# HERE‐Bi: Feasibility and Acceptability of a Self‐Esteem Intervention for Young Bisexual People to Reduce Non‐Suicidal Self‐Injury

## TL;DR

A self-esteem therapy for young bisexual people who self-harm is shown to be safe, acceptable, and feasible, with potential to reduce self-harm and improve identity and belonging.

## Contribution

This study introduces a feasible, affirmative self-esteem intervention tailored for young bisexual individuals to reduce non-suicidal self-injury.

## Key findings

- The 8-week intervention was found to be safe and acceptable with no serious adverse events.
- Participants showed improvements in self-esteem, reduced self-harm, and increased positive identity and belonging.
- Flexible, personalized therapy approaches improved engagement and perceived effectiveness.

## Abstract

Bisexual youth are at a disproportionate risk of non‐suicidal self‐injury (NSSI). Unique stressors, such as biphobia and bi‐erasure, and their impact on self‐esteem, identity and a sense of belonging may help explain this disproportionate risk. Affirmative therapies promote self‐acceptance and identity affirmation and may therefore be effective in boosting self‐esteem and reducing NSSI.

This study aimed to assess the feasibility and acceptability of a cognitive behavioural therapy‐based, self‐esteem intervention for young bisexual people (aged 16–25) with experience of NSSI thoughts, urges and behaviour. Secondarily, this study examined indicators of change on measures of self‐esteem, NSSI, identity and belongingness.

A case series design was used with eight participants who experienced NSSI urges, thoughts or behaviours in the previous 6 months. Participants received an affirmative, 8‐week, self‐esteem intervention and completed measures of self‐esteem, NSSI, belongingness and identity.

Six participants attended all eight therapy sessions, and two opted out before completion. There were no serious adverse events. The intervention was deemed to be acceptable and feasible, and evidence of improvements on measures of self‐esteem, NSSI, positive identity and thwarted belongingness was observed.

The results suggest that this intervention is a safe, acceptable and feasible intervention, warranting further evaluation. Revisions and considerations for future trials of this affirmative therapy are proposed.

A virtually delivered, one‐to‐one affirmative self‐esteem intervention is feasible, acceptable and safe for young bisexual people.Affirmative therapy that incorporates systemic considerations into formulations is helpful for individuals to differentiate between internalised biphobia and unhelpful thinking patterns.Interventions that are flexible and responsive to the needs of the participant aid engagement and perceived effectiveness.

A virtually delivered, one‐to‐one affirmative self‐esteem intervention is feasible, acceptable and safe for young bisexual people.

Affirmative therapy that incorporates systemic considerations into formulations is helpful for individuals to differentiate between internalised biphobia and unhelpful thinking patterns.

Interventions that are flexible and responsive to the needs of the participant aid engagement and perceived effectiveness.