Understanding the Context of Novel Interventions for Self-Injurious Thoughts and Behaviors: A Reply to Nielsen et al.

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Abstract

In this response to the commentary by Nielsen, Kirtley, & Townsend (in press), the authors note several points of agreement related to further testing of therapeutic evaluative conditioning (TEC) for self-injurious thoughts and behaviors (SITBs), navigating logistical and ethical issues surrounding mobile interventions, and integrating such interventions into traditional practice. They also note a common mission held by Nielsen et al., themselves, and the SITB research community more broadly: the large-scale reduction of SITBs. Given that national rates of SITBs have never declined appreciably and have been on the rise in recent decades, there is an urgent need for progress toward this goal. However, they also highlight several unsupported or inaccurate assumptions and specific points made by Nielsen et al. that are important to correct for the sake of accuracy and progress in the prediction and prevention of SITBs. These include an overly narrow conceptualization of what constitutes an intervention; an unsupported model of the causes of SITBs and how to best prevent them; an erroneous belief about the iatrogenic effects of SITB stimulus exposure; and inaccuracies in their description of the development, testing, and release of TEC. The authors hope that this brief discussion of the evidence will facilitate progress toward the mission of large-scale reductions in SITBs.

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