The perceived utility and scope of ecological momentary assessment and interventions for non-suicidal self-injury: A needs-based dynamic risk perspective

Background Non-suicidal self-injury (NSSI) is characterized by rapid within-person fluctuations in thoughts and urges. Yet, treatments rely on retrospective and static approaches for assessments and interventions. Ecological Momentary Assessment (EMA) and Ecological Momentary Interventions (EMIs) may enable more dynamic support in real time. This study examined the perceived utility and scope of these new digital modalities from the perspectives of treatment-seeking individuals and mental health professionals. Methods Semi-structured interviews were conducted with 30 treatment-seeking individuals engaging in NSSI, after completing a four-week EMA period, and with 14 professionals who used EMA in treatment. Interviews explored experiences with EMA and perspectives on EMIs and were analyzed using reflexive thematic analysis. Results Three themes were identified. First, EMA and EMIs were perceived as extending therapeutic support by enhancing awareness, reflection, and skill use in daily life. Second, participants emphasized that EMIs must be tailored to changing needs in function of changing risk. This informed the development of a Needs-Based Dynamic Risk and Intervention Model for NSSI, distinguishing needs and interventions through a traffic-light analogy across resilient (i.e., mental health promotion), emerging risk (i.e., vulnerability regulation), and high risk (i.e., behavioral interruption) states. Third, EMIs were viewed as valuable when embedded in blended care and implemented through shared decision-making, balancing system- and user-initiated support. Conclusion Integrating EMA and EMIs into treatment has potential to provide needs-tailored support for individuals who self-injure. Future work should focus on empirically validating the proposed dynamic model and co-designing EMI components that address fluctuating needs in daily life.