Examining the Role of Theory of Mind and Emotion Regulation in Predicting Self-harming Behaviors in Adolescents

Document Type : Original Article

Authors

1 Department of Psychology, Payame Noor University, Tehran, Iran

2 Department of Psychology, Islamic Azad University, Rasht Branch, Rasht, Iran

3 Department of Psychology, Islamic Azad University, Science and Research Branch, Tehran, Iran

4 Department of Psychology, Islamic Azad University, Bushehr Branch, Bushehr, Iran

Abstract

Background: Self-harm has emerged as a significant concern within the realm of public health, particularly during the adolescent years, where such behaviors have witnessed a notable escalation.
 
Objectives: This study aims to explore the influence of the theory of mind and emotion regulation in the anticipation of self-harming tendencies among adolescents.
 
Methods: The study was conducted using both correlational and cross-sectional design. The target population for this research consisted of all adolescents residing in Tehran from April to November 2023 who had previously engaged in self-harming actions. The target population encompassed all teenagers in Tehran with a history of self-harming behaviors. A sample of 89 teenagers with such a history was selected through the purposive sampling method. The research employed several measurement instruments, including the Theory of Mind Scale, the Cognitive Emotion Regulation Questionnaire, and the Self-Harm Inventory. The collected data were analyzed in SPSS version 27 software using Pearson correlation and multiple regression techniques. The significance level for this research was set at 0.05.
 
Results: The current study findings indicated that the initial statement of the theory of mind had no significant impact on self-harm (P=0.593). However, the components of the Introductory Theory of Mind (P=0.001) and Advanced Aspects of the Theory of Mind (P=0.009) had a detrimental and significant influence on self-harm.
 
Conclusion: Regarding the components of the theory of mind, the introductory theory of mind and more advanced aspects have a mitigating effect on self-harm in teenagers who engage in self-harming behaviors.

Keywords


Acknowledgments: The information in this article is taken from the author’s thesis, which was approved by the Ethics Code: IR.PNU.REC.1402.246. The author expresses thanks and recognition to all the people who took part in the study and offered help, as well as their families.

 

Availability of data and materials: The study's dataset can be accessed upon request from the corresponding author either during the submission process or after the publication of the study

 

Conflicts of interests: There is no conflict of interest.

 

Consent for publication: The Publisher must receive the signed Consent to Publish from the Authors in order to publish their Work.

 

Ethics approval and consent to participate: The information in this article is taken from the author’s thesis, which was approved by the Ethics Code: IR.PNU.REC.1402.246. T. Informed consent was also obtained. The study was conducted in accordance with the principles of the Helsinki Declaration.

 

Financial disclosure: This study did not receive any funding support.

 

Author contributions: Z. A.: Contributed to the conception of the work, revising the draft; M.D.: Approving the final version of the manuscript, Z. A.: Agreeing on all aspects of the work; M.D. and F.M. P.: Contributed to the data analysis and interpretation, critical revision, and approval of the final version of the manuscript; S. A. and M. R.: Contributed to acquiring data, drafting the manuscript, and approving the final version; F.M. P. and S. A.: Contributed to the conception and design of the study, critical revision, and approval of the manuscript's final version; M. R.: Contributed to the conception and design of the study, data interpretation, drafting of the manuscript and critical revision, and approval of final version.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

1. Ying WK, Rahman M, Kiyu A. Prevalence and Factors Determining Adolescents Risk Taking Behaviours in Sarawak, Malaysia. IIUM Medical Journal Malaysia. 2024 Jan 1;23(01). https://doi.org/10.31436/imjm.v23i01.2425
https://doi.org/10.31436/imjm.v23i01.2425
 
2. Varley D, Fenton C, Gargan G, Taylor O, Taylor A, Kirby N, Morton M, Barrow J, Hatton C, Wright B. A systematic review of systematic reviews exploring the factors related to child and adolescent self-harm. Adolescent Psychiatry. 2022 Jul 1;12(2):79-114. https://doi.org/10.2174/2210676612666220721101210
https://doi.org/10.2174/2210676612666220721101210  
 
3. Leddie G, Fox C, Simmonds S. Nurses' experiences of working in the community with adolescents who self-harm: A qualitative exploration. J Psychiatr Ment Health Nurs. 2022 Oct;29(5):744-754. doi: 10.1111/jpm.12806 (PubMed: 34797016).
https://doi.org/10.1111/jpm.12806
PMid:34797016  
 
4. Kookalani Z, Bahari M, Sanatkaran A. The Effect of Eight Weeks of Aerobic Exercise on Self-Harm Symptoms in Adolescent Girls in Karaj. Journal of Applied Psychological Research. 2020 Aug 22;11(2):241-53. 10.22059/japr.2020.287526.643338  
 
5. Ghamooshi F, Sobhi A, Kiani Q, Ahmadi MS. The Relationship of Emotional Child Abuse, Borderline Personality, and Self-harm Behavior with the Mediating Role of Object Relation in Female Adolescents. International Journal of School Health. 2022 Jan 1;9(1):26-35. 10.30476/intjsh.2022.93307.1192  
 
6. Dorol O, Mishara BL. Systematic review of risk and protective factors for suicidal and self-harm behaviors among children and adolescents involved with cyberbullying. Preventive medicine. 2021 Nov 1;152:106684. https://doi.org/10.1016/j.ypmed.2021.106684
https://doi.org/10.1016/j.ypmed.2021.106684
PMid:34538376  
 
7. Iveson MH, Ball EL, Whalley HC, Deary IJ, Cox SR, Batty GD, John A, McIntosh AM. Childhood cognitive ability and self-harm and suicide in later life. medRxiv (Preprint). 2023 Feb 11:2023.02.10.23285747. doi: 10.1101/2023.02.10.23285747 . (PubMed: 36798203).
https://doi.org/10.1101/2023.02.10.23285747  
 
8. Shafti M, Taylor PJ, Forrester A, Pratt D. The Co-occurrence of Self-Harm and Aggression: A Cognitive-Emotional Model of Dual-Harm. Front Psychol. 2021 Feb 25;12:586135. doi: 10.3389/fpsyg.2021.586135 .(PubMed: 33716854).
https://doi.org/10.3389/fpsyg.2021.586135
PMid:33716854 PMCid:PMC7946988  
 
9. Qian H, Shu C, Feng L, Xiang J, Guo Y, Wang G. Childhood Maltreatment, Stressful Life Events, Cognitive Emotion Regulation Strategies, and Non-suicidal Self-Injury in Adolescents and Young Adults With First-Episode Depressive Disorder: Direct and Indirect Pathways. Front Psychiatry. 2022 Apr 12;13:838693. doi: 10.3389/fpsyt.2022.838693 .(PubMed: 35492724).
https://doi.org/10.3389/fpsyt.2022.838693
PMid:35492724 PMCid:PMC9039129  
 
10. Madjar N, Segal N, Eger G, Shoval G. Exploring Particular Facets of Cognitive Emotion Regulation and Their Relationships With Non-suicidal Self-Injury Among Adolescents. Crisis. 2019 Jul;40(4):280-286. doi: 10.1027/0227-5910/a000566 .(PubMed: 35492724).
https://doi.org/10.1027/0227-5910/a000566
PMid:30813824  
 
11. Dour HJ, Cha CB, Nock MK. Evidence for an emotion-cognition interaction in the statistical prediction of suicide attempts. Behav Res Ther. 2011 Apr;49(4):294-8. doi: 10.1016/j.brat.2011.01.010.(PubMed: 21353203).
https://doi.org/10.1016/j.brat.2011.01.010
PMid:21353203  
 
12. Chen H, Hong L, Tong S, Li M, Sun S, Xu Y, Liu J, Feng T, Li Y, Lin G, Lu F, Cai Q, Xu D, Zhao K, Zheng T. Cognitive impairment and factors influencing depression in adolescents with suicidal and self-injury behaviors: a cross-sectional study. BMC Psychiatry. 2023 Apr 12;23(1):247. doi: 10.1186/s12888-023-04726-8 .(PubMed: 37046299).
https://doi.org/10.1186/s12888-023-04726-8
PMid:37046299 PMCid:PMC10099683  
 
13. Cha CB, Wilson KM, Tezanos KM, DiVasto KA, Tolchin GK. Cognition and self-injurious thoughts and behaviors: A systematic review of longitudinal studies. Clin Psychol Rev. 2019 Apr;69:97-111. doi: 10.1016/j.cpr.2018.07.002 .(PubMed: 30166197).
https://doi.org/10.1016/j.cpr.2018.07.002
PMid:30166197  
 
14. Hasking P, Whitlock J, Voon D, Rose A. A cognitive-emotional model of NSSI: using emotion regulation and cognitive processes to explain why people self-injure. Cogn Emot. 2017 Dec;31(8):1543-1556. doi: 10.1080/02699931.2016.1241219 .(PubMed: 30166197).
https://doi.org/10.1080/02699931.2016.1241219
PMid:27702245  
 
15. Alkire D, McNaughton KA, Yarger HA, Shariq D, Redcay E. Theory of mind in naturalistic conversations between autistic and typically developing children and adolescents. Autism. 2023 Feb;27(2):472-488. doi: 10.1177/13623613221103699 .(PubMed: 35722978).
https://doi.org/10.1177/13623613221103699
PMid:35722978 PMCid:PMC9763550  
 
16. Devine RT, Apperly IA. Willing and able? Theory of mind, social motivation, and social competence in middle childhood and early adolescence. Dev Sci. 2022 Jan;25(1):e13137. doi: 10.1111/desc.13137 .(PubMed: 34235829).
https://doi.org/10.1111/desc.13137
PMid:34235829  
 
17. Sotomayor-Enriquez K, Gweon H, Saxe R, Richardson H. Open dataset of theory of mind reasoning in early to middle childhood. Data Brief. 2023 Dec 2;52:109905. doi: 10.1016/j.dib.2023.109905 .(PubMed: 38146306).
https://doi.org/10.1016/j.dib.2023.109905
PMid:38146306 PMCid:PMC10749232  
 
18. Smogorzewska J, Szumski G, Bosacki S, Grygiel P, Osterhaus C. Longitudinal relations between theory of mind and academic achievement among deaf and hard-of-hearing school-aged children. J Exp Child Psychol. 2024 Mar;239:105806. doi: 10.1016/j.jecp.2023.105806 .(PubMed: 37967482).
https://doi.org/10.1016/j.jecp.2023.105806
PMid:37967482  
 
19. Laghi F, Terrinoni A, Cerutti R, Fantini F, Galosi S, Ferrara M, Bosco FM. Theory of mind in non-suicidal self-injury (NSSI) adolescents. Conscious Cogn. 2016 Jul;43:38-47. doi: 10.1016/j.concog.2016.05.004 .(PubMed: 27236355).
https://doi.org/10.1016/j.concog.2016.05.004
PMid:27236355  
 
20. Moon H, Nam G, Hur JW. Neural correlates of affective theory of mind in medication-free non-suicidal self-injury: An fMRI study. Front Psychiatry. 2022 Jul 22;13:850794. doi: 10.3389/fpsyt.2022.850794 .(PubMed: 35935406).
https://doi.org/10.3389/fpsyt.2022.850794
PMid:35935406 PMCid:PMC9354394  
 
21. Fidell LS, Tabachnick BG. Preparatory data analysis. Handbook of psychology: Research methods in psychology. 2003 Mar 19;2:115-41.
https://doi.org/10.1002/0471264385.wei0205  
 
22. Muris P, Steerneman P, Meesters C, Merckelbach H, Horselenberg R, van den Hogen T, van Dongen L. The TOM test: A new instrument for assessing theory of mind in normal children and children with pervasive developmental disorders. Journal of autism and developmental disorders. 1999 Feb;29:67-80. https://link.springer.com/article/10.1023/A:1025922717020
https://doi.org/10.1023/A:1025922717020
PMid:10097996  
 
23. Aliakbari M, Juibari AK, Amirabadi F, Shaghaghi F, Zare N, Khaleghi F. The role of Theory of Mind and executive function in predicting empathy. Advances in Cognitive Science. 2013. https://psycnet.apa.org/record/2013-44426-001  
 
24. Khorashad BS, Baron-Cohen S, Roshan GM, Kazemian M, Khazai L, Aghili Z, Talaei A, Afkhamizadeh M. The "Reading the Mind in the Eyes" test: investigation of psychometric properties and test-retest reliability of the persian version. Journal of autism and developmental disorders. 2015 Sep;45:2651-66. https://link.springer.com/article/10.1007/s10803-015-2427-4
https://doi.org/10.1007/s10803-015-2427-4
PMid:25832800  
 
25. Garnefski N, Koopman H, Kraaij V, ten Cate R. Brief report: Cognitive emotion regulation strategies and psychological adjustment in adolescents with a chronic  
 
disease. Journal of adolescence. 2009 Apr;32(2):449-54. https://doi.org/10.1016/j.adolescence.2008.01.003
https://doi.org/10.1016/j.adolescence.2008.01.003
PMid:18775562  
 
26. Samani S, Sadeghi L. Psychometric properties of the cognitive emotion regulation questionnaire. Psychological methods and models. 2010 Sep 23;1(1):51-62. https://dorl.net/dor/20.1001.1.22285516.1389.1.1.5.9  
 
27. Mizani S, Rezaei A, Khayyer M, Shegefti NS. The Mediating Role of Cognitive Emotion Regulation for Maladaptive Schemas and Negative Affects AmongYouth. Quarterly Journal of Psychological Methods and Models Spring. 2021;12(43).DOI:10.30495/jpmm.2021.4712  
 
28. Sansone RA, Wiederman MW, Sansone LA. The self‐harm inventory (SHI): Development of a scale for identifying self‐destructive behaviors and borderline personality disorder. Journal of clinical psychology. 1998 Nov;54(7):973-83. https://doi.org/10.1002/(SICI)1097-4679(199811)54:7%3C973::AID-JCLP11%3E3.0.CO;2-H
https://doi.org/10.1002/(SICI)1097-4679(199811)54:7<973::AID-JCLP11>3.0.CO;2-H  
 
29. Sansone RA, Sansone LA. Measuring self-harm behavior with the self-harm inventory. Psychiatry (Edgmont). 2010 Apr 1;7(4):16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877617/  
 
30. Hashemi Razini H, Dehghan M, Rasooli A. Discrimination self-harming individuals from normal people based on positive and negative experiences, neuroticism and motivational values characters. Quarterly of Applied Psychology. 2019;12(4):553-71.  
 
31. Karimi F, Farahbakhsh K, Moatamedi A, Salimi H. Self-harm Behavior Affected by Mentalization and Family Relationships in high school Girl's Adolescents 14-18 years old (Qualitative Research). Knowledge & Research in Applied Psychology. 2021 Nov 22;22(3):47-61. https://doi.org/10.30486/jsrp.2019.582144.1633  
 
32. HUANG F, LIU T. Effect of theory of mind on non-suicidal self-injury behavior in adolescent patients with depressive disorder for the first hospitalization. Chinese Journal of Behavioral Medicine and Brain Science. 2022:990-5. https://pesquisa.bvsalud.org/portal/resource/pt/wpr-956192  
 
33. Sundar SP, Bhola P. Dimensional Personality Traits and Non-suicidal Self Injury Among Emerging Adults: The Mediating Role of Mentalization. Psychological Studies. 2022 Jun;67(2):218-27. https://doi.org/10.1007/s12646-022-00663-w
https://doi.org/10.1007/s12646-022-00663-w  
 
34. Fateminia M, Hasani F, Borjali A, Golshani F. The Mediating role of Emotional Intelligence in Explaining the Causal Relations between Theory of Mind and Cognitive Flexibility with Borderline Personality Disorder Traits in Adolescents. Quarterly Journal of Psychological Methods and Models Winter. 2023;13(50). 10.30495/jpmm.2023.31089.3719  
 
35. In S, Hur JW, Kim G, Lee JH. Effects of distraction, cognitive reappraisal, and acceptance on the urge to self-harm and negative affect in non-suicidal self-injury. Current Psychology. 2021 Aug 14:1-8. https://doi.org/10.1007/s12144-021-02151-2
https://doi.org/10.1007/s12144-021-02151-2  
 
36. Sabet Dizkuhi K, Abolghasemi A, Kafi Masuleh SM. Analysis of relationships between impulsivity emotion regulation and resilience with mental health components in university students with self-harm behaviors. Journal of Clinical Psychology. 2023 Mar 21;15(1). 10.22075/jcp.2023.28519.2536  
 
37. Saadat SH, Mousavi SE, Ahmadi G, Ebrahimi LS, Siahi A, Zandifar H. The role of emotion regulation strategies in emotional disorders of soldiers with history of self-harm attempts (suicidal and non-suicidal). Journal of military medicine. 2020;22(1):64-73. https://doi.org/10.30491/JMM.22.1.54  
 
38. Anbaraki Z, Reshehri AP. Investigating the relationship between lifestyle, emotion regulation, and negative perfectionism with suicidal ideation. Journal of Fundamentals of Mental Health. 2022 Dec 1;24(6). 10.22038/jfmh.2022.21483