Acceptance-Based and ACT-Informed Interventions for Non-Suicidal Self-Injury in Adolescents: A Systematic Review and Exploratory Meta-Analysis.
Highlights: What are the main findings? Evidence for primarily ACT, ERITA, and IERITA interventions is promising but remains preliminary. The strongest current evidence concerns therapist-guided IERITA evaluated in a single randomized trial, while evidence for primarily ACT interventions and other E...
| Published in: | Children Vol. 13; no. 7; pp. 972 - 998 |
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| Main Authors: | , |
| Format: | equations & formulas research systematic review tables/charts Journal Article |
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MDPI
Jul2026
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=195798409&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 195798409 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 22279067 LW6K jtl: Children issn: 22279067 maglogo: N pubinfo: dt: Jul2026 vid: 13 iid: 7 pid: 97109 pub: MDPI artinfo: ui: 195798409 195798409 195798409 10.3390/children13070972 195798409 ppf: 972 ppct: 26 formats: tig: atl: Acceptance-Based and ACT-Informed Interventions for Non-Suicidal Self-Injury in Adolescents: A Systematic Review and Exploratory Meta-Analysis. aug: au: Giannakopoulos, Georgios Prassou, Afroditi affil: Department of Child and Adolescent Psychiatry, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, 115 27 Athens, Greece sug: subj: Adolescent Behavior Self-Injurious Behavior Therapy Behavior Therapy Methods Acceptance and Commitment Therapy Internet-Based Intervention Emotional Regulation In Adolescence Adaptation, Psychological Human Male Female Adolescence Systematic Review Meta Analysis PubMed Descriptive Statistics Data Analysis Software Checklists Confidence Intervals Mental Health Adolescent: 13-18 years Male Female ab: Highlights: What are the main findings? Evidence for primarily ACT, ERITA, and IERITA interventions is promising but remains preliminary. The strongest current evidence concerns therapist-guided IERITA evaluated in a single randomized trial, while evidence for primarily ACT interventions and other ERITA formats remains preliminary. What are the implications of the main findings? Therapist-guided IERITA may warrant further evaluation as a promising adjunctive or stepped-care option for carefully selected adolescents; however, current evidence is insufficient to support its routine implementation or its use as a replacement for established treatments, particularly DBT-A for high-risk youth. Larger preregistered randomized trials with active comparators, longer follow-up, and mediation analyses are needed before any of these interventions can be considered established treatments for adolescent NSSI. Background/Objectives: Non-suicidal self-injury (NSSI) in adolescence is associated with emotion dysregulation, experiential avoidance, psychiatric morbidity, and later suicidal risk. Interventions based primarily on acceptance and commitment therapy (ACT) target psychological flexibility, acceptance, cognitive defusion, and values-based action, whereas emotion regulation individual therapy for adolescents (ERITA) and internet-delivered emotion regulation individual therapy for adolescents (IERITA) principally target emotion dysregulation while incorporating selected acceptance-related and ACT-consistent components, making these approaches theoretically relevant to adolescent NSSI. Methods: We conducted a systematic review and exploratory meta-analysis informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. PubMed, Scopus, Web of Science, and EBSCO were searched on 10 April 2026. Eligible studies included adolescents or predominantly adolescent samples in which NSSI was the central clinical target or NSSI-specific outcomes were separately extractable and evaluated primarily ACT, ACT-informed, acceptance-based, ERITA, or IERITA interventions. Quantitative syntheses were restricted to controlled studies with extractable data. Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), trial registries, and dedicated regional or gray literature sources were not searched; 15 reports remained unretrieved, so the evidence base may be incomplete. Results: Six full-text primary adolescent NSSI intervention studies met inclusion criteria: two controlled primarily ACT studies, one randomized ERITA feasibility trial, two uncontrolled ERITA feasibility/open studies, and one randomized IERITA trial. The strongest single-study evidence came from therapist-guided IERITA, which reduced masked assessor-rated NSSI frequency more than treatment as usual, with an incidence rate ratio of 0.34 (95% confidence interval [CI] 0.20 to 0.57). Two-study exploratory random-effects syntheses yielded estimates in the direction of benefit for continuous NSSI outcomes, Hedges' g = −0.45 (95% CI −0.85 to −0.05; k = 2), and process outcomes, Hedges' g = 1.25 (95% CI 0.83 to 1.68; k = 2). These estimates are hypothesis-generating and imprecise as estimates of a generalizable treatment effect because each synthesis contained only two clinically and methodologically heterogeneous studies. Although I2 was 0% in both syntheses, these estimates are highly uncertain with only two studies and should not be interpreted as evidence of true homogeneity. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, certainty was moderate for the single masked clinician-rated IERITA outcome and very low for the pooled continuous NSSI and process-outcome evidence. Conclusions: Primarily ACT, ERITA, and IERITA interventions may be promising for adolescent NSSI, but the evidence remains preliminary and mostly of very low certainty. The pooled estimates are exploratory, hypothesis-generating, and imprecise and should not be interpreted as evidence of treatment efficacy. The strongest single-study evidence concerns therapist-guided IERITA and was rated as moderate in certainty, whereas the evidence for primarily ACT interventions and pooled process outcomes was very low in certainty and requires confirmation in larger preregistered randomized trials with standardized outcomes, longer follow-up, active comparators, and process measures. pubtype: Academic Journal doctype: equations & formulas meta analysis research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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