Reducing Non-Suicidal Self-Injury through Body Acceptance Treatment

Participants who engaged in recurrent non-suicidal self-injury (NSSI) and were weight suppressed (WS) reported significant improvements in body image and depressive symptoms compared to controls after an online treatment to increase body acceptance, replicating earlier findings.7  This study found a trend toward decreased perceived likelihood of future non-suicidal self-injury (NSSI)  in intervention participants compared to controls.7

A randomized controlled trial (RCT) of an online version of the Body Project (eBody Project) adapted for male as well as female participants, The Body Acceptance Program, compared to a suicide risk monitoring/crisis intervention control condition was conducted with 60 civilian adults (81% female, 90% White) with WS and recent NSSI.7  The study reported the following:

  • Non-suicidal self-injury (NSSI) is a robust predictor of future suicide attempts1 indicating it is an important risk factor to target for suicide prevention.
  • Greater weight suppression (i.e., the difference between one’s highest adult weight and current weight) has, in turn, been linked to NSSI, creating an opportunity to reduce NSSI via treatments that target mediators between weight suppression and suicide risk, including drive for thinness and depressed mood2. The Body Project, in which verbal, written, and behavioral exercises critique the thin ideal cause cognitive dissonance that results in reduced drive for thinness and depressed mood3–6, supporting its potential value for reducing NSSI. 

This RCT involved online recruitment and assessment with suicide monitoring and crisis intervention from graduate students, so there is no evidence for military participants or context. Given the online modality, the intervention could be implemented as an online treatment with clinician support for suicide monitoring in military settings. Of note, there are extensive resources available for the group based Body Project intervention at, but resources for the online eBody Project and the adapted The Body Acceptance Program used in this trial are not currently publicly available.8

1. Franklin, J. C. et al. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol. Bull. 143, 187–232 (2017).
2. Keel, P. K., Jean Forney, K., Buchman-Schmitt, J. M., Kennedy, G. A. & Joiner, T. E. Examining the link between weight suppression and non-suicidal self-injurious behaviors. Eat. Behav. 30, 66–71 (2018).*
3. Stice, E., Rohde, P., Durant, S. & Shaw, H. A preliminary trial of a prototype internet dissonance-based eating disorder prevention program for young women with body image concerns. J. Consult. Clin. Psychol. 80, 907–916 (2012).
4. Stice, E., Shaw, H., Burton, E. & Wade, E. Dissonance and Healthy Weight Eating Disorder Prevention Programs: A Randomized Efficacy Trial. J. Consult. Clin. Psychol. 74, 263–275 (2006).
5. Mitchell, K. S., Mazzeo, S. E., Rausch, S. M. & Cooke, K. L. Innovative interventions for disordered eating: Evaluating dissonance-based and yoga interventions. Int. J. Eat. Disord. 40, 120–128 (2007).
6. Becker, C. B., Smith, L. & Ciao, A. C. Reducing eating disorder risk factors in sorority members: A randomized trial. Behav. Ther. 36, 245–253 (2005).
7. Kennedy, G. A. et al. Reducing anticipated non-suicidal self-injury by improving body esteem in individuals with weight suppression: A proof of concept study. Int. J. Eat. Disord. 52, 206–210 (2019).*
8. Stice, E., Rohde, P., Shaw, H., & Gau, J. M. (2020). Clinician-led, peer-led, and internet-delivered dissonance-based eating disorder prevention programs: Effectiveness of these delivery modalities through 4-year follow-up. Journal of consulting and clinical psychology, 88(5), 481–494.