On this In Dialog podcast, we’re joined by Dr. Bethany Cliffe, a analysis fellow on the College of Westminster. Beth’s analysis pursuits embrace self-harm, suicide prevention, and digital well being.
The main target of this podcast will probably be on self-harm and expertise.
Dialogue factors embrace:
- The prevalence of self-harm in youngsters and younger folks and which teams are extra in danger than others.
- The type of assist that’s usually accessed by youngsters and younger individuals who self-harm.
- What the proof tells us about interventions for self-harm.
- Perception into the BlueIce app – a prescribed evidence-based app – together with the way it was developed.
- The effectiveness of BlueIce and the way it’s being assessed.
#ListenLearnLike
Subscribe to ACAMH psychological well being podcasts in your most popular streaming platform. Simply seek for ACAMH on; SoundCloud, Spotify, CastBox, Deezer, Google Podcasts, Podcastaddict, JioSaavn, Hear notes, Radio Public, and Radio.com (not accessible within the EU). Plus we’re on Apple Podcasts go to the hyperlink or click on on the icon, or scan the QR code.
Dr. Bethany Cliffe is a analysis fellow on the College of Westminster. She is a qualitative researcher with an curiosity in self-harm, suicide prevention and digital interventions.
Transcript
[00:00:10.000] Jo Carlowe: Good day, welcome to the In Dialog podcast sequence for the Affiliation for Youngster and Adolescent Psychological Well being, or ACAMH for brief. I’m Jo Carlowe, a Freelance Journalist with a specialism in psychology. Right now, I’m interviewing Dr. Bethany Cliffe, Analysis Fellow on the College of Westminster. Bethany has an curiosity in self-harm and suicide prevention and digital well being. Self-harm and expertise would be the focus of at this time’s podcast.
Should you’re a fan of our In Dialog sequence, please subscribe in your most popular streaming platform, tell us how we did, with a ranking or overview, and do share with mates and colleagues.
Beth, welcome. Thanks for becoming a member of me. Are you able to begin with a short introduction about who you’re and what you do?
[00:00:52.392] Dr. Bethany Cliffe: In fact. So, firstly, thanks a lot for talking with me at this time. So, it’s an actual pleasure. However as you mentioned, I’m Dr. Bethany Cliffe, but it surely’s a little bit of a mouthful, so Beth is ok, and I’m at the moment a Analysis Fellow on the College of Westminster, engaged on a mission, evaluating using surveillance applied sciences for suicide prevention in public locations.
I began working in analysis in round 2017. My first position was working with Professor Paul Stallard over on the College of Tub, and we had been a digital intervention known as ‘Sleepio’, for insomnia in younger folks and that, kind of, kickstarted my curiosity in how tech can slot in with psychological well being. And I realised rapidly there’s a number of psychological well being apps accessible, however the proof base was fairly skinny and so, I received fairly enthusiastic about interested by if younger persons are eager to entry these psychological well being apps, then we not less than want to ensure there’s ones on the market that they’ll belief. So, I then went straight from that into my PhD, which was self-harm in college college students and the way tech can slot in with that. I’ve executed just a few different, type of, tech in psychological well being roles since and now, right here I’m.
[00:01:54.378] Jo Carlowe: Good, thanks. We’ll focus extra particularly on tech and psychological well being in a second, however simply to supply some context, Beth, how prevalent is self-harm in youngsters and younger folks and are some teams extra in danger than others?
[00:02:10.652] Dr. Bethany Cliffe: An enormous concern with self-harm is it’s fairly a hidden downside. Numerous information round prevalence comes from issues like hospital admissions or folks presenting to main care, however typically, younger folks don’t truly current to those locations. So, it’s fairly tough to get correct statistics about prevalence. So, it’s fairly underreported, however bearing that in thoughts, I feel round 20% of younger persons are prone to self-harm, however yeah, I might say take that with a pinch of salt.
And yeah, some persons are positively extra in danger than others. There’s an entire vary of threat elements that might imply somebody’s extra weak to self-harm and that could possibly be issues like having skilled abuse as a toddler, having a tough residence life, tough household life, a number of battle. Issues like experiencing better adversity by means of being a part of a minoritised group, having different psychological well being difficulties, like despair or consuming issues, for instance, and being bullied or socially remoted. I imply, there’s a number of various factors that may improve somebody’s morbidity, and interested by intersectionality and issues like that, as nicely.
It’s actually necessary to problem the stereotypes round self-harm. I feel there’s this concept that self-harm is one thing that occurs completely to younger white ladies, when in actuality, it could have an effect on folks of any background. So, we’ve received to not make assumptions about who might or might not be self-harming, while additionally, type of, making an allowance for that there are particular threat elements which can be value searching for.
[00:03:29.588] Jo Carlowe: Yeah, nice, that’s very useful. What sort of assist will a teen who’s self-harming usually entry?
[00:03:36.829] Dr. Bethany Cliffe: It varies, actually. I imply, self-harm varies a lot from person-to-person when it comes to what it appears to be like like, how self-harm is known, in addition to the, type of, help-seeking behaviours they’d have, as nicely. And plenty of younger individuals who self-harm would favor to talk to a good friend or a member of the family, that, type of, extra shut contact, whereas others wouldn’t wish to open up to them what they really feel is guilt or disgrace round their self-harm, so they like to speak to knowledgeable, whose, type of, job it’s to cope with it, I suppose, and so they can undergo CAMHS.
There’s additionally numerous strain and accountability on colleges with regards to self-harm, ‘trigger younger folks spend numerous their time there and colleges, in fact, do the very, easiest with what they’ve, however with know they’re fairly under-resourced, so that may be fairly difficult. There’s additionally the extra casual kinds of assist, so issues like peer assist, which numerous younger individuals who battle to entry these, type of, skilled companies, or in the event that they’ve had a nasty expertise with in search of assist, then, yeah, they’ll entry these extra, type of, casual peer areas. And I feel they’ll discover this fairly validating, being a part of these communities the place folks understand how they really feel and so they can, type of, perceive what that particular person’s going thorough. However there are, in fact, additionally dangers of peer assist, like being triggered and listening to different folks’s tales, studying new methods of self-harm. So, it’s necessary to be conscious of that.
It’s additionally necessary to acknowledge that while there are various kinds of assist accessible, younger folks can face fairly just a few obstacles in accessing them, with, you understand, self-harm being fairly stigmatised and being fairly arduous to speak about and, you understand, that, type of, guilt and disgrace. So, while there’s a number of assist accessible, we have to make it simpler for folks to entry it and we have to make it simpler for folks to reveal self-harm and can get a extremely supportive response after they do.
[00:05:07.468] Jo Carlowe: What does the proof inform us about interventions for self-harm? What works and what doesn’t work?
[00:05:14.053] Dr. Bethany Cliffe: Sadly, with self-harm, the proof base is kind of shaky. There was a Cochrane Evaluate executed a few years in the past and so they checked out a wide range of completely different interventions, like cognitive behavioural remedy, dialectical behaviour remedy, household remedy, and many others. And fairly surprisingly, and disappointingly, as nicely, they didn’t actually discover a lot proof of impact of any of the interventions they checked out, which was, yeah, very stunning. I feel DBT got here out on prime, if you’ll, when it comes to there was some proof of that, however the analysis they had been drawn from, they mentioned was fairly poor high quality, so it was arduous to attract any agency conclusions, actually.
However issues that usually work nicely with interventions are issues like serving to to develop coping abilities, serving to develop methods for regulating feelings with out resulting in self-harm. Issues like downside fixing, communication abilities, thought difficult, that kind of factor. One which works rather well is taking a strength-based method. I feel so typically with younger individuals who self-harm, there’s numerous emphasis on their deficits and what they’re missing, however I feel what works rather well is working with that younger particular person to consider what strengths they’ve. And we all know self-harm is a tough factor to stay with, in order that they do have power. I feel serving to them to grasp that and acknowledge that could be a actually useful place to start out.
However I feel, as nicely, one of many key points that I’m eager about in the intervening time, that’s a little bit of a brand new physique of labor, I suppose, is that – is beginning to, type of, query this concept of what an intervention that’s efficient appears to be like like or how we outline or measure that. And I feel usually, there’s this concentrate on an intervention being efficient if it stops self-harm or reduces self-harm, which is, in fact, necessary. We don’t need folks to be self-harming. However once we communicate to younger folks about what enchancment or restoration appears to be like like for them, they don’t typically point out self-harm. As a substitute, they’ll say issues like, “I would like to have the ability to spend time with my mates.” “I wish to do issues that I get pleasure from.” “I would like to have the ability to take care of myself and apply self-care.” “I wish to stay a fulfilled and significant life.”
And I feel that it’s actually necessary to acknowledge that what’s necessary for a teen won’t be stopping or lowering self-harm simply but, however as a substitute serving to them deal with the misery that’s inflicting the self-harm within the first place. And so, once we’re interested by what interventions work and doesn’t – and don’t work, I feel it’s necessary to perhaps take a broader method and never simply take into consideration whether or not that particular person has stopped self-harming, but when they’re feeling higher and in the event that they’re residing a extra fulfilled life.
[00:07:29.976] Jo Carlowe: Let’s dig a bit into using expertise and well being, and particularly, we’re going to have a look at BlueIce. So, it is a prescribed evidence-based app. Are you able to describe the app? Who’s it for, what does it appear to be and what does it do?
[00:07:46.138] Dr. Bethany Cliffe: BlueIce is now truly freely accessible for anyone to obtain on Apple on Android app shops, and it’s, primarily, a digital toolbox that was developed with and for younger folks. So, it begins off with a temper diary, the place you may say in the event you’re feeling – in the event you’re having a superb day, in the event you’re having a nasty day, and you’ll add notes as to why you’re feeling that means. And that, type of, maps onto a calendar. So, you may observe your temper over time. You possibly can attempt to determine doable triggers and issues that imply that you just’re having a greater day, yeah, to attempt to assist perceive your temper higher and, additionally, to attempt to get some perspective of I do even have some good days. After which, from that, if the particular person places that they’re having a nasty day, it then routes them by means of to the ‘Temper Lifting’ part, which has a number of completely different ideas in it of issues to attempt to choose you again up if you’re having a nasty day.
And so, it comes preloaded with some ideas, but it surely’s personalisable, so you may delete these and add your personal. And there’s completely different sections, like ‘Getting Energetic’, so, type of, bodily actions or hobbies, that type of factor. There’s a ‘Music’ part, so you may have playlists or explicit songs. There’s a ‘Good Time’ part, so you may add photographs or memes, inspirational quotes, issues like that. There’s ‘Guided Meditation’, there’s ‘Thought Difficult’. So, there’s heaps happening in there, after which, as soon as they’re, type of, going by means of that part, if the particular person remains to be feeling down or feeling like they may self-harm, the app then routes them by means of to a ‘Contact’ part, the place they’ll import contacts of mates or relations they really feel they’d have the ability to name in a tough second. And it additionally comes preloaded with Childline and 111, as nicely.
So, it’s fairly a complete app that’s received heaps in there and as I mentioned, it’s – it was initially developed for adolescents, however my PhD was it with college college students, as nicely. So, I feel it’s – you understand, it does have a broader utility than simply younger folks.
[00:09:38.858] Jo Carlowe: Hmmm hmm. So, ranging from what sort of age wouldn’t it be acceptable, as younger as 11 or…?
[00:09:43.397] Dr. Bethany Cliffe: Yeah, so what’s fascinating with BlueIce is there’s nothing within the app that explicitly mentions self-harm. So, it’s fairly appropriate for any age, actually, so long as, you understand, dad and mom are completely happy for kids to be utilizing it. So, yeah, round 11 or 12.
[00:09:57.200] Jo Carlowe: Hmmm hmm, and the way did it come about and the way was it developed and why is it known as BlueIce?
[00:10:04.448] Dr. Bethany Cliffe: Hmmm. So, it was developed with younger folks and Clinicians, and it happened by means of a sequence of workshops with younger folks. It was fairly an iterative course of. That they had a number of concepts about what to incorporate within the app and so they additionally got here up with the identify. So, ‘Blue’ is, you understand, feeling blue, feeling down, and ‘Ice’ stands for in case of emergency. So, that was their concept.
[00:10:25.622] Jo Carlowe: Yeah, makes good sense. And also you mentioned it’s downloadable. Can everyone entry it?
[00:10:33.231] Dr. Bethany Cliffe: Yeah, yeah. So, it’s utterly free to entry. It’s accessible on Apple and Android. So, yeah, anyone can obtain it in the event that they want to.
[00:10:40.310] Jo Carlowe: And the way efficient is BlueIce when it comes to – nicely, it’s fascinating, my query to you was going to be when it comes to self-harm discount, however you’ve truly mentioned that isn’t at all times a main focus for younger folks. It’s about bettering temper, high quality of life and so forth. However how efficient is it and the way is it being assessed?
[00:11:03.457] Dr. Bethany Cliffe: So, there was an preliminary analysis executed of BlueIce again in 2018 and the findings for that had been actually optimistic. So, on the finish of, I feel it was a 12-week research interval, round three quarters of the contributors had both stopped self-harming or had lowered self-harming, and there have been additionally important enhancements in wellbeing. So, scores on issues like anxiousness and despair scales had been a lot, significantly better, and there’s additionally good acceptability, as nicely. So, I feel it was round 90% of contributors needed to maintain utilizing the app after the research.
So, that was actually optimistic, and there’s been a newer RCT executed now as nicely, and the paper for that has actually simply been accepted. So, hopefully, that will probably be out quickly. However that RCT additionally discovered that utilizing that app lowered the necessity for hospital admissions, which was nice, and general, they’ve, principally, proven that the app is secure. You realize, there’s no detrimental results of it. So, even for the individuals who don’t essentially discover it useful, it’s not going to trigger any hurt.
After which, my PhD was it with college college students and yeah, I didn’t focus a lot on lowering self-harm. I checked out, type of, urges to self-harm and I did discover that utilizing the app has considerably lowered these ideas of self-harm. So, folks had been feeling the necessity to self-harm much less. I additionally discovered important enhancements in anxiousness and despair, however I additionally checked out coping, which was one in all my key issues I needed to concentrate on, as a result of that’s what college students I’ve spoken to had mentioned what they actually needed out of an intervention was feeling like they may cope higher. And so, I discovered that after utilizing the app, they did have an growing coping self-efficacy. So, they had been extra assured of their skills to manage.
And what was actually fascinating is we additionally noticed a shift from the extra adverse coping types, like avoidant coping, in direction of extra optimistic ones, like reappraisal. So, yeah, there was actually optimistic, type of, quantitative outcomes, and the qualitative suggestions that we get from the app, usually, is issues like “It helps to re-shift my focus away from self-harm while doing one thing that I get pleasure from, which helps to, type of, regulate feelings.” And it’s a great way of studying coping methods that may then be used exterior of the app. So, one participant mentioned, for instance, that they had been in a scenario the place they didn’t have their telephone on them and so they had been feeling like that they had the urge to self-harm, after which they had been in a position to bear in mind the methods that they’d recognized throughout the app and use these, which was very nice to listen to.
So, yeah, a number of optimistic suggestions, however in fact, you understand, it’s not for everyone. For some folks an app isn’t sufficient and so they favor that, type of, skilled assist to get to the foundation of the issue. So, it’s not for everyone, but it surely’s useful to supply for some. And likewise, what was actually fascinating was that they mentioned contributors suggestions usually was that while it’s useful for self-harm, sure, additionally they mentioned that as a result of there’s nothing throughout the app that explicitly references self-harm, additionally they thought it could possibly be useful for individuals who simply wish to verify in with their temper, or people who find themselves perhaps fighting examination stress or a temper dysfunction, for instance. So, it appears that evidently there’s fairly a broad utility of it, actually. So, I’d have an interest to see the way it will get used sooner or later.
[00:14:03.232] Jo Carlowe: Yeah, and presumably, it could possibly be utilized in a complementary means with skilled makes use of. It’s not one or the opposite, presumably?
[00:14:10.939] Dr. Bethany Cliffe: Yeah, completely and we did have that suggestions, as nicely. So, folks mentioned that it was useful to maintain observe of how they’ve been feeling all through the week, so after they had their subsequent session, they may look again and say, “Oh, truly,” you understand, “this occurred final week and now I’m feeling this manner.” As a result of they mentioned that usually, after they received to their session, all they may take into consideration was how they had been feeling that day, whereas it had helped them take a look at the entire week and have that better, type of, reflection on how their temper had been fluctuating and what triggered that. So, yeah, they mentioned it labored fairly nicely as a, type of, adjunct to that counselling, as nicely.
[00:14:41.674] Jo Carlowe: And is it well-known? I imply, is – and the way – is it extensively used, is it?
[00:14:45.977] Dr. Bethany Cliffe: Not but, no, as a result of up till this RCT, it had solely been accessible on a prescription foundation by means of sure CAMHS. However now that the RCT findings are out, or practically out, and we are able to say with, you understand, numerous certainty, that it’s secure [inaudible – 15:28] has made it extensively accessible and so, yeah, now anyone can obtain it, but it surely’s nonetheless early days. It was solely launched a few weeks in the past, I feel, so…
[00:15:08.111] Jo Carlowe: Hmmm hmm. Okay, that’s nice. It’s a extremely useful overview. Beth, what else is within the pipeline for you that you just want to share with us?
[00:15:16.350] Dr. Bethany Cliffe: For the time being, I’m engaged on a extremely fascinating mission with great colleagues at College of Westminster, Middlesex, Glasgow, Canterbury Christ Church, on a three-year NIHR funded mission. And we’re primarily surveillance applied sciences which can be utilized in public locations for suicide prevention, so issues like sensible CCTV or movement activated expertise, issues like that. And we’re whether or not they are often efficient for figuring out anyone susceptible to suicide after which getting that response initiated.
After which, I’m additionally trying – with the qualitative work, we’re whether or not they’re additionally, type of, acceptable and what the ethics are round them, which is basically fascinating. And we’re hoping to place some steering collectively for individuals who could be contemplating implementing these applied sciences. So, if persons are going to be utilizing them, then we’re going to attempt to say tips on how to use them in a means that’s extra useful than dangerous. So, hopefully, we’ll have some actual sensible implications from this, but it surely’s early days.
[00:16:13.768] Jo Carlowe: Hmmm, it sounds fascinating. Lastly, Beth, what’s your take residence message for our listeners?
[00:16:20.362] Dr. Bethany Cliffe: So, I feel the important thing factor that I actually at all times am fairly enthusiastic to get throughout is {that a} huge accountability if anyone has disclosed self-harm to us and the way we handle that. And I feel there’s a lot emphasis round, you understand, in the event you’re struggling, it’s good to communicate up, it’s good to ask for assist. However one of many key issues that stops that’s folks being petrified of what the response could be and other people having these horror tales of getting spoken up and it not having gone very nicely.
And so, I feel there’s that accountability on us to be sure that if anyone does open up to us, then we’re managing that nicely, and ensuring that we’re, you understand, not being judgmental, we’re not making any assumptions about why that particular person’s self-harming or what their self-harm would possibly appear to be. However as a substitute, giving them the time and area to actually inform their story and simply being actually supportive of that. And I feel what’s actually necessary is working with that younger particular person to seek out out what they want, or as I mentioned earlier, you understand, serving to them realise they’ve strengths and constructing on these. Constructing on the talents they have already got. Serving to them to get no matter it’s that they want, actually. It’s all so essential for serving to younger folks on their path to managing self-harm, which is not any simple factor to do.
[00:17:25.952] Jo Carlowe: Glorious. Beth, thanks ever a lot. For extra particulars on Dr. Bethany Cliffe, please go to the ACAMH web site, www.acamh.org, and Twitter @ACAMH. ACAMH is spelt A-C-A-M-H, and don’t overlook to comply with us in your most popular streaming platform, tell us in the event you benefit from the podcast, with a ranking or overview, and do share with mates and colleagues.
