuous severity outcomes, DBT-based intervention (SMD -1.42, 95% CI -2.33 to -0.52), CBT-based and third-wave CBT approaches (SMD -1.21, 95% CI -2.23 to -0.19), and general psychosocial or nursing interventions (SMD -1.64, 95% CI -2.81 to -0.48) all favoured lower severity. Heterogeneity in this continuous network was very high, at I² = 95.1%, meaning the pooled estimates varied substantially across trials.

The broader dichotomous self-harm network included only two studies, limiting what can be concluded about that outcome domain. In sensitivity analyses, excluding trials at high risk of bias preserved the direction of the principal binary and continuous estimates, although heterogeneity in the continuous network remained substantial.

The authors conclude that DBT/DBT-A, CBT and problem-solving interventions, and some group or comprehensive psychosocial interventions may reduce adolescent NSSI/self-harm risk or severity. They emphasise important limitations: the evidence network was sparse and largely anchored to treatment as usual or usual care, several treatment nodes were supported by single studies, and continuous outcomes were highly heterogeneous. These constraints mean the results should be interpreted as comparative signals rather than a definitive treatment hierarchy.

The findings offer a structured starting point for clinicians and researchers weighing psychosocial options for adolescents who self-harm, while underscoring the need for more and better-connected randomised trials before firm treatment rankings can be established.

Subject of Research: Psychosocial interventions for non-suicidal self-injury and self-harm in adolescents

Article Title: Psychosocial interventions for non-suicidal self-injury and self-harm outcomes in adolescents: A systematic review and network meta-analysis

Article References: Cao, S., Lu, F., He, C., Peng, W., Tong, Y., Yu, T., Wang, Q., & Ye, Z. (2026). Psychosocial interventions for non-suicidal self-injury and self-harm outcomes in adolescents: A systematic review and network meta-analysis. BMC Psychology. https://doi.org/10.1186/s40359-026-05607-x

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05607-x

Keywords: non-suicidal self-injury, self-harm, adolescents, DBT, CBT, network meta-analysis, systematic review, psychosocial interventions, mental health, randomised controlled trials, Psychosocial, interventions