Investigating the Impact of Lived Experience Stories on Self-Harm, Mood, and Help-Seeking Intentions: Web-Based Between-Participants Experimental Study in Individuals With Recent Self-Harm

BACKGROUND: Lived experience stories are often used on formal help sites as a support resource for individuals who self-harm. While self-harm-related internet use provides an alternative for individuals who are not yet ready or are unwilling or unable to access support offline, it has also been shown to unintentionally reinforce self-harm behavior. There are several components that might influence whether a lived experience story is perceived as helpful, unhelpful, or potentially harmful, and the evidence supporting that these encourage help-seeking in the reader is limited. OBJECTIVE: This study is part of a mixed methods project that aimed to investigate how variations in help-seeking messages contained within online lived experience stories are interpreted by and psychologically impact those with a history of self-harm. METHODS: Individuals with a recent history of self-harm were recruited via newsletters, social media, and websites run by the university and mental health charities to take part in an online experiment. During the experiment, participants were randomized to read stories that either mentioned (1) self-help strategies, (2) seeking help from informal and formal sources, or (3) did not mention help-seeking. Help-seeking intentions, mood, entrapment, and expectations of future self-harm were measured, and participants provided feedback on the stories. RESULTS: =0.10; adjustment for age, gender, and help-seeking history included). Participants in the "self-help" condition (n=83) reported lower negative affect after reading the stories compared to participants in the "no help" condition (n=80; mean difference=-3.97, 95% CI -7.72 to -0.22; P=.04) and the "informal/formal" help condition (n=75; mean difference=-3.70, 95% CI -7.55 to 0.14; P=.06). A key criticism of the stories was that they were unrelatable, but this sentiment was less prevalent among those in the "no help" condition. Key positives were that the stories included a realistic but hopeful outlook of recovery (less prevalent in the "informal/formal help" condition) and were supportive (less prevalent in the "no help" condition). CONCLUSIONS: While the inclusion of self-help strategies in a lived experience story reduced its impact on negative affect, the inclusion of self-help strategies or seeking help from others did not encourage help-seeking intentions. Making stories relatable, authentic, and providing multiple strategies for support might be key to encouraging help-seeking, but more research is needed.