EFFECTIVENESS OF EMOTION REGULATORY PSYCHO-EDUCATIONAL PROGRAM ON SELF-INJURY AND EMOTION-REGULATION STRATEGIES IN ADOLESCENTS

Abstract

Self-injury is among the most common risk factors in adolescence, and it is known that self- injury is closely associated with not being able to regulate emotions functionally. The aim of this study; To test the effectiveness of the emotion regulation psychoeducational program on self- injury behavior and emotion regulation strategies in adolescents. This research is based on a 2X2 (experiment and control x pretest-posttest) quasi-experimental model. This research was conducted with 204 students studying at a vocational high school in Şanlıurfa in the 2021-2022 academic year. Emotion Regulation Scale for Adolescents and Inventory of Statements About Self-Injury were used as data collection tools in the study. A total of 24 people, 12 in the experimental group and 12 in the control group, participated in the study. After the pre-test measurements of the experimental and control groups were taken, an eight-session Emotion Regulation Psychoeducation program based on emotion-focused therapy and dialectical behavioral therapy, developed by the researchers, was applied to the members of the experimental group. No action was taken in the control group. One week after the Emotion Regulation Psychoeducation program was completed, post-test measurements of the experimental and control groups were made. The effectiveness of the psychoeducational program was tested with a two-way ANOVA for mixed designs. As a result of the analysis, it was seen that the mean scores of self-injury and internal dysfunctional emotion regulation of the experimental group participating in the psycho-education program were significantly lower than the control group. The findings reveal that the Emotion Regulation Psychoeducation program is effective on self-injury and internal dysfunctional emotion regulation strategies

Keywords

• Self-injury
• Emotion Regulation
• Adolescence
• Psycho-education

DUYGU DÜZENLEME PSİKO-EĞİTİM PROGRAMI UYGULAMASININ ERGENLERDE KENDİNE ZARAR VERME VE DUYGU DÜZENLEME STRATEJİLERİ ÜZERİNDEKİ ETKİSİ

Abstract

Kendine zarar verme ergenlik döneminde en sık görülen risk faktörleri arasında yer aldığı ve kendine zarar vermenin duyguları işlevsel olarak düzenleyememe ile yakından ilişkili olduğu bilinmektedir. Bu çalışmanın amacı; duygu düzenleme psiko-eğitim programının ergenlerde kendine zarar verme davranışı ve duygu düzenleme stratejileri üzerindeki etkililiğini sınamaktır. Bu araştırma 2X2'lik (deney ve kontrol x ön test-son test) yarı deneysel modele dayalıdır. Bu araştırma 2021-2022 eğitim öğretim yılında Şanlıurfa ilinde bir meslek lisesinde okuyan 204 öğrenci ile yapılmıştır. Bu çalışmada Ergenler İçin Duygu Düzenleme Ölçeği ve Kendine Zarar Verme Envanteri kullanılmıştır. Çalışmaya 12'si deney 12'si kontrol grubunda olmak üzere toplam 24 kişi katılmıştır. Deney ve kontrol grubunun ön test ölçümleri alındıktan sonra deney grubu üyelerine araştırmacılar tarafından geliştirilen, duygu odaklı terapi ve diyalektik davranışçı terapi temelli sekiz oturumluk Duygu Düzenleme Psiko-eğitim programı uygulanmıştır. Kontrol grubuna herhangi bir işlem yapılmamıştır. Duygu Düzenleme Psikoeğitim programı tamamlandıktan bir hafta sonra deney ve kontrol grubunun son test ölçümleri yapılmıştır. Psiko-eğitim programının etkililiği karışık desenler için çift yönlü ANOVA ile test edilmiştir. Analizler sonucunda uygulanan psiko-eğitim programına katılan deney grubunun kendine zarar verme ve içsel işlevsel olmayan duygu düzenleme puan ortalamalarının kontrol grubuna göre manidar düzeyde azaldığı görülmüştür. Elde edilen bulgular Duygu Düzenleme Psiko-eğitim programının kendine zarar verme ve içsel işlevsel olmayan duygu düzenleme stratejileri üzerinde etkili olduğunu ortaya koymaktadır.

Keywords

• Kendine zarar verme davranışı
• Duygu düzenleme
• Ergenlik
• Psikoeğitim

References

1. Akdemir, A., & Gündüz, B. (2022). Duygu Düzenleme Becerileri Psikoeğitim Programının Ergenlerin Duygu Düzenleme Güçlüğü ve Reaktif-Proaktif Saldırganlıklarına Etkisi. Eğitim ve Bilim, 47(209), 311-334.
2. Aksoy, A., & Ögel, K. (2003). Kendine zarar verme davranışı. Anadolu Psikiyatri Dergisi, 4 (4), 226-236.
3. Alkan, A. (2020). The investigation of the preventive effectiveness of a dialectical behavior therapy skills traınıng program adapted for Turkish college students. (Yayımlanmamış Yüksek Lisans Tezi). Bahçeşehir Üniversitesi.
4. Bentley, K. H., Nock, M. K., Sauer-Zavala, S., Gorman, B. S., & Barlow, D. H. (2017). A functional analysis of two transdiagnostic, emotion-focused interventions on nonsuicidal self-injury. Journal of Consulting and Clinical Psychology, 85 (6), 632.
5. Bignell, H. (2021). Using an educational psychologist led psychoeducation group skills intervention to develop the emotion regulation skills of further education students. (Unpublished Doctoral Dissertation). Cardiff University.
6. Bildik, T., Somer, O., Kabukçu Başay, B., Başay, Ö., & Özbaran, B. (2013). The validity and reliability of the Turkish version of the inventory of statements about self-injury. Türk Psikiyatri Dergisi, 24(1), 49-57.
7. Bhui, K., McKenzie, K., & Rasul, F. (2007). Rates, risk factors & methods of self harm among minority ethnic groups in the UK: a systematic review. BMC public health, 7 (1), 1-14.
8. Brace, N., Kemp, R., & Snelgar, R. (2003). SPSS for psychologists. A guide to data analysis using SPSS for windows. New York: Palgrave Macmillan.

9. Brown, N. W. (2011). Psychoeducational groups. ABD: Taylor-Francis.
10. Brown, R. C., & Plener, P. L. (2017). Non-suicidal self-injury in adolescence. Current psychiatry reports, 19(3), 1-8.
11. Buerger, A., Emser, T., Seidel, A., Scheiner, C., von Schoenfeld, C., Ruecker, V., ... & Romanos, M. (2022). DUDE-a universal prevention program for non-suicidal self-injurious behavior in adolescence based on effective emotion regulation: study protocol of a cluster-randomized controlled trial. Trials, 23 (1), 1-16.
12. Büyüköztürk, Ş. (2017). Sosyal bilimler için veri analizi el kitabı (23. Baskı). Ankara: Pegem Akademik Yayıncılık.
13. Casey, B. J., & Jones, R. M. (2010). Neurobiology of the adolescent brain and behavior: implications for substance use disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 49 (12), 1189-1201.
14. Chen, W. L.,& Chun, C. C. (2019). Association between emotion dysregulation and distinct groups of non-suicidal self-injury in Taiwanese female adolescents. International Journal of Environmental Research and Public Health, 16 (18), 33-61.
15. Claes, L., Luyckx, K., Baetens, I., Van de Ven, M. & Witteman C. (2015). Bullying and victimization, depressive mood, and non-suicidal self-injury in adolescents: the moderating role of parental support. J Child Fam Study, 24, 3363–3371.
16. Cohen, J. W. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.
17. Corey, M. S., Corey, G., & Corey, C. (2021). Psikolojik danışmada gruplar: Süreç ve uygulamalar (F. Aysan, S. Balcı Çelik ve A. Uz Baş, Çev.). Ankara: Nobel Yayıncılık.
18. Coughlan, K., Tata, P., & MacLeod, A. K. (2017). Personal goals, well-being and deliberate self-harm. Cognitive Therapy and Research, 41(3), 434-443.
19. Çelik, F. G. H., & Hocaoğlu, Ç. (2017). Kasıtlı Kendine Zarar Verme Davranışı. Psikiyatride Güncel Yaklaşımlar, 9 (2), 209-226.
20. DeLucia-Waack, J. L. (2006). Leading psychoeducational groups for children and adolescents. Sage Publications.
21. Demir, P. (2020). Ergenlerde kendine zarar verme davranışı ve çocukluk çağı örselenme yaşantıları ilişkisinde duygu düzenleme becerisinin aracı rolü. (Yayımlanmamış Yüksek Lisans Tezi). Kocaeli Üniversitesi.
22. Deplus, S., Billieux, J., Scharff, C. and Philippot, P. (2016). A mindfulness-based group intervention for enhancing self-regulation of emotion in late childhood and adolescence: A pilot study. International Journal of Mental Health and Addiction, 14(5), 775-790.
23. Dingle, G. A., Hodges, J., & Kunde, A. (2016). Tuned in emotion regulation program using music listening: Effectiveness for adolescents in educational settings. Frontiers in psychology, 7, 859.
24. Duy, B., & Yıldız, M. A. (2014). Ergenler için duygu düzenleme ölçeği’nin Türkçe’ye uyarlanması. Turkish Psychological Counseling and Guidance Journal, 5(41), 23-35.
25. Ender Sarıçalı, Z. (2020). Duygu düzenleme programının ön ergenlerin duygu düzenleme stratejileri üzerindeki etkisi. (Yayımlanmamış Doktora Tezi) Anadolu Üniversitesi.
26. Erikson, E.H. (1968). Identity: Youth and Crisis. Norton, New York.
27. Eyüboğlu, D., Güvenir, T., Kavurma, C., & Varol Taş, F. (2018). Kendine zarar verme davranışı olan ergenlerin aile işlevselliği. Klinik Psikiyatri Dergisi, 21 (4), 370-379.
28. Favazza, A. R. (1989). Why patients mutilate themselves. Psychiatric Services, 40 (2), 137-145.
29. Favazza, A. R. (1998). The coming of age of self-mutilation. The Journal of nervous and mental disease, 186(5), 259-268.
30. Feigenbaum, J. (2010). Self-harm–the solution not the problem: The dialectical behaviour therapy model. Psychoanalytic Psychotherapy, 24 (2), 115-134.
31. Field, A., & Hole, G. (2019). Araştırma nasıl tasarlanır ve raporlaştırılır (Çev. Ed. Özer, A.). Ankara: Anı.
32. Fleischhaker, C., Böhme, R., Sixt, B., Brück, C., Schneider, C., & Schulz, E. (2011). Dialectical behavioral therapy for adolescents (DBT-A): a clinical trial for patients with suicidal and self-injurious behavior and borderline symptoms with a one-year follow-up. Child and adolescent psychiatry and mental health, 5(1), 1-10.
33. Gibson, J., Booth, R., Davenport, J., Keogh, K., & Owens, T. (2014). Dialectical behaviour therapy-informed skills training for deliberate self-harm: A controlled trial with 3-month follow-up data. Behaviour Research and Therapy, 60, 8-14.
34. Giese-Davis, J., Koopman, C., Butler, L. D., Classen, C., Cordova, M., Fobair, P., ... & Spiegel, D. (2002). Change in emotion-regulation strategy for women with metastatic breast cancer following supportive-expressive group therapy. Journal of Consulting and Clinical Psychology, 70 (4), 916.
35. Gratz, K. L., Conrad, S. D., & Roemer, L. (2002). Risk factors for deliberate self-harm among college students. The American Journal of Orthopsychiatry, 72(1), 128–140. doi:10.1037/0002- 9432.72.1.128
36. Gratz, K. L., & Gunderson, J. G. (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behavior therapy, 37 (1), 25-35.
37. Gratz, K. L., & Roemer, L. (2008). The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university. Cognitive behaviour therapy, 37 (1), 14-25.
38. Greenberg, L. (2006). Emotion-focused therapy: A synopsis. Journal of Contemporary Psychotherapy, 36(2), 87-93.
39. Greenberg, L. S. (2010). Emotion-focused therapy: An overview. Turkish Psychological Counseling and Guidance Journal, 4(33), 1-12.
40. Greenberg, L. E. (2015). Duygu odaklı terapi: Danışanlara duygu koçluğu yapmak (S. Balcı Çelik, Çev.). Ankara: Nobel.
41. Gross, J.J., & Thompson, R.A. (2007). Emotion regulation: Conceptual foundations. In J.J. Gross (Ed.), Handbook of emotion regulation. New York, NY: The Guilford Press.
42. Gülgez, Ö., & Gündüz, B. (2015). Diyalektik Davranış Terapisi Temelli Duygu Düzenleme Programının Üniversite Öğrencilerinin Duygu Düzenleme Güçlüklerini Azaltmadaki Etkisi. Çukurova University Faculty of Education Journal, 44 (2), 191-208.
43. Hasking, P. A., Coric, S. J., Swannell, S., Martin, G., Thompson, H. K., & Frost, A. D. (2010). Brief report: Emotion regulation and coping as moderators in the relationship between personality and self-injury. Journal of Adolescence, 33 (5), 767-773.
44. Houck, C. D., Hadley, W., Barker, D., Brown, L. K., Hancock, E. and Almy, B. (2016). An emotion regulation intervention to reduce risk behaviors among at-risk early adolescents. Prevention Science, 17 (1), 71-82.
45. Jacobs, D., Walsh, B. W., McDade, M., & Pigeon, S. (2009). Signs of self-injury prevention manual. Wellesley Hills, MA: Screening for Mental Health.
46. Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection. New York: Brunner-Routledge.
47. Joiner, T. (2002). The trajectory of suicidal behavior over time. Suicide and Life- Threatening Behavior, 32, 33-41.
48. Jutengren, G., Kerr, M., & Stattin, H. (2011). Adolescents' deliberate self-harm, interpersonal stress, and the moderating effects of self-regulation: A two-wave longitudinal analysis. Journal of School Psychology, 49 (2), 249-264.
49. In-Albon, T., Ruf, C., & Schmid, M. (2013). Proposed diagnostic criteria for the DSM-5 of nonsuicidal self-injury in female adolescents: diagnostic and clinical correlates. Psychiatry Journal, 159-208. doi: 10.1155/2013/159208
50. Kimball, J. S., & Diddams, M. (2007). Affect regulation as a mediator of attachment and deliberate self-harm. Journal of College Counseling, 10(1), 44–53.
51. Kimball, J. S. (2009). Treatment for deliberate self-harm: Integrating emotion-focused therapy. Journal of Contemporary Psychotherapy, 39(3), 197-202.
52. Koole, S. L. (2009). The psychology of emotion regulation: An integrative review. Cognition and Emotion, 23(1), 4-41.
53. Koole, S. L. (2010). The psychology of emotion regulation: an integrative review. (In J. D. Houwerand ve D. Hermans (Eds), Cognition and emotion: reviews of current research and theories (ss. 128-167). New York: Taylor & Francis Group.
54. Koenig, J., Rinnewitz, L., Warth, M., Hillecke, T. K., Brunner, R., Resch, F., & Kaess, M. (2017). Psychobiological response to pain in female adolescents with nonsuicidal self-injury. Journal of Psychiatry and Neuroscience, 42(3), 189-199.
55. Koerner, K. (2012). Doing dialectical behavior therapy a practical guide. New York: The Guilford Press.
56. Klonsky, E. D., Oltmanns, T. F., & Turkheimer, E. (2003). Deliberate self-harm in a nonclinical population: Prevalence and psychological correlates. American Journal of Psychiatry, 160(8), 1501-1508.
57. Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27, 226 – 239. doi:10.1016/j.cpr.2006.08.002.
58. Klonsky, E. D., & Glenn, C. R. (2009). Assessing the functions of non-suicidal self-injury: Psychometric properties of the Inventory of Statements About Self-injury (ISAS). Journal of Psychopathology and Behavioral Assessment, 31(3), 215-219.
59. Klonsky, E. D. (2011). Non-suicidal self-injury in United States adults: prevalence, sociodemographics, topography and functions. Psychological Medicine, 41 (9), 1981-1986.
60. Lee Bracken, K., Berman, M. E., McCloskey, M. S., & Bullock, J. S. (2008). Deliberate self-harm and state dissociation: An experimental investigation. Journal of Aggression, Maltreatment & Trauma, 17 (4), 520-532.
61. Leahy, R. L. (2002). A model of emotional schemas. Cognitive and behavioral practice, 9 (3), 177-190.
62. Leahy, R. L., Tirch, D., & Napolitano, L. A. (2011). Emotion regulation in psychotherapy: A practitioner's guide. Guilford press.
63. Leahy, R. L. (2016). Emotional schema therapy: A meta‐experiential model. Australian Psychologist, 51 (2), 82-88.
64. Lim, K. S., Wong, C. H., McIntyre, R. S., Wang, J., Zhang, Z., Tran, B. X., Tan, W., Ho, C. S., & Ho, R. C. (2019). Global Lifetime and 12-Month Prevalence of Suicidal Behavior, Deliberate Self-Harm and Non-Suicidal Self-Injury in Children and Adolescents between 1989 and 2018: A Meta-Analysis. International Journal of Environmental Research and Public Health, 16 (22), 4581. doi: 10.3390/ijerph16224581
65. Linehan, M. (2014). DBT Skills training manual. Guilford Publications.
66. Lodebo, B. T., Möller, J., Larsson, J. O., & Engström, K. (2017). Socioeconomic position and self-harm among adolescents: a population-based cohort study in Stockholm, Sweden. Child and adolescent psychiatry and mental health, 11 (1), 1-9.
67. Marissen, M.A., Meuleman, L., & Franken, I.H. (2010). Altered emotional information processing in borderline personality disorder: An electrophysiological study. Psychiatry Research: Neuroimaging, 181, 226–232.
68. Marshall, C., & Rossman, G. B. (2014). Designing qualitative research. New York: Sage Publications, Inc.
69. Martin, J., Cloutier, P. F., Levesque, C., Bureau, J. F., Lafontaine, M. F., & Nixon, M. K. (2013). Psychometric properties of the functions and addictive features scales of the Ottawa Self-Injury Inventory: a preliminary investigation using a university sample. Psychological assessment, 25 (3), 1013.
70. McKenzie, K. C., & Gross, J. J. (2014). Nonsuicidal self-injury: an emotion regulation perspective. Psychopathology, 47 (4), 207-219.
71. Metz, S. M., Frank, J. L., Reibel, D., Cantrell, T., Sanders, R., & Broderick, P. C. (2013). The effectiveness of the learning to BREATHE program on adolescent emotion regulation. Research in Human Development, 10 (3), 252-272.
72. Mikolajczak, M., Petrides, K. V., & Hurry, J. (2009). Adolescents choosing self-harm as an emotion regulation strategy: The protective role of trait emotional intelligence. British Journal of Clinical Psychology, 48 (2), 181-193.
73. Moller, C. I., Tait, R. J., & Byrne, D. G. (2013). Deliberate self-harm, substance use, and negative affect in nonclinical samples: a systematic review. Substance Abuse, 34 (2), 188-207.
74. Muehlenkamp, J. J. (2006). Empirically supported treatments and general therapy guidelines for non-suicidal self-injury. Journal of Mental Health Counseling, 28(2), 166-185.
75. Muehlenkamp, J. J., Walsh, B. W., & McDade, M. (2010). Preventing non-suicidal self-injury in adolescents: The signs of self-injury program. Journal of Youth and Adolescence, 39 (3), 306-314.
76. Neacsiu, A. D., Eberle, J. W., Kramer, R., Wiesmann, T., & Linehan, M. M. (2014). Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: A pilot randomized controlled trial. Behaviour Research and Therapy, 59, 40-51.
77. Nock, M. K., Teper, R., & Hollander, M. (2007). Psychological treatment of self‐injury among adolescents. Journal of Clinical Psychology, 63 (11), 1081-1089.
78. Nock, M. K. (2010). Self-injury. Annual Review of Clinical Psychology, 6(1), 339-363.
79. Ohlis, A. (2020). Deliberate self-harm among adolescents: course, outcome and treatment. (Unpublished Doctoral Dissertation). Karolinska Institutet.
80. Page, A., Lewis, G., Kidger, J., Heron, J., Chittleborough, C., Evans, J., & Gunnell, D. (2014). Parental socio-economic position during childhood as a determinant of self-harm in adolescence. Social Psychiatry and Psychiatric Epidemiology, 49 (2), 193-203.
81. Paivio, S. C. (2013). Essential processes in emotion-focused therapy. Psychotherapy, 50 (3), 341-345.
82. Paivio, S. C., & Greenberg, L. S. (2001). Introduction: Treating emotion regulation problems. Journal of Clinical Psychology, 57(2), 153-155.
83. Plener, P. L., Schumacher, T. S., Munz, L. M., & Groschwitz, R. C. (2015). The longitudinal course of non-suicidal self-injury and deliberate self-harm: a systematic review of the literature. Borderline personality disorder and emotion dysregulation, 2 (1), 1-11.
84. Phillips, K. F. V. & Power, M. J. (2007). A new selfreport measure of emotion regulation in adolescents: The regulation of emotions questionnaire. Clinical Psychology and Psychotherapy, 14, 145–156.
85. Pos, A. E., & Greenberg, L. S. (2007). Emotion-focused therapy: The transforming power of affect. Journal of Contemporary Psychotherapy, 37 (1), 25-31.
86. Prinstein, M. J., Heilbron, N., Guerry, J. D., Franklin, J. C., Rancourt, D., Simon, V., & Spirito, A. (2010). Peer influence and nonsuicidal self injury: Longitudinal results in community and clinically-referred adolescent samples. Journal of Abnormal Child Psychology, 38(5), 669-682.
87. Rahman, M. A., Todd, C., John, A., Tan, J., Kerr, M., Potter, R., ... & Brophy, S. (2018). School achievement as a predictor of depression and self-harm in adolescence: linked education and health record study. The British Journal of Psychiatry, 212 (4), 215-221.
88. Robins, C. J., & Chapman, A. L. (2004). Dialectical behavior therapy: Current status, recent developments, and future directions. Journal of Personality Disorders, 18 (1), 73-89.
89. Rodriguez-Blanco, L., Carballo, J. J., & Baca-Garcia, E. (2018). Use of ecological momentary assessment (EMA) in non-suicidal self-injury (NSSI): A systematic review. Psychiatry Research, 263, 212-219.
90. Sahlin, H., Bjureberg, J., Gratz, K. L., Tull, M. T., Hedman, E., Bjärehed, J., ... & Hellner, C. (2017). Emotion regulation group therapy for deliberate self-harm: A multi-site evaluation in routine care using an uncontrolled open trial design. BMJ open, 7 (10), e016220.
91. Smead, R. (1995). Skills and techniques for group work with children and adolescents. Research PressPub.
92. Silk, J.S., Steinberg, L. & Morris, A.S. (2003). Adolescents' emotion regulation in daily life: Links to depressive symptoms and problem behavior. Child Development, 74 (6), 1869 1880.
93. Sim, L., Adrian, M., Zeman, J., Cassano, M., & Friedrich, W. N. (2009). Adolescent deliberate self‐harm: Linkages to emotion regulation and family emotional climate. Journal of research on adolescence, 19 (1), 75-91.
94. Shiner, A. (2008). Self-harm in adolescence. InnovAiT, 1 (11), 750-758. doi:10.1093/innovait/inn119
95. Thompson, E., Thomas, S.A., Nesi, Jç, Bettis, A.H., Ransford B., et al. (2019). Emotion dysregulation and non-suicidal self-injury: A systematic review and meta-analysis. Eur Psychiatry, 59, 25-36.
96. Thompson, R. A., Lewis, M. D., & Calkins, S. D. (2008). Reassessing emotion regulation. Child Development Perspectives, 2(3), 124-131.
97. Uludağlı, N. P., & Sayıl, M. (2009). Orta ve ileri ergenlik döneminde risk alma davranışı: Ebeveyn ve akranların rolü. Türk Psikoloji Yazıları, 12(23), 14-24.
98. Yaghoubi, R., Bayazi, M. H., Babaei, M., & Asadi, J. (2020). Comparison of the Effectiveness of Emotion-Focused Therapy Group and Schema Group Therapy on the Difficulties in Emotion Regulation and Health Promoting Lifestyle of Obese Women. International Journal of Health Studies, 6(4), 29-35.
99. Yasfard, G., Abaspour Azar, Z., & Hosseini Almadani, S. A. (2019). Comparing the Effectiveness of group Dialectical Behavior Therapy and Solution-Focused Brief Therapy on Self-Esteem, Cognitive-Emotional Regulation and Non-Suicidal Self-Injury in daughters. Iranian Journal of Health Education and Health Promotion, 7(4), 343-358.
100. Yeo, A. J., Germán, M., Wheeler, L. A., Camacho, K., Hirsch, E., & Miller, A. (2020). Self‐harm and self‐regulation in urban ethnic minority youth: a pilot application of dialectical behavior therapy for adolescents. Child and Adolescent Mental Health, 25(3), 127-134.
101. Yıldız, M. A. (2016). Ergenlerde yalnızlık ile pozitiflik arasındaki ilişkide duygu düzenleme yöntemlerinin çoklu aracılığı. Eğitim ve Bilim, 41(186), 217-231.
102. Dünya Sağlık Örgütü (‎2014)‎. Health for the world's adolescents: a second chance in the second decade: summary. World Health Organization. https://apps.who.int/iris/handle/10665/112750, (Erişim Tarihi: 12.08.2022).