Hoe de smartphone risico voor zelfverwonding bij jongvolwassen kan helpen detecteren
Ondanks de vele kritische blikken naar het smartphonegebruik van jongeren, kan de smartphone ook een cruciaal klinisch hulpmiddel zijn. Dankzij dit medium kregen we een beter inzicht in wanneer iemand acuut risico loopt om zichzelf opzettelijk te verwonden in het dagelijkse leven. Dit was deel van het DAILY-project aan de KU Leuven, waarbij we gebruik maakten van de smartphone, die steeds binnen handbereik is, als klinisch hulpmiddel in het voorkomen van zelfverwondend gedrag.
Uit internationale cijfers blijkt dat ongeveer één op vijf jongeren en jongvolwassenen zichzelf opzettelijk verwondt voor hun 25ste levensjaar. Onder zelfverwondend gedrag (ZVG) verstaan we het opzettelijk toebrengen van schade aan het eigen lichaam zonder de intentie om zichzelf van het leven te benemen. Vaak voorkomende voorbeelden hiervan zijn zichzelf krabben, snijden of branden. Bij ons, in Vlaanderen, geeft ongeveer één op tien studenten aan zichzelf opzettelijk verwond te hebben in het afgelopen jaar. Deze cijfers zijn alarmerend hoog. Ondanks dat ZVG frequent voorkomt, is het thema nog vaak taboe. Zo bestaat er bijvoorbeeld nog het misverstand dat de meeste jongeren zichzelf verwonden om aandacht te krijgen. Hoewel we nu weten dat meeste jongeren zichzelf verwonden om even hun aandacht te kunnen afwenden van verdriet en emotionele pijn, weten we nog steeds niet wanneer jongeren een risico lopen om zichzelf te verwonden. Het in kaart brengen van de risico-momenten in het dagelijkse leven is dus hoogstnodig voor een adequate ondersteuning van deze jongeren.
Ingrijpen op het juiste moment
Om bij te dragen aan gepaste klinische hulp voor jongeren die zichzelf verwonden, onderzochten we in deze masterproef welke gevoelens en gedachten ZVG triggeren in het dagelijkse leven. Als we namelijk weten wat maakt dat iemand zich komende minuten of uren zou verwonden, kunnen we proberen ingrijpen op het juiste moment om zo te verwijden dat iemand ZVG stelt. Ander onderzoek toont namelijk aan dat het doorgaans tussen één en dertig minuten duurt voor dat iemand handelt naar de drang tot zelfverwonding. Dit geeft ons dus een korte, maar zeer concrete mogelijkheid om te voorkomen dat iemand schade toebrengt aan zichzelf.
We moeten dus meteen ingrijpen wanneer het knipperlicht van groen naar oranje springt, maar voor het op rood springt en het te laat is. - Promotor Glenn Kiekens, 2021
Tijdens een klinische sessie is het moeilijk een nauwkeurig beeld te krijgen van de gevoelens en gedachten die ZVG triggeren, aangezien de cliënt moet reflecteren over de afgelopen week. Over deze reflectie is geweten dat ze sterk gekleurd is door hoe men zich op dat moment voelt. Dit is net waar de smartphone het verschil kan maken, want die heeft de cliënt vaak bij.
De smartphone als blik op de stroom van gedachten, gevoelens en gedragingen
Waar onderzoekers vroeger gelimiteerd waren door gedachten of gevoelens enkel te bevragen in één lange vragenlijst, laat de ontwikkeling van de smartphone nu toe om meerdere, kleine vragenlijsten te sturen per dag. Deze vragenlijsten peilen naar welke gedachten, gevoelens of gedragingen momenteel aanwezig zijn (bv. “Op dit moment, hoe sterk is de drang aanwezig om jezelf te verwonden zonder de wens je leven te beëindigen?”).
Met deze innovatieve manier van bevraging wilde we een initieel, maar grondig beeld schetsen van welke gevoelens (bv. negatieve gevoelens zoals zich alleen of angstig voelen) of gedachten (bv. piekergedachten of kritische gedachten over zichzelf) de drang tot zelfverwonding triggeren. Drie participanten, die zich reeds enkele jaren verwonden, kregen een maand lang, zes keer per dag, een korte vragenlijst naar hun smartphone toegestuurd.
Hoe de smartphone het verschil maakt
De resultaten van de drie casestudies maakten duidelijk dat zowel de drang tot zelfverwonding als negatieve gevoelens en gedachten sterk schommelen over verschillende uren en dagen heen. Zoals weergegeven op de figuur, zijn de meeste gevoelens of gedachten niet steeds in dezelfde mate aanwezig en verschillen deze schommelingen tussen de drie participanten. Dit toont dat de smartphone ons een diepgaand inzicht geeft in de individuele tendensen van de gevoelens en de drang tot zelfverwonding over de tijd heen.
Een tweede belangrijke bevinding was dat elke persoon verschilde in welke gevoelens en gedachten gepaard gingen met een sterkere drang tot zelfverwonding. Voor de ene persoon zorgden negatieve gevoelens in combinatie met piekergedachten voor een sterkere drang tot ZVG, waar de andere persoon deze drang ervaarde wanneer enkel negatieve gevoelens aanwezig waren. Deze resultaten suggereren dat het verschil in acuut risico tussen personen eerder een regel dan een uitzondering is. Dit beklemtoont de noodzaak voor zorgvuldige, klinische begeleiding op maat van het unieke individu.
Conclusie
Ondanks dat deze masterscriptie enkel een initieel beeld geeft, tonen onze resultaten het belang en de toepasbaarheid van de smartphone in het detecteren wanneer iemand acuut risico loopt om zichzelf te verwonden en dat net dit voor ieder individu uniek is. Hiermee hopen we in de toekomst een brug te kunnen slaan tussen het onderzoek en de klinische praktijk, want enkel als we weten wanneer jongeren een risico lopen voor ZVG kunnen we klinische hulp bieden op maat van het individu. Zo zouden we in de toekomst kunnen ingrijpen via de smartphone (bv. door alternatieven voor ZVG voor te stellen die niet schadelijk zijn) om zo de juiste ondersteuning te bieden op het moment wanneer dit het meest nodig is. De smartphone zal de psycholoog nooit vervangen. Wel kan het een behulpzaam instrument zijn om risico voor zelfverwonding te signaleren als jongeren niet bij de psycholoog zijn, om zo zelfverwonding te kunnen voorkomen in hun dagelijkse leven.
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