Combining Habit Reversal Training Using Temporary Tattoos With DBT Skills to Reduce Non-Suicidal Self-Injury: Feasibility and Preliminary Outcomes

Abstract

Non-suicidal self-injury encompasses several deliberately harmful behaviours used by some clients to manage distress. It has significant health risks, including accidental death. This single-case study explores the integration of temporary tattooing and a dialectical behaviour therapy (DBT) - informed skills-based intervention to treat non-suicidal self-injury in a female diagnosed with borderline personality disorder. The intervention was designed to redirect self-injurious behaviours toward self-expression through artistic temporary tattooing, conceptualised as a form of habit reversal training. Over 15 sessions, temporary tattooing was conceptualised as both a competing and reinforcing behaviour, aiming to promote mindfulness, self-expression, and affect regulation. Quantitative data from diary cards demonstrated increased use of DBT skills and temporary tattooing, accompanied by a reduction in the frequency of self-harm. Qualitative feedback suggested that the tattoos functioned as positive reinforcement, enhancing autonomy and positive identity formation. Findings support the therapeutic potential of temporary tattooing as a feasible adjunct to DBT skills in treating non suicidal self-injury. Implications for clinical practice, limitations, and recommendations for future research are discussed.