Physical pain can sometimes be as effective as other strategies in reducing psychological distress, according to new research published in the journal Emotion.

Self-injurious behavior among adolescents with mental health problems is a serious public health concern around the world, but the new findings indicate that the use of benign physical pain to regulate emotion is common outside of this population as well.

“I had been studying body-based coping skills for people who struggle with regulating their emotions, such as smiling, rhythmic tapping, and deep breathing. I became interested in the topic of pain because a great deal of the literature on non-suicidal self-injury (NSSI) indicates that one reason people engage in self-injurious behavior is to regulate extreme emotional states,” said study author Ashley Doukas, a clinical instructor at NYU Langone Health.

“An incidental finding in many of the studies looking at NSSI proxies (such as non-harmful pressure, heat, and cold) is that the healthy ‘control’ populations also report reductions in negative emotion after receiving a painful stimulus. This got me thinking that pain itself might be the primary mechanism in self-regulation, rather than the injurious component, per se.”

“Furthermore, it made me think that benign forms of pain might be used to self-regulate more widely by the general population, yet go unnoticed due to the lack of a shock factor that NSSI has. We wanted to see if, given the choice, people without NSSI histories would voluntarily inflict pain to cope with negative emotions,” Doukas explained.

In the study, the researchers exposed 60 individuals to upsetting images and provided them with two cognitive strategies and two physical methods to cope with negative emotion. The participants were told they could reduce distress by either thinking of something other than the picture, changing the meaning of the picture in their mind, self-administering a painful shock, or self-administering a painless electrical stimulation.

Doukas and her colleagues found that 67.5% of participants elected for the painful shock at least once. During 16 trials, the participants chose the painful stimulation between 0 to 13 times, with an average of twice per person. In addition, the painful stimulation as rated as equally effective in regulating negative emotion compared with other coping strategies.

Doukas hopes that the findings “de-stigmatize those who engage in self-injurious behavior. There is a lot of shame and hiding when people engage in self-injurious behavior, and well-meaning people might not understand why people do it.”

“While of course we do not want people to put themselves at risk for infection or accidental death, the fact is that human beings use pain to manage their emotions all the time — think of an intense massages to relax, and putting extra hot sauce on tacos to make them more intense and enjoyable. While the injurious aspect of NSSI can be alarming to many, the infliction of pain on oneself may not be inherently pathological, and may actually be making good use of some basic biological responses to pain, such as endorphins,” she told PsyPost.

In a replication of previous research, the researchers also had the participants sit alone in an empty room for 10 minutes, and instructed them not to sleep, read, or use their cell phone. The participants were, however, allowed to self-administer painful or painless electrical stimulation as frequently as they wished.

Approximately 60% of the participants decided to painfully shock themselves at least once. The number of times participants chose to receive the painful electrical stimulation ranged from 0 to 69, with an average of about 13.

“In understanding the self-regulatory function of pain to either reduce intense negative emotions, or induce emotions during an unpleasant state of emotional numbing (such as boredom), we can better understand how clinical and non-clinical populations cope with negative emotions,” Doukas said.

“Perhaps voluntarily inflicting pain exists on a spectrum from ‘healthy’ to ‘unhealthy’, and it is the behavior (e.g. cutting), and not the mechanism of action (i.e., pain) that might determine where that boundary lies. In destigmatizing pain and recognizing its potential to be helpful, we can broaden our understanding of now clinical and non-clinical populations might use the biological response to pain to help them get through the day a bit better.”

Of course, the researchers are not endorsing self-injury as a method of coping with emotional distress.

“Our hope is that our research, and research like it, can expand treatment options for those who do engage in dangerous NSSI behavior like cutting or burning skin. For example, one possibility might be integrating TENS units (electrical stimulation devices which are often used in physical therapy settings) into a harm reduction treatment plan,” Doukas explained.

“By removing stigma, and looking at the behavior from a neutral scientific standpoint, we hope that both clinicians and the lay public can understand not only why clinical populations engage in NSSI, but how to treat it more effectively. I would also caution people against purchasing a TENS unit and/or self-inflicting pain without first consulting their physician about whether it is safe for them.”

The study, “Hurts So Good: Pain as an Emotion Regulation Strategy“, was authored by Ashley M. Doukas, Wendy M. D’Andrea, Wesley E. Gregory, Brandon Joachim, Kellie A. Lee, Gabriella Robinson, Steven J. Freed, Vivian Khedari-DePierro, Kendall A. Pfeffer, McWelling Todman, and Greg J. Siegle.