A family-based blended psychological programme for adolescents with non-suicidal self- injury: feasibility, acceptability, and preliminary outcomes

Imagine the human mind as a high-performance car. Sometimes, the engine runs hot, the brakes feel sticky, or the navigation system glitches, leading the driver to make dangerous turns. In the world of psychology, this is often called Non-Suicidal Self-Injury (NSSI). It's when a person, usually a teenager, deliberately hurts their own body—like cutting or burning—not to end their life, but to cope with overwhelming emotional pain. It's a signal that the car's internal systems are overwhelmed.

For a long time, doctors have tried to fix these "engines" using powerful tools like Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). Think of these as master mechanics who teach drivers how to tune their engines and handle the road better. But there's a catch: these mechanics are rare, expensive, and the lessons are long and intense. Meanwhile, the digital world offers a new kind of tool: apps and online programs that act like a GPS, guiding drivers step-by-step. But a GPS alone can be lonely, and a mechanic alone can be hard to find. The big question for science right now is: What happens if we build a blended garage? One where a real mechanic checks the engine face-to-face, but also hands the driver a high-tech GPS to use on their own? This paper explores exactly that idea, testing if mixing human connection with digital support can help teenagers and their families navigate the rough roads of self-injury.

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The Experiment: A Blended Garage for Troubled Teens

A team of researchers in China decided to test this "blended garage" idea. They set up a study in a psychiatric hospital, inviting 60 pairs of teenagers and their main caregivers (usually parents) to join. The goal was to see if a six-week program that mixed face-to-face group sessions with a WeChat mini-program (a popular app in China) could help.

The researchers split the families into two groups based on the order they arrived at the hospital, like lining up cars at a service station.

• The Intervention Group: These families got the full "blended" treatment. They met in small groups for face-to-face sessions where they learned skills like how to spot negative thoughts, how to calm down when emotions run high, and how to talk to each other without fighting. But they didn't stop there. They also used a WeChat app called "Zhiji 2.0" to do homework. The app gave them short, 15-to-20-minute lessons three times a week, covering things like mindfulness and how to handle stress.
• The Routine Care Group: These families got the standard care the hospital usually provides. They still saw doctors and nurses, and they even got some check-ins (via phone or WeChat) just to make sure they were okay, but they didn't get the specific skills training or the structured app lessons.

What They Found: The Engine Runs Smoother

After six weeks, the researchers checked the "gauges" on both groups. They looked at how much self-injury happened, how hard it was for the teens to control their emotions, and how much anxiety or depression everyone felt. They also asked the families if they liked the program.

Here is the story of what happened:

1. The Teens Got Better
The teenagers in the blended group showed a much bigger drop in self-injury behaviors compared to the routine care group. It wasn't just a tiny change; the numbers suggested a real improvement. They also felt less depressed and less anxious. Imagine a driver who was previously swerving wildly now finding a steady lane; that's what the data showed for the teens in the blended program.

2. The Parents Got a Boost, Too
This is a crucial part of the story. The parents (caregivers) in the blended group also felt better. Their own anxiety and depression scores went down more than the parents in the routine care group. It seems that when the whole family learns the same "driving skills" together, the stress on the parents eases up, too.

3. The "Family Car" Didn't Change Much
Interestingly, the study didn't find a clear difference in how the families functioned as a unit. The researchers measured things like how well the family got along and supported each other. While the individuals felt better, the overall "family engine" didn't seem to shift dramatically in just six weeks. The authors suggest that family dynamics are like old, rusted gears; they might need more time or a different kind of wrench to fix than just six weeks of lessons.

4. Did People Actually Use the Tools?
The researchers wanted to know if the program was practical.

• Recruitment: They successfully signed up 90.9% of the eligible families who were asked.
• Sticking with it: 80% of the families finished the whole study.
• Using the App: Most teens and parents actually did the app lessons. About 87% of the teens completed at least 13 out of 16 online sessions, and they spent an average of 249.6 minutes on the app. The parents were a bit busier, completing about 12.7 sessions on average.
• Face-to-Face: Most families attended the in-person group sessions, though some missed a session due to feeling unwell or scheduling conflicts.

5. Safety First
The researchers kept a close eye on safety. During the study, a few participants in both groups (about 8% total) showed signs of higher suicide risk. This happened in both the blended group and the routine care group, meaning the new program didn't accidentally make things worse, nor did it completely prevent these risks (which is expected in such a serious condition). In every case, the medical team stepped in immediately to keep everyone safe. No one got seriously hurt physically from self-injury during the study.

The Verdict: A Promising New Tool

The paper concludes that this blended approach is feasible (it can be done in a real hospital) and acceptable (families liked it). It suggests that mixing face-to-face therapy with digital homework is a practical way to help teenagers who hurt themselves and their families.

However, the authors are careful not to call this a "cure" or a "magic bullet." They describe the results as preliminary support. Because the study wasn't a perfect random lottery (they used admission order to assign groups) and the sample size was relatively small (48 families finished), they can't say for sure that the program caused all the improvements yet. They also noted that the study was short, so we don't know if the benefits last for months or years.

In short, the study suggests that giving teenagers and their parents a "hybrid toolkit"—part human coach, part digital guide—is a promising way to start fixing the engine. It's not the final answer, but it's a very strong hint that this is the right direction to drive.