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Urge Surfing, Alternatives, and Harm Reduction

Image titled "Practice tolerating the urge." Doodle of a person with dark hair pulled up into a  bun, light skin,  a red striped shirt, a gold watch, and an anxious look on their face. They  are saying, "Ok. I can definitely make it through the next 3 minutes."

To follow my post earlier this week on developing (new) coping skills rather than attempting to just desert our old ones, here are a few examples of ways to practice new skills (like asking for support, distraction, or alternative behaviors) when there is an urge or desire for self-harm.

Image titled "Try alternatives." Doodle of a person's hand with a snapped rubber band around it. The person is saying, "Yeouch!"

Instagram recently removed a different version of this post, which discussed/illustrated how the NHS (universal healthcare in the UK), based on research, is adopting a controversial model as best-practice, and how their model is working to reduce frequency and severity of episodes for people struggling with this issue (I’ve shared a bit of that content- mostly a list of research studies underlining the effectiveness of this approach- below).

It is easy to think, like the algorithms that edit us, that an issue is black or white, good or bad, pro- or anti-, but healing occurs when we can move into the grey areas and, with footing on the foundation of evidence from emerging research, engage people where they are with solutions that work.

Image titled "Use your people and or  distraction." Doodle of a light-skinned person holding a phone that has text exchanges on it that show a friend checking in and asking how the can  help.

If you are struggling with self-harm, know that you have so many options for getting good support – *and* you have the right to change providers if the support you are getting isn’t right for you. If you are having trouble reaching out for support, text the @crisistextline or ask a trusted friend to help you get connected with mental health services.

Image titled "Text 'HOME'  to 741741 to reach the Crisis Text Line." Doodle of a person with light skin and dark hair peeking over a table at a phone that haas a text sent to that number.

When it comes to other addictive behaviors, harm reduction is an increasingly standard practice, but with self-harm there’s often an all-or-nothing response. If self harm is someone’s only effective coping mechanism, it’s worth considering if we should focus less on an all-or-nothing approach, and more on developing new coping skills (like using social supports or participating in activities that self-soothe), providing tools and resources to learn to tolerate painful emotions (like information and support in learning to “urge surf” and mindfully noticing and “ride” the wave of the urge to harm) and information on harm reduction: like how to minimize the harm of self-harm episodes, when and if they do occur, through hygiene, good wound care, and making sure that shame doesn’t result in neglect of open wounds.

Image titled "Coping with Self-Harm Urges."

Research on Urge Surfing and Harm Reduction

Research shows that some teens who engage in self-harming behaviors find harm reduction techniques to be empowering, because harm reduction approaches empower teens to care for themselves and manage their own behaviors. The same research indicates that harm reduction can help to decrease negative feelings post-self-harm behaviors and increases the liklehood of getting adequate care for wounds from self harm episodes. Research also suggests that therapy and coping strategies (like distracting activities or urge surfing) can be used alongside harm reduction practices for maximum benefit.

According to a small research study spanning 6 years on women ages 20-58 years old in an inpatient mental health setting, harm reduction works. This study surveyed positive risk-taking, which is similar to harm reduction (or “harm minimization”). A positive risk-taking approach allows space for someone thinking of harming themselves to think out the risk of self-harm. Rather than dismissing the urges, in this research study, individuals were allowed to consider what the self-harming behaviors would be and what the result of those behaviors would bring. Additionally, in this study persons were not prohbitited from engaging in non-life-threatening self harm. If participants chose to act on their thoughts, harm reduction techniques would be employed (clean, safe spaces; non-shaming intervention; discussion and reflection).

Using this model over 6 years, the self-harming behaviors in study participants reduced in frequency. This shows a correlation to the space provided by the service: a space that does not restrict, which often leads to an increase in self-harming behaviors due a lack of felt control, and a space that offers a sense of feeling held and feeling connected, which allows for emotions to be explored and emotional needs to be met. This also correlates to both positive risk-taking and harm reduction techniques.

If you or someone you care about is in danger, call 911 or, in non-emergency situations, text the Crisis Text Line at 741741.

To learn more about urge surfing, and how ride out urges without acting on them, check out this article: https://severancemag.com/urge-surfing-ease-the-mind-by-riding-the-wave/

For academic research supporting harm reduction for self harm, see https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpm.12508 or https://www.sciencedirect.com/science/article/pii/S0272735806000961 or this research, which discusses this approach as the current recommended standard by the national institute of health in the UK: https://doi.org/10.1080/15332985.2011.575726

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