Self-Harm Monitoring Plans

Living with self-harming thoughts can be incredibly hard and often requires careful, professional support. It isn’t only hard in the moments when the urge to self-harm is strongest, either. It might be in the quiet moments, too, when you’re wondering how long this will continue.

What helps is having something concrete to work with, a way to understand what’s going on, and a plan for what to do when things feel like too much.

If you’ve found this article, you’re likely already asking the tough questions about why this is happening and what you can do to feel safer. Asking those questions can help lay the foundations for a support system that helps you move from simply managing difficult moments to something more effective and long-lasting. This article will explore:

• What self-harm is and why people engage in it.
• How tracking self-harm triggers can help you recognize patterns.
• How to build a self-harm monitoring plan and what it should include.
• Self-harm prevention strategies for adults.
• Coping alternatives to self-harm and therapy for self-harm behaviors.
• When and how to seek mental health support for self-harm.

Understanding Self-Harm and the Urge to Hurt Yourself

Self-harm isn’t a psychiatric diagnosis. Instead, it is a behavior, and a more common one than you might think.^[1]

The term self-harm is defined as an intentional self-injury or self-poisoning regardless of suicidal intent. For many adults, it develops as a way to manage overwhelming emotions when other outlets aren’t available or haven’t worked. In that regard, self-harm is not an attention-seeking behavior; it’s often rooted in emotional regulation.^[2]

Recovery from self-harm can be difficult, but it is possible. Recovery does, however, require more than willpower alone, and a good place to start is learning what drives the behavior and then building a toolkit that can help you interrupt the process.^[3]

Why People Self-Harm

Understanding cutting or other self-harm behavior in adults is the first step toward finding effective alternatives that don’t cause harm. Self-harming behaviors such as cutting, scratching, burning, or hitting may help you:^[4]

• Manage emotions.
• Reduce negative feelings like shame.
• Deal with anger or rage.

But as you have likely experienced, the relief is only temporary.

Part of the reason why self-harm can feel relieving and difficult to resist may be biological, involving changes in crucial systems in the brain.^[5] Some people who self-injure describe self-harm like an old friend, something they rely on in times of need. This is one reason it can be so difficult to stop, even when part of you genuinely wants to.^[3]

It’s also worth understanding what self-harm is and isn’t, because some common misconceptions can add unnecessary shame or fear to an already challenging experience. Self-harm doesn’t always occur with suicidal intent. Many people self-harm without ever having thoughts of suicide. However, it’s important to understand that a history of self-harm raises your risk of suicide significantly.^[6]

What Triggers Self-Harm

Understanding what sets self-harm in motion can help you address the triggers at their roots. Triggers are either interpersonal (based on your interactions with others) or intrapersonal (based on what’s happening in your mind).

Interpersonal triggers might include: 

• Bullying.
• Rejection.
• Conflict.
• Family pressure.

Intrapersonal triggers include: 

• Negative self-perception.
• Feelings of powerlessness.
• Intense negative emotions.

In both cases, self-harm is perceived as a way to reclaim loss of control.^[6]

You may not be fully aware of what sets your urges in motion until you start tracking self-harm triggers. Once you can recognize the chain of events that leads to self-harm, it gives you an opportunity to interrupt it.^[7]

Building a Self-Harm Monitoring Plan

A self-harm monitoring plan is just as it sounds: a written, personalized document that helps you recognize when you’re at risk and know what to do before the situation becomes too difficult to manage.^[1][8]

These plans work best when made collaboratively with your therapist. However, a self-developed plan you work on at home is far better than having no plan at all. The purpose of a self-harm monitoring plan isn’t to eliminate all distress. Instead, it is designed to give you a reliable roadmap for managing urges to self-harm.^[8]

What a Self-Harm Monitoring Plan Includes

A self-harm monitoring plan outlines warning signs that a crisis might be building. For example, you might list the specific feelings, thoughts, or behaviors that tend to precede the urge to self-harm.^[8]

The plan includes internal coping strategies you can use to de-escalate the situation, such as:

• Mindfulness practices.
• Physical activity (if accessible to you).
• Creative expression, like painting or drawing.

The plan also lists specific people you can reach out to for help, such as family or friends. A list of professional contacts is included as well, such as your therapist, general practitioner, and crisis line numbers.^[1][8]

Self-harm monitoring plans include a means restriction component, too. For example, you identify specific methods you might use to self-harm and restrict your access to them, such as storing or securing items you use to self-harm out of sight.^[8]

Once your plan is in place, it’s important to have a copy for yourself and to share it with others, if you have people in your life you feel comfortable sharing it with. Safety plans for self-harm recovery become more effective as you learn what works for you and what doesn’t. Plans should therefore be reviewed and updated regularly to adapt to changes in your situation.^[1][8]

Reducing Self-Harm Urges in the Moment

One of the best self-harm prevention strategies adults can use is to delay acting on the urge. Even delaying acting on the urge by a few minutes can increase the likelihood that the urge will pass without self-harm occurring.^[9]

If you have someone you feel safe reaching out to, that can also reduce self-harm urges. It isn’t even necessary to talk about self-harm. Instead, simply having a conversation and feeling connected to someone can help you navigate your feelings.

Physical activity offers much the same effect. Being as active as you can may help relieve stress and release endorphins to boost your mood.^[9]

Distraction and substitution methods can also be effective self-injury prevention techniques, especially when they’re matched to the emotion driving the urge. For example, you may use:^[9]

• Exercise as a physical outlet for anger.
• A soothing activity, like a warm bath, when you’re feeling sad.
• A sensory activity like listening to music when you feel empty inside.

How to Track Self-Harm Triggers Over Time

Tracking self-harm triggers is typically done with a daily journal. You can record details about:

• Your mood.
• Urge intensity.
• Events that happened that day.
• What you did in response.

Doing so gives you the data needed to identify patterns that might not be obvious in the moment.^[7]

If you prefer technology to pen and paper, there are also self-monitoring phone apps that can serve the same purpose. Some of these apps even include short check-in questions at random intervals throughout the day. The app then compiles your answers into a graph that makes it easy to see trigger patterns over the course of weeks and months.^[10]

Tracking your state of mind consistently over time in whatever format works best for you is genuinely valuable. It gives you the data about yourself that makes your safety plan smarter, more personalized, and more effective. It also allows for improved emotional regulation without self-harm.

Long-Term Self-Harm Recovery

Recovery from self-harm isn’t linear. Most people experience a push-and-pull between periods of progress and setbacks. This is a normal part of the process, not a sign of weakness or failure.^[3]

Long-term recovery involves two primary components:

1. Having therapeutic support.
2. Building effective coping strategies that address the underlying drivers of your behavior.

Preventing relapse in self-harm requires ongoing attention even when things feel manageable. Continuing your monitoring plan, even during stable periods, can help you build tools now that will help protect you later.^[10][11]

Therapy for Self-Harm Behaviors

A well-supported therapeutic intervention for self-harm is cognitive behavioral therapy (CBT). CBT can help reduce the incidence of self-harming behaviors, while also addressing depression and feelings of hopelessness that often underlie the urge to self-harm.^[11]

Dialectical behavior therapy (DBT) is another potentially effective option, especially for people who self-harm frequently. DBT reduces the number of self-harm episodes by providing training in:^[11]

• Emotional regulation.
• Mindfulness.
• Distress tolerance.

These therapies work best when combined with an active safety and monitoring plan. The plan provides a safety net between sessions, while the therapy sessions themselves help you understand and work through what’s driving the urge to self-harm.^[1]

Coping Alternatives to Self-Harm

Learning how to stop self-harming also involves having coping strategies to rely on when urges to self-harm rise to the surface. The most effective coping strategies address the underlying emotions driving your urges. For example, things that can make a significant difference in how you cope include:^[3][12]

• Finding community if you feel alone.
• Creating distance from harmful relationships when it’s safe to do so.
• Finding purpose through work or volunteering if you feel empty.

Having a broad toolkit tends to be more effective than relying on a single strategy alone.^[3]

Understanding Recovery as Nonlinear

Recovery is perhaps best described as a subjective journey. It isn’t linear; you may go months without harming yourself, then find yourself hurting again. But that doesn’t mean you’re starting over; it may mean that additional support or coping strategies were needed at that time.^[3]

Shame can be a trigger for self-harm, and releasing some of that shame from setbacks like this can be freeing. Normalizing the ongoing nature of recovery can be freeing as well.

Despite some setbacks, one of the most powerful things you can build is the belief you can handle a crisis. As you successfully navigate one crisis and another, that self-belief will become one of the strongest predictors of your sustained recovery.^[3][13]

When and How to Ask for Help

Professional help can make your monitoring plan and coping toolkit all the more powerful.^[1] Yet, the fear of judgment and stigma might make you reluctant to seek help. These are valid concerns, and they’re worth naming as you seek the support you need.

Signs It’s Time to Reach Out for Professional Support

Getting help for self-harm should happen immediately if your self-harming behaviors are becoming:

• More frequent.
• More severe.
• Harder to resist.

More severe wounds or signs of infection that require medical attention are important signs that you need additional help, too.^[1]

Sometimes suicidal thoughts happen alongside urges to self-harm. This is yet another sign to reach out. This combination of thoughts and urges significantly raises the risk of severe injury or death.^[1] If this is the case, reaching out to 911 or 988 is the right call, even if it feels hard.

Get Help for Self-Harm With Mission Connection

Taking steps toward safety, be that making a monitoring plan, learning to manage your urges, or simply reading this article, is meaningful and reflects genuine courage. The next step is to get the professional mental health treatment you need to continue taking steps toward safer living.

At Mission Connection, you will find outpatient mental health care specifically for self-harm. Individual therapy, group therapy, virtual telehealth, and a hybrid program that combines in-person and virtual care are all offered.

If you’re ready to take that next step, reach out to us online or call us at 866-833-1822 to learn about how we treat self-harm. Recovery is real. Help is available. We’re ready to walk with you on this journey.