Delivering real-time support for self-injury : A systematic review on ecological momentary interventions

Introduction: Ecological momentary interventions (EMIs) delivered via smartphone apps have gained attention as a potential tool for addressing self-injurious thoughts and behaviors (SITB), particularly non-suicidal self-injury (NSSI). This systematic review aims to assess the efficacy and feasibility of smartphone-based EMIs in reducing SITB and improving mental health outcomes. Methods: A systematic review was conducted, focusing on smartphone-based EMIs targeting SITB, with particular emphasis on those addressing NSSI. The latest search was made in February 2025. Results: Sixteen studies featuring smartphone-based EMIs were included. Overall, these studies showed promising evidence for the reduction of SITB. Specifically, several studies reported reductions in NSSI frequency and improvements in emotional regulation among participants. Feasibility and acceptability data showed good results. Limitations: Key limitations include small sample sizes, study heterogeneity, lack of follow-up, reliance on self-reports, and absence of standardized tools to distinguish NSSI from other self-injurious behaviors. Conclusions: Results are promising, while the efficacy of smartphone-based EMIs SITB requires further validation through large-scale and well-designed studies. The integration of digital interventions into broader mental health care strategies offers a potential avenue for addressing the treatment gap in at-risk populations, particularly those with limited access to traditional care.