Background. The treatment of deliberate self-harm (parasuicide)
remains limited in efficacy. Despite
a range of psychosocial, educational and pharmacological interventions
only one approach,
dialectical behaviour therapy, a form of cognitive-behaviour therapy (CBT),
has been shown to
reduce repeat episodes, but this is lengthy and intensive and difficult
to extrapolate to busy clinical
practice. We investigated the effectiveness of a new manual-based treatment
varying from
bibliotherapy (six self-help booklets) alone to six sessions of cognitive
therapy linked to the
booklets, which contained elements of dialectical behaviour therapy.Methods. Thirty-four patients, aged between 16 and 50, seen
after an episode of deliberate self-harm,
with personality disturbance within the flamboyant cluster and a previous
parasuicide
episode within the past 12 months, were randomly assigned to treatment
with manual-assisted
cognitive-behaviour therapy (MACT N=18) or treatment as usual
(TAU N=16). Assessment of
clinical symptoms and social function were made at baseline and repeated
by an independent
assessor masked to treatment allocation at 6 months. The number and rate
of all parasuicide
attempts, time to next episode and costs of care were also determined.Results. Thirty-two patients (18 MACT; 14 TAU) were seen at
follow-up and 10 patients in each
group (56% MACT and 71% TAU) had a suicidal act during the 6 months. The
rate of suicidal
acts per month was lower with MACT (median 0·17/month MACT;
0·37/month TAU; P=0·11)
and self-rated depressive symptoms also improved (P=0·03).
The treatment involved a mean of 2·7
sessions and the observed average cost of care was 46% less with MACT (P=0·22).Conclusions. Although limited by the small sample, the results
of this pilot study suggest that this
new form of cognitive-behaviour therapy is promising in its efficacy and
feasible in clinical practice.
Who benefits most from therapist-assisted internet-delivered cognitive behaviour therapy in clinical practice? Predictors of symptom change and dropout
