If you are hurting yourself, or thinking about it, please talk to a doctor or contact a crisis helpline. This article is about a research result and is not a source of urgent help.
Self-injury frequently accompanies depression, and it is one of the places where the standard depression treatments are not obviously the right tool. A trial published in BMC psychiatry in 2026 tested a therapy built specifically for that combination, and produced a result that is easy to over-read. [pubmed-depression-jun-2026-source]
What the researchers did
Eighty people with major depressive disorder and a history of non-suicidal self-injury were recruited from four hospitals and randomly assigned to one of two weekly group programmes for 13 weeks: dialectical behaviour therapy skills training, or a social support group. Everyone continued their usual medication. Assessors did not know which group anyone was in.
Alongside the questionnaires, participants had resting-state brain scans before and after.
What they found
Both programmes worked. Self-injury and depression improved in both groups over the 13 weeks. That is the trial’s clearest result and it does not favour either therapy.
The difference appeared when the sample was split by age. Among the 13 to 17 year olds, DBT skills training produced substantially larger improvements in both self-injury and depression than the support group did.
The scans changed in the DBT group. Activity in the insula, a region involved in bodily awareness and emotional processing, dropped after the skills training, and the size of the depression improvement tracked one of those changes.
Why the age finding needs holding lightly
The headline here is a subgroup analysis, and subgroup analyses are the part of a trial where enthusiasm most often outruns the evidence.
Eighty participants split across two treatments gives 40 per arm. Split those again by age and the groups being compared are small, which makes each estimate unstable. A difference that looks dramatic in a group that size can be an ordinary consequence of chance, and the more ways a dataset is divided, the more likely it is that one of the divisions produces something striking.
None of that means the finding is wrong. Age-related differences in how people respond to skills-based therapy are plausible, and DBT has a considerable independent evidence base in adolescents. It means the appropriate description is that this is worth testing directly, rather than that DBT works better for teenagers.
Why the brain imaging is the weakest part
The insula results read impressively and carry less weight than they appear to.
The authors themselves flag the reason: medication was not tracked during the intervention. If some participants changed antidepressant dose over 13 weeks, that alone could produce the scan differences, and the trial cannot separate the two explanations.
There is a more general point too. Effective psychological therapy should be visible in the brain, because thoughts and brain activity are not two separate things. Finding a neural correlate of a therapy that worked confirms the therapy worked; it does not independently confirm anything else. Imaging tends to make a result feel more scientific than the same result stated in words, and it is worth noticing when that is happening.
Would a skills-based therapy suit how you are struggling?
This is not a diagnostic tool and it does not score risk. It is a way of seeing whether the kind of therapy this trial studied matches your difficulty.
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Ask a doctor or therapist specifically about dialectical behaviour therapy, by name. Availability varies enormously between areas, and knowing the name of what you are asking for makes a difference to what you get offered.
Worth raising at an appointment, particularly the items about the gap between knowing and doing. That gap is what skills-based approaches target, and it is a specific enough complaint to be useful to a clinician.
Skills training suits a particular kind of difficulty. If yours is more about persistent low mood or negative thinking than about intensity and impulse, standard cognitive behavioural therapy is the more usual starting point.
What to take from it
That both a structured skills course and a support group reduced depression and self-injury over three months is the useful, well-supported finding, and it is quietly encouraging. Group treatment for this problem does something.
Whether DBT skills training is specifically better for adolescents is a good question that this trial raises and does not answer.
If this is your situation now
If you are hurting yourself, tell a doctor. It is far more common than people assume and it is treatable, and there are specific therapies for it rather than just general advice. If you are having thoughts of suicide, contact your local emergency services or a crisis helpline now.
Our depression overview covers the established treatments and how to get assessed.
The source
These findings are drawn from “Insular spontaneous activity changes after dialectical behavior therapy skills training for depressed patients with non-suicidal self-injury: a randomized controlled trial” (Lei M, Wu S, Hang Y, et al., 2026), published in BMC psychiatry. Read the full study on PubMed.