An interventional study of Cutting Down Program - a three-month cognitive-behavioral psychotherapy focused on reducing self-injury urges and behaviors in adolescents in Self Injurious Behavior and Self Injurious Behavior Without Suicidal Intent, sponsored by University of Haifa. Not yet recruiting at 1 site in Israel. Open to participants aged 12 Years to 18 Years. Per ClinicalTrials.gov, last updated 2026-11-03.
Sponsored by University of Haifa · Not applicable, Interventional, and Treatment
Non-suicidal self-injury (NSSI), defined as deliberate self-inflicted destruction of body tissue without intent to die, is particularly prevalent during mid-adolescence, with prevalence estimated around 16-22% in community samples. Although distinct from suicidality, NSSI is a strong predictor of suicidal attempts. Yet intervention studies addressing self-injury urges and behaviors in youth remain scarce. The Cutting Down Program (CDP) is currently one of the most promising interventions for adolescents who self-harm. This three-month intervention, evidenced in a randomized controlled trial, integrates techniques from cognitive-behavioral (CBT) and dialectic-behavioral (DBT) therapies. Recently, an updated CDP protocol was developed to more directly address suicidality and involve parents in the treatment. This study will test the updated protocol with a sample of adolescents who self-harm, recruited from schools and treated by educational psychologists of the Israeli Psychological and Counseling Services (SHEFI). We will examine the intervention's effects on mental health outcomes (e.g., self-injury) and on potential mediators (emotion regulation and parental emotion socialization), to clarify its mechanisms of change.
The intervention's effects will be assessed in a pilot sample of 40 adolescents aged 12-18. Adolescents identified by school counselors as engaging in self-injury will be referred to SHEFI nationwide, as part of routine assessment and treatment procedures. Twenty expert educational psychologists trained in the CDP will each treat two adolescents. Following an initial intake, the adapted CDP includes 14 weekly sessions over three months: 12 with the adolescent and 3 with the parents. A final follow-up session (session 15) will be held with the adolescent and their parents three months after the end of treatment. Adolescents and one parent (the same parent throughout) will complete self-report questionnaires at four time points: before treatment, after the second parent session (2 months), towards the end of treatment (3 months), and at follow-up (6 months).
All therapists in the study are expert educational psychologists. They will complete a two-day training led by the principal investigator (senior researcher and a clinical psychology experienced with the CDP) and an educational psychologist experienced in the CDP. Following this training, they will take part in year-long group supervision in small groups every two weeks, led by clinical or educational psychologists experienced with the CDP, which will serve as a space for consultation. All training and supervision will be conducted online to allow nationwide participation. Treatment sessions will take place in person at local SHEFI branches.
303 studies on the registry are indexed under Self-Injurious Behavior; 105 are open to participants now.
This study's planned enrollment of 40 is below the median of 70 across 254 interventional studies indexed under Self-Injurious Behavior.
Browse Self-Injurious Behavior studies →University of Haifa is the lead sponsor of 105 studies on the registry; 27 are open to participants now.
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Psychotherapeutic treatment
Behavioral: Cutting Down Program - a three-month cognitive-behavioral psychotherapy focused on reducing self-injury urges and behaviors in adolescents
The CDP protocol in this project consists of 12 weekly individual 50-minute sessions, three parents sessions and one follow-up meeting with the family. Modules include: 1. Psychoeducation about self-injury, understanding personalized functions of self-injury, discussing motivation for change, risk assessment for suicidality and safety plan. 2. Emotional identification and management, activities scheduling, identifying and managing negative thoughts and self-judgment, and committing to goals. 3. Coping strategies, including problem solving, assertiveness, management of anxiety, anger or hopelessness, mindfulness, emotion regulation and alternatives for self-injury. 4. Progress review, identifying triggers and reinforcing coping strategies to maintain progress and post-treatment. Parents meetings focus on psychoeducation about self-injury and skills for emotion validation and support of alternatives to self-injury. The third session involves both parents and adolescents, emphasizing pare
Self injury behaviors
Deliberate Self-Harm Inventory (DSHI): A 6-item self-report assessing the frequency of different types of non-suicidal self-injury behaviors adapted for the last month. The items are rated from 1 (not at all) to 5 (5 times or more), with the request to enter the exact number of self harm behaviors if participant selected any option that is more than 1. The minimum sum score is 6, and the maximun depends on the exact number of self harm behaviors the participant reports, with higher number indicates higher fequency of non-suicidal self injurious behaviors. The scale will also be administered one time before the beginning of the treatment asking about the last 6 months, using only the 1-5 item rating (min sum score: 6, max sum score: 30). The version asking about the last month will be administered at four time points as described in the Time Frame.
Time frame: (1) Before the first treatment meeting (2) 2 months after the treatment starts (after the 2nd parent session), (3) 3 months after the treatment starts (towards the end of the treatment), (4) 3 months after the end of the treatment (follow up).
Self injury thoughts
Alexian Brothers Urge to Self-Injure Scale (ABUSI). A 5-item self-report addressing frequency and intensity of urges to self-injure in the past week. Each item is rated from 1 (not at all) to 7 (almost all the time/strong intensity of urges). The minimal sum score is 5 and the maximal is 35, with higher scores indicating higher frequency and intensity of urges to self-injure.
Time frame: (1) Before the first treatment meeting (2) 2 months after the treatment starts (after the 2nd parent session), (3) 3 months after the treatment starts (towards the end of the treatment), (4) 3 months after the end of the treatment (follow up).
Suicidal thoughts and behaviors
Columbia Suicide Severity Rating Scale, Child Version (C-SSRS). A 7-item self-report assessing incidence and severity of suicidal thoughts and behaviors. The first six items, scored as 0 (no) or 1 (yes), ask about the last two weeks, and the seventh item is an open question asking about the number of suicidal behaviors in the last month. The scale's score is the highest item endorsed among the first six items. Minimum score is 0 and maximum score is 6, with higher score indicating greater severity of suicidal thoughts and behaviors.
Time frame: (1) Before the first treatment meeting (2) 2 months after the treatment starts (after the 2nd parent session), (3) 3 months after the treatment starts (towards the end of the treatment), (4) 3 months after the end of the treatment (follow up).
Depressive symptoms
Short Mood and Feelings Questionnaire (SMFQ); A 13-item self report assessing the the respondent's recent feelings and behaviors, focusing on depressive symptoms in the last two weeks. Each item is rated from 0 (untrue) to 2 (true). The sum score can range from 0 to 26, with higher score indicating more depressive symptoms.
Time frame: (1) Before the first treatment meeting (2) 2 months after the treatment starts (after the 2nd parent session), (3) 3 months after the treatment starts (towards the end of the treatment), (4) 3 months after the end of the treatment (follow up).
Emotion dysregulation
Difficulties in Emotion Regulation Scale (DERS) - short version. An 18-item self-report assessing difficulties in regulating emotional distress. Key dimensions include nonacceptance of emotions, and difficulties in goal-directed behavior, impulse control, emotion awareness and clarity, and in use of regulation strategies. Each item is rated from 1 (almost never) to 5 (almost always). The sum score can range from 18 to 90, with higher score indicating more emotion dysregulation.
Time frame: (1) Before the first treatment meeting (2) 2 months after the treatment starts (after the 2nd parent session), (3) 3 months after the treatment starts (towards the end of the treatment), (4) 3 months after the end of the treatment (follow up).
Parental emotion socialization
Coping with Children's Negative Emotions Scale, measured in two versions: a. Adolescents' Perceptions of Parent (CCNES-APP). b. CCNES-A parent's perception. Each version includes the same nine scenarios depicting adolescents' emotional distress, for which respondents select the parent's responses. Responses range from validating, expressive encouragement, emotion- focus reactions and problem-focus reactions, to distress , minimizing or punitive reactions. There are seven possible parental responses to each of the 9 scenarios, with each response rated from 1 (very unlikely) to 7 (very likely). The final score is divided into two average scores: supportive responses and unsupportive responses. Each score can range from 1 to 7, with higher score indicating greater likelihood that parents use this type of responses. Parents and adolescent versions will be computed separately to create distinct informant scores on parental emotion socialization.
Time frame: (1) Before the first treatment meeting (2) 2 months after the treatment starts (after the 2nd parent session), (3) 3 months after the treatment starts (towards the end of the treatment), (4) 3 months after the end of the treatment (follow up).
Sociodemographic information for descriptive purposes
Data will be collected from parents questionnaire on demographics, household composition, place of birth, parental involvement, parental socioeconomic status and religiosity using questions derived from the Global School-Based Pupil Health Survey (GSHS). The only ordinal items ask about socioeconomic status (min - 1, max - 5, with higher score indicating lower SES), degree of parental education (min - 1, max - 4, with higher score indicating higher educational degree).
Time frame: Before the first treatment meeting.
Plan to share: Yes — Only IPD used in the results publication - upon request or through the university repository. Study design and planned statistical analyses will be registered in OSF on Nov. 2026
Supporting information: Study protocol, Statistical analysis plan, Informed consent form, Clinical study report
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
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