Triggers Online Resulting in Nonsuicidal Self-Injury (TORN)

Non-suicidal self-injury represents a major worldwide mental health concern in adolescents. This project approach aims to examine the role of social media usage in the development and maintenance of adolescent non-suicidal self-injury. This project focusses on the potential triggering effect of stimuli (words, pictures) that adolescents share in online groups related to non-suicidal self- injury. Additionally, it will study the effect of social exclusion on these trigger factors, noting that adolescents with non-suicidal self-injury are more sensitive to negative feedback from others. The team led by Oswald D. Kothgassner is recruiting 50 young people with non-suicidal self-injury and 25 healthy young people in order to get a better understanding of the triggering factors of non-suicidal self-injury in the context of social media platforms. The project consists of three studies: (1) a study using ecological momentary assessment over seven days is conducted in order to identify events, cognitions and affects in their daily lives that may lead to non-suicidal self-injury; (2) a laboratory study is set to identify triggers for non-suicidal self-injury (e.g. certain words, details in pictures) and will be analyzed by measuring eye-tracking and physiological recordings; (3) a laboratory study is conducted to predict the influence of social exclusion on trigger effects. To our knowledge, this is the first study to investigate triggering effects of social media content in adolescents with non-suicidal self-injury conducting an everyday study as well as laboratory experiments. The team uses a multi- method approach including biological, behavioral and self-report measures to understand an issue that is highly relevant in clinical work.

Adolescents who engage in nonsuicidal self-injury react particularly strongly to distressing content on social media Our research shows that adolescents who engage in self-injury are especially sensitive to images and experiences related to self-injury, particularly on social media. Such content can increase stress and strengthen the urge to self-injure again. This is highly relevant for prevention and treatment. Nonsuicidal self-injury refers to the deliberate harming of one's own body without the intention to die, for example by cutting, scratching, or hitting objects hard enough to cause injury. This behavior is relatively common during adolescence and is often linked to severe emotional distress, reduced quality of life, and other mental health problems. Many affected adolescents report that self-injury helps them cope with overwhelming emotions in the short term. Social media are a central part of everyday life for young people. At the same time, there is growing concern that images or texts related to self-injury may be distressing and may trigger renewed urges. In the TORN project, we therefore examined how adolescents with and without a history of self-injury respond to such content, both in the laboratory and in daily life. In a first study, we found that adolescents with a history of self-injury looked at self-injury images more quickly and for longer than at other types of images. At the same time, they reported a stronger urge to self-injure. This pattern was not found in adolescents without such a history. These findings suggest that this kind of content has a different meaning for particularly vulnerable adolescents than it does for their healthy peers. In a second study, we followed adolescents in their daily lives for one week using repeated smartphone assessments. We found that distressing events that happened on social media were more often linked to increased stress, worse mood, and stronger urges to self-injure than distressing events that happened offline. This suggests that not only images, but also negative social experiences online, such as exclusion or bullying, can be highly distressing. In a third study, we examined more closely what happens after social exclusion. After an experimentally induced experience of being left out, adolescents with a history of self-injury reacted more strongly to distressing cues, reported more stress, and experienced stronger urges to self-injure. At the same time, we also observed signs of increased bodily stress. Overall, the TORN project shows that social media can be an important trigger for vulnerable adolescents-not for all young people, but for a particularly at-risk group. This has clear practical implications: clinicians, parents, and schools should address distressing online content more directly. Adolescents need support in learning safer ways to regulate emotions, recognize warning signs early, and navigate social media more safely.