Korean Journal of Culture and Social Issue (한국심리학회지 : 문화 및 사회문제)

Korean Psychological Association of Culture and Social Issues (한국문화및사회문제심리학회)
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Factors affecting Non-suicidal self-injury: Ecological Momentary Assessment using a Daily Diary Method study

일상생활에서의 비자살적 자해에 영향을 미치는 요인: 생태순간평가 일기법 연구

  • 권호인 (전주대학교 상담심리학과) ;
  • 김선진 (서천군 청소년상담복지센터)
  • Received : 2023.06.16
  • Accepted : 2023.07.21
  • Published : 2023.08.31
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Abstract

This study was conducted to understand the emotional and situational context where non-suicidal self-injury occurs in everyday life. Sixty adults(age 19-35) completed daily surveys assessing positive and negative emotions, stressful events, self-injury thoughts, and behaviors for two weeks. Using a total of 663 collected entries, we analyzed specific personal emotions and stressful events related to non-suicidal self-injurious thoughts and behaviors. As a result, high negative emotions, low positive emotions, and total stress event scores were significantly related to self-injury thoughts and behaviors. In the model in which both emotion and stress were inserted as predictors, the low level of positive emotion showed a significant related to non-suicidal self-injurious behavior. These results suggest that negative emotion management and overall positive emotion reinforcement are important in emotion regulation intervention for non-suicidal self-injurious patients. The meaning of this study is that it searched for risk factors of non-suicidal injury in everyday life using a short-term longitudinal method.

본 연구는 일상생활에서 비자살적 자해가 발생하는 정서 및 상황적 맥락을 파악하고자 하는 목적으로 수행되었다. 이를 위해 만 19세 이상 35세 이하의 성인 60명이, 14일 동안 하루에 한 번씩 전자일기에 접속하여 그날의 긍정 및 부정 정서, 스트레스 사건, 자해 사고 및 행동 여부에 대해 기록하였다. 수집된 총 663건의 엔트리를 활용하여 비자살적 자해 사고 및 행동과 관련된 개인의 정서, 스트레스 사건을 분석하였다. 그 결과, 개인 간 수준의 높은 부정 정서와 낮은 긍정 정서, 스트레스 사건 총점은 각각 자해 사고 및 행동과 유의한 관련성을 보였다. 부정 및 긍정 정서와 스트레스 모두가 투입된 모형에서는 개인 간 수준의 낮은 긍정 정서가 비자살적 자해 행동과 유의한 관련성을 보였다. 이러한 결과는 비자살적 자해 경험자의 정서 조절 개입에 있어 부정 정서 관리뿐 아니라 긍정 정서 강화가 중요하다는 것을 시사한다. 본 연구는 단기 종단적 방법을 통해 일상생활에서 비자살적 자해의 위험 요인을 탐색했다는 것에 연구의 의의가 있다.

Keywords

Acknowledgement

이 논문은 2020년 대한민국 교육부와 한국연구재단의 인문사회분야 중견연구자지원사업의 지원을 받아 수행된 연구임(NRF-2020S1A5A2A010428588)

References

  1. 강상진 (2016). 다층모형. 서울: 학지사.
  2. 권혁진, 권석만 (2017). 한국판 자해기능 평가지(The Functional Assessment of Self-Mutilation)의 타당화 연구: 대학생을 중심으로. 한국심리학회지: 임상심리 연구와 실제, 3(1), 187-205.
  3. 김지윤, 김성연, 이동훈 (2020). 비자살적 자해의 중단 및 유지집단 간 비교연구: 자해 특성과 통합적 이론모델의 위험요인을 중심으로. 한국심리학회지: 상담 및 심리치료, 32(3), 1095-1124. https://doi.org/10.23844/KJCP.2020.08.32.3.1095
  4. 김지윤, 조영희, 이동훈 (2021). 여자 대학생의 비자살적 자해 유지에 대한 사례연구: 생물심리사회모델을 중심으로. 한국심리학회지: 상담 및 심리치료 33(1), 29-60. https://doi.org/10.23844/KJCP.2021.02.33.1.29
  5. 백선혜 (2019). 청소년 자해 경험에 대한 현상학적 연구. 한양대학교 일반대학원 박사학위논문.
  6. 우 정, 권호인 (2021). 생태순간평가(EMA) 일기법을 활용한 비자살적 자해경험 분석. 한국콘텐츠학회논문지, 21(3), 720-729. https://doi.org/10.5392/JKCA.2021.21.03.720
  7. 이재호, 조윤영, 전정윤 (2018.11.10). "중고생 7만여명 자해 경험... 우리아이는 상관없다고요?". 한겨레21. https://www.hani.co.kr/arti/society/society_general/869668.html
  8. 정은지, 이승연 (2021). 대학생의 스트레스, 부정정서, 비자살적 자해의 관계: 부정 긴급성과 긍정정서의 조절된 매개효과. 한국심리학회지: 발달, 34(1), 81-100. https://doi.org/10.35574/KJDP.2021.3.34.1.81
  9. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA.
  10. Armey, M. F., Crowther, J. H., & Miller, I. W. (2011). Changes in ecological momentary assessment reported affect associated with episodes of nonsuicidal self-injury. Behavior Therapy, 42(4), 579-588.
  11. Baetens, I., Claes, L., Muehlenkamp, J., Grietens, H., & Onghena, P. (2011). Non-suicidal and suicidal self-injurious behavior among flemish adolescents: A web-survey. Archives of Suicide Research, 15(1), 56-67.
  12. Berman, J., & Wallace, P. H. (2007). Cutting and the pedagogy of self-disclosure. University of Massachusetts Press.
  13. Brittlebank, A. D., Cole, A., Hassanyeh, F., Kenny, M., Simpson, D., & Scott, J. (1990). Hostility, hopelessness and deliberate self harm: A prospective follow-up study. Acta Psychiatrica Scandinavica, 81(3), 280-283. https://doi.org/10.1111/j.1600-0447.1990.tb06497.x
  14. Claes, L., Houben, A., Vandereycken, W., Bijttebier, P., & Muehlenkamp, J. (2010). Brief report: The association between non-suicidal self-injury, self-concept and acquaintance with self-injurious peers in a sample of adolescents. Journal of Adolescence, 33(5), 775-778. https://doi.org/10.1016/j.adolescence.2009.10.012
  15. Fahrenberg, J., Myrtek, M., Pawlik, K., & Perrez, M. (2007). Ambulatory assessment-monitoring behavior in daily life settings. European Journal of Psychological Assessment, 23(4), 206-213. https://doi.org/10.1027/1015-5759.23.4.206
  16. Fawcett, J., Clark, D. C., & Busch, K. A. (1993). Assessing and treating the patient at risk for suicide. Psychiatric Annals, 23(5), 244-255. https://doi.org/10.3928/0048-5713-19930501-05
  17. Guerry, J. D., & Prinstein, M. J. (2009). Longitudinal prediction of adolescent nonsuicidal self-injury: Examination of a cognitive vulnerability-stress model. Journal of Clinical Child & Adolescent Psychology, 39(1), 77-89. https://doi.org/10.1080/15374410903401195
  18. Hasking, P., Rees, C. S., Martin, G., & Quigley, J. (2015). What happens when you tell someone you self-injure? The effects of disclosing NSSI to adults and peers. BMC public health, 15, 1-9.
  19. Heath, N. L., Ross, S., Toste, J. R., Charlebois, A., & Nedecheva, T. (2009). Retrospective analysis of social factors and nonsuicidal self-injury among young adults. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 41(3), 180-186. https://doi.org/10.1037/a0015732
  20. Hillbrand, M. (1995). Aggression against self and aggression against others in violent psychiatric patients. Journal of Consulting and Clinical Psychology, 63(4), 668-671. https://doi.org/10.1037/0022-006X.63.4.668
  21. Hilt, L. M., Cha, C. B., & Nolen-Hoeksema, S. (2008). Nonsuicidal self-injury in young adolescent girls: moderators of the distressfunction relationship. Journal of Consulting and Clinical Psychology, 76(1), 63-71. https://doi.org/10.1037/0022-006X.76.1.63
  22. Hooley, J. M., & St. Germain, S. A. (2014). Nonsuicidal self-injury, pain, and self-criticism: Does changing self-worth change pain endurance in people who engage in self-injury? Clinical Psychological Science, 2(3), 297-305. https://doi.org/10.1177/2167702613509372
  23. Kerr, P. L., Muehlenkamp, J. J., & Turner, J. M. (2010). Nonsuicidal self-injury: a review of current research for family medicine and primary care physicians. The Journal of the American Board of Family Medicine, 23(2), 240-259. https://doi.org/10.3122/jabfm.2010.02.090110
  24. Kiekens, G., Hasking, P., Nock, M. K., Boyes, M., Kirtley, O., Bruffaerts, R., Myin-Germeys, I., & Claes, L. (2020). Fluctuations in affective states and self-efficacy to resist non-suicidal self-injury as real-time predictors of non-suicidal self-injurious thoughts and behaviors. Frontiers in Psychiatry, 11, Article 214. https://doi.org/10.3389/fpsyt.2020.00214
  25. Klonsky, E. D. (2011). Non-suicidal self-injury in United States adults: prevalence, sociodemographics, topography and functions. Psychological medicine, 41(9), 1981-1986. https://doi.org/10.1017/S0033291710002497
  26. Klonsky, E. D., & Muehlenkamp, J. J. (2007). Self-injury: A research review for the practitioner. Journal of clinical psychology, 63(11), 1045-1056. https://doi.org/10.1002/jclp.20412
  27. Klonsky, E. D., & Olino, T. M. (2008). Identifying clinically distinct subgroups of self-injurers among young adults: a latent class analysis. Journal of consulting and clinical psychology, 76(1), 22-27. https://doi.org/10.1037/0022-006X.76.1.22
  28. Lloyd, E. E., Kelley, M. L., & Hope, T. (1997). Self-mutilation in a community sample of adolescents: Descriptive characteristics and provisional prevalence rates. Poster session presented at the annual meeting of the Society for Behavioral Medicine, New Orleans, LA.
  29. Muehlenkamp, J., Brausch, A., Quigley, K., & Whitlock, J. (2013). Interpersonal features and functions of nonsuicidal self-injury. Suicide and Life- Threatening Behavior, 43(1), 67-80. https://doi.org/10.1111/j.1943-278X.2012.00128.x
  30. Muehlenkamp, J. J., Engel, S. G., Wadeson, A., Crosby, R. D., Wonderlich, S. A., Simonich, H., & Mitchell, J. E. (2009). Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients. Behaviour Research and Therapy, 47(1), 83-87. https://doi.org/10.1016/j.brat.2008.10.011
  31. Nock, M. K., & Favazza, A. R. (2009). Nonsuicidal self-injury: Definition and classification. In M. K. Nock (Ed.), Understanding nonsuicidal self-injury: Origins, assessment, and treatment (pp. 9-18). American Psychological Association.
  32. Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-Injurious Thoughts and Behaviors Interview: development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309-317. https://doi.org/10.1037/1040-3590.19.3.309
  33. Nock, M. K., Joiner Jr, T. E., Gordon, K. H., Lloyd-Richardson, E., & Prinstein, M. J. (2006). Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144(1), 65-72. https://doi.org/10.1016/j.psychres.2006.05.010
  34. Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72(5), 885-890. https://doi.org/10.1037/0022-006X.72.5.885
  35. Nock, M. K., Prinstein, M. J., & Sterba, S. K. (2009). Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults. Journal of Abnormal Psychology, 118(4), 816-827. https://doi.org/10.1037/a0016948
  36. Nock, M. K. (2010). Self-injury. Annual review of clinical psychology, 6, 339-363. https://doi.org/10.1146/annurev.clinpsy.121208.131258
  37. Ross, S., & Heath, N. (2002). A study of the frequency of self-mutilation in a community sample of adolescents. Journal of Youth and Adolescence, 31, 67-77. https://doi.org/10.1023/A:1014089117419
  38. Shiffman, S., Stone, A. A., & Hufford, M. R. (2008). Ecological momentary assessment. Annu. Rev. Clin. Psychol., 4, 1-32. https://doi.org/10.1146/annurev.clinpsy.3.022806.091415
  39. Shingleton, R. M., Eddy, K. T., Keshaviah, A., Franko, D. L., Swanson, S. A., Yu, J. S., ... & Herzog, D. B. (2013). Binge/purge thoughts in nonsuicidal self-injurious adolescents: An ecological momentary analysis. International Journal of Eating Disorders, 46(7), 684-689. https://doi.org/10.1002/eat.22142
  40. Simeon, D., Stanley, B., Frances, A,. Mann, J. J., Winchel, R., & Stanley, M. (1992). Self-mutilation in personality disorders: psychological and biological correlates. The American Journal of Psychiatry. 149(2), 221-226.
  41. Tice, D. M., Bratslavsky, E., & Baumeister, R. F. (2001). Emotional distress regulation takes precedence over impulse control: If you feel bad, do it!. Journal of Personality and Social Psychology, 80(1), 53.
  42. Turner, B. J., Cobb, R. J., Gratz, K. L., & Chapman, A. L. (2016). The role of interpersonal conflict and perceived social support in nonsuicidal self-injury in daily life. Journal of Abnormal Psychology, 125(4), 588-598. https://doi.org/10.1037/abn0000141
  43. Turner, B. J., Wakefield, M. A., Gratz, K. L., & Chapman, A. L. (2017). Characterizing interpersonal difficulties among young adults who engage in nonsuicidal self-injury using a daily diary. Behavior Therapy, 48(3), 366-379. https://doi.org/10.1016/j.beth.2016.07.001
  44. Turner, B. J., Yiu, A., Claes, L., Muehlenkamp, J. J., & Chapman, A. L. (2016). Occurrence and co-occurrence of nonsuicidal self-injury and disordered eating in a daily diary study: Which behavior, when?. Psychiatry Research, 246, 39-47. https://doi.org/10.1016/j.psychres.2016.09.012
  45. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063-1070. https://doi.org/10.1037/0022-3514.54.6.1063
  46. Whitlock, J., Muehlenkamp, J., & Eckenrode, J. (2008). Variation in nonsuicidal self-injury: Identification and features of latent classes in a college population of emerging adults. Journal of Clinical Child & Adolescent Psychology, 37(4), 725-735. https://doi.org/10.1080/15374410802359734
  47. Wilkins, J., & Coid, J. (1991). Self-mutilation in female remanded prisoners: I. An indicator of severe psychopathology. Criminal Behaviour and Mental health, 1(3), 247-267. https://doi.org/10.1002/cbm.1991.1.3.247