> We follow-up 5hrs later and ask general questions about their experience with the life line.

> If they are experiencing self harm, in addition to crisis lines, we offer them a single-session online intervention on managing sh. For that, we see significant improvements pre vs post on measures like “self-hatred”, and “desire to stop selfharm”, with medium effect sizes (.4-.8 cohen’s d). Very hard to show enduring effects for this, however.

Are you measuring in such a way that you can realistically determine which effects are due to the online intervention and which are due to the SH itself? I ask because after SH, especially a few hours later, I consistently have increased "desire to stop selfharm", and lessened "self-hatred". SH has that effect on me, hence its unfortunate use as a coping mechanism.