Avoiding Self-harm (WIP)

Asking yourself questions about your self-harm and tracking when you self-harm or have self-harm urges can help you identify what causes your self-harm and what function your self-harm has. You could do this in a notebook, on your phone, you could use an online tool, like this one, or a mood tracking app (such as this one).

Some people find that tracking how long they have been self-harm free can make their urges worse, others find it a good source of motivation.

Here are some example questions to ask yourself about self-harm:

• Why did you first start self-harming?
• In what way(s) does self-harm help you?
• What things or situations cause self-harm urges? Are urges sudden or do they build over time?
• Do you notice any other patterns to your self-harm?
• Before you hurt yourself, how do you feel? What are you thinking? Do you act differently?
• After you hurt yourself, how do you feel? What are you thinking? Do you act differently?

Here are some examples of questions to ask yourself when tracking self-harm/urges:

• What were you doing that day?
• What happened before you had self-harm urges/self-harmed? Did something specific cause the urges? Was the urge sudden or did it build over time?
• How did you feel, what were you thinking, and how were you behaving before you hurt yourself/had urges?
• What did you try other than self-harm, if anything?
• How did you hurt yourself, if you did?
• How did you feel, what were you thinking, and how were you behaving after you hurt yourself or the urge passed?

It's ok if you don't know the answer to some or even any of these questions, it can take time to figure things out and even if you never do that's okay as well.

This exercise is usually best done when you do not feel like self-harming.

On a piece of paper or your phone create four lists titled "pros of hurting yourself", "cons of hurting yourself", "pros of not hurting yourself", and "cons of not hurting yourself". For each list try and come up with as many pros/cons as possible, think back to times before when you've self-harmed. How did it help? How did it make the situation worse? Have you ever regretted harming yourself? What about times you have successfully avoided self-harming?

It's okay if you find it difficult to find reasons for any of the lists, you can always come back to this another time. In some situations, the pros of self-harm do outweigh the cons and that is ok. It just means you might still need to use self-harm sometimes until you can deal with the issues that cause you to self-harm in safer ways.

Reading or listening to other people's reasons for avoiding self-harm can help you feel less alone and think of reasons for yourself.

Because self-harm can be helpful and self-harm urges can be very overwhelming, it can be even more difficult to remember why you want to reduce self-harming or quit in the moment. Keeping reminders of your reasons to not self-harm on you or with your self-harm tools can help remind you when you’re struggling. Below are some ideas of things to remind you of your reasons in these moments.

• Photos of things you enjoy
• Items that remind you of positive memories
• The pros/cons list from above
• supportive letters from yourself or loved ones, these letters could include:
  • Things you've regretted about self-harming
  • Positive things that have happened or you felt because you didn't hurt yourself
  • Things you are looking forward to
  • Things that could help you feel better or help you avoid self-harming
• An app like I Am Sober to track reasons for not self-harming

If you're trying to reduce how often you self-harm or be more in control, but not quit, setting boundaries or rules around when you self-harm can help. For example...

• Only self-harming during a certain time (for example, from 8-9pm)
• Trying a certain number of alternatives before hurting yourself
• Talking to someone about how you're feeling before you hurt yourself
• Sending a pre-written message to someone saying you need help or to talk
• Not self-harming till previous injuries are fully healed
• Waiting a certain amount of time before hurting yourself
• Only hurting yourself if you have first-aid supplies

A small barrier can give you the time to calm down or think of other things to do.

• Plan to go swimming with someone soon
• ...or to wear an outfit that shows the area you want to harm
• Go somewhere public/with other people
• Keep busy in general
• Invite a friend around
• Put your self-harm tools somewhere hard to get at
  • Wrap them in plastic wrap
  • Put them on a high shelf
  • Give them to someone else

Self-harm urges can sometime be a bit like a wave; they build in intensity until they peak and then they crash back down. Urge surfing is a strategy for managing this intense wave where instead of acting on the urge you notice it and sit through it until it passes. It is not about distracting. The more you practice surfing the wave of self-harm urges the easier it can be to get through them without harming yourself.

1. Acknowledge and name the urge; think, say out loud, or write it down (e.g. "I am having the urge to self-harm")
2. Notice your thoughts/feelings; don't try and fight or supress them
3. Remind yourself the urge will end; think about times before when urges have passed without hurting yourself, try deep breaths if that helps you, visualise the "wave" crashing and fading
4. When the peak of the wave urge passes, congratulate yourself
5. It may be useful to try other strategies now, like self-harm replacements, simulation alternatives, or distractions now

The "5-minute rule" is when you delay self-harming by setting a timer for a short, doable, amount of time (for example, 5 minutes) in which you tell yourself you are not going to self-harm but instead wait out the urge. You could also use something like a song instead of a timer. While the timer is going you can try using another self-harm avoidance strategy, like distractions, replacements, simulation alternatives, or urge surfing.

When the timer has run out hopefully the urge has passed too, if it has, congratulate yourself for waiting it out. If the urge is still there, you can set another timer and try again, or you can choose to harm yourself instead. If you do choose to harm yourself, you should still congratulate yourself for delaying for as long as you did.

1. When you feel like self-harming, draw a butterfly (or multiple) where you want to harm
   • You can name the butterfly after a loved one if you like or have someone else draw the butterfly for you
   • You could also use something like body markers, henna, or a temporary tattoo
   • You can draw anything, it doesn't have to be a butterfly, try another animal, stars, reasons to not harm yourself, lyrics, or something else
2. Allow the butterfly to fade with time, without washing or rubbing it off
3. If you don't self-harm and the butterfly fades naturally you have successfully completed the challenge, remember to celebrate this achievement even if it feels small
   • You can use something like a recovery bracelet, keychain, or paper chain where you add a bead/loop every time you successfully complete the challenge to remind yourself of your achievements
4. If you self-harm before the butterfly has faded, you can wash it off and try again or find another strategy to try instead. Remember that trying is also an achievement and that even small progress is progress

These alternatives recreate or mimic some of the physiological effects of self-harm, like pain and endorphin or adrenaline rushes.

• Put on Capsaicin cream/roll or tiger balm where you want to harm (causes a burning sensation)
• Hold ice or rubbing it where you want to harm
• Wax your legs or pluck your eyebrows
• Get a piercing or tattoo
• self-harm recovery pen
• Splash your face with cold water, take a cold shower
• Clench your fists or clap your hands hard
• Watching horror movies with jump scares or action movies
• Soak a washcloth in water and then freeze it for when you have self-harm urges
• Snap a rubber band on yourself
• Intense exercise
• Try progressive muscle relaxation
• Eat very spicy or sour food
• Press your hands into a wall as hard as possible
• Acupuncture rings or rollers

These alternatives recreate or mimic some of the visual aspects of self-harm, like blood, injuries, or bandages.

• Use bandages/plasters where you want to harm
• Draw self-harm injuries or scars on yourself with makeup, body markers, etc.
• self-harm recovery pen
• Get a piercing or tattoo
• Use fake blood, red food colouring, or paint
• Cut/tear/burn/etc. something other than your body
• Colour in old scars or places you've hurt before
• "cut" on Fatal to the Flesh
• Add red food colouring to water and freeze it to use where you want to harm
• Cover your hand in PVA/Elmer's glue then peel it off
• Drink ice cold water
• Draw self-harm on a photo or drawing of yourself
• Make art that looks like self-harm

These alternatives recreate or mimic some of the routine and motions of self-harm, such as blood, injuries, or bandages.

• Care for the area you want to harm as if you had; rinse it with water, bandage, change the bandages, etc.
• hit something soft
• self-harm recovery pen
• Wash where you want to harm with a bar of soap
• Drag a blunt item across where you want to cut
• Put together a first-aid kit or self-soothe box
• Draw injuries where you want to harm
• "cut" on Fatal to the Flesh
• Swallow round sweets (like skittles)
• Cut/tear/burn/etc. an item other than your body
• Everything but Rule"
  1. Do all the 'rituals' you usually would before self-harming; going to your room, unpacking first-aid supplies and sh tools, turning on music, etc.
  2. When you get to the point where you would normally harm yourself stop
  3. if you want, draw wounds where you would normally harm
  4. Do everything you would normally do after harming yourself; rinse the are you "harmed", put on bandages, rest, etc.
     • You can change your 'ritual' over time, so you don’t have to go through as many steps to ease your self-harm urges
     • This strategy may not work if you don't have a consistent self-harm ritual
     • If you don't think you can avoid harming if your tools are around, skip the part about getting out your tools or skip this strategy

Think about the reasons and functions of your self-harm and make a table with the columns labelled with your different reasons for harming yourself and rows for delaying, distraction, simulation, and replacement strategies like in the example below.

Think about what could help or what has helped in the past when you've had self-harm urges and write those strategies into each box of the table. Try and be specific about what strategies you want to use (for example, name specific exercises instead of just "exercise"). You might also want to organsie your strategies in other ways, like numbering them from least to most effective or colour coding them. You can decorate your menu however you like, try and make it something you'll want to actually use.

It might also be useful to include a list of people, organisations, or helplines you can contact for support on the back as well as a reminders of reasons to not self-harm. Try and keep your menu somewhere you will see it when you have self-harm urges (for example, with your self-harm tools) and somewhere easily accessible, like on your phone. If any of your strategies require an item, try and keep that near your menu too.

It's ok if you can't fill every box or only have a few strategies, you can always update your menu later and there is no point in adding things you won’t use or won’t find helpful.

• Put on bandages or seek medical attention
• Call my partner
• Make myself a snack
• Journal about how I'm feeling and why I harmed in my self-harm diary
• Watch a comfort show and rest
• Try and not beat myself up about it; remeber self-harming doesn't make me a bad person or failure