Clinical Benefits and Challenges of Ecological Momentary Assessment in Individuals Who Self-Injure and Seek Mental Health Treatment

Introduction: Non-suicidal Self-Injury (NSSI) is a highly prevalent transdiagnostic behavior among treatment-seeking individuals. The use of Ecological Momentary Assessment (EMA) shows clinical potential for engaging patients outside the therapy room, but the utility for individuals who self-injure remains unclear. This prospective study evaluates self-reported benefits (e.g., increased self-insight and self-efficacy) and challenges (e.g., beep disturbances and emotional discomfort) associated with using EMA among individuals reporting past-month NSSI at treatment intake.Methods: In this cohort study, 124 treatment-seeking adolescents and adults who self-injure completed baseline assessments and participated in a 28-day EMA protocol with six daily self-monitoring assessments of emotions, cognitions, and behaviors (including self-injury). After one month, participants received an EMA feedback survey assessing general and NSSI-specific increases in self-insight, self-efficacy, EMA compliance, beep disturbances, and emotional discomfort.Results: Of 124 participants, 98 completed the EMA survey (Response Rate = 79.03%). Average EMA compliance was 74.87% (SD = 18.78) and decreased linearly across time. Four in five patients (78.57%) reported experiencing at least one benefit. After using EMA, 32.65% reported increased general self-insight, 64.58% reported increased NSSI-specific self-insight, 9.28% reported increased general self-efficacy, and 41.67% reported improved NSSI-specific self-efficacy. Across the sample, 7.29% experienced EMA in treatment as tiring, stressful, at times overwhelming, and not enjoyable. Higher levels of emotional discomfort were significantly associated with lower compliance (r=-0.29, p=.004), higher beep disturbance (r=.37, p < .001), and lower general self-insight (r=-0.28, p=.006).Conclusion: Although the use of EMA in treatment may evoke emotional discomfort in patients, it may help promote NSSI-specific self-insight and self-efficacy outside the therapy room in patients who self-injure.