Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: the POPMACT study

Abstract

Brief cognitive behaviour therapy is of limited efficacy in reducing self-harm repetition, but the findings taken in conjunctin with the economic evaluation (Byford et al. 2003) indicate superiority of MACT over TAU in terms of cost and effectiveness combined.

Psychosocial interventions following self-harm in adults: a systematic review and meta-analysis

“…For information on the effectiveness of the remaining interventions not covered in this report the reader is instead referred to our review in the Cochrane Library. 13 A total of 29 trials were therefore included in the present review (Figure 1; Supplementary Document SD3), comprising 18 trials of cognitive behavioural-based psychotherapy (CBT), [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] three trials of dialectical behaviour therapy (DBT), [36][37][38] and four trials each of case management [39][40][41][42] and postcards. [43][44][45][46] (Insert Figure 1 about here)…”

“…[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Data on the proportion of patients repeating self-harm by the end of treatment was only available for one trial, 27 in which there was no apparent effect (23/171 vs. 27/142, OR 0·66, 95% CI 0·36 to 1·21, N=313). However, CBT-based therapy was associated with fewer participants repeating self-harm at the six month (OR 0·54, 95% CI 0·34 to 0·85, N=1,317; Figure 2) and 12 month follow-up assessments (OR 0·80, 95% CI 0·65 to 0·98, N=2,232; Figure 2).…”

Emotion regulation as mediator of treatment outcome in therapy for deliberate self‐harm

“…An RCT of brief CBT versus usual care showed that brief CBT was of limited effi cacy in reducing DSH (Tyrer et al, 2003), whereas an RCT of cognitive therapy (CT) reported favourable outcomes with regard to the number of suicide attempts, depression severity and thoughts of hopelessness (Brown et al, 2005). The BOSCOT trial evaluated the clinical effectiveness and cost-effectiveness of CBT for suicidal patients with borderline personality disorder Palmer et al, 2006).…”

Policy on the prevention of suicidal behaviour; one treatment for all may be an unrealistic expectation

“…Additional problems result from the often necessary use of multi-centre trials where effect sizes may be underestimated due to contamination in centres where there is little difference between 'treatment as usual' (TAU) and the intervention on trial. 11 A fourth area of difficulty is the diversity of the population at risk, the characteristics of which vary according to age, gender, ethnic group, diagnosis and behaviour. This group comprises individuals with overlapping diagnoses of depressive disorders, bipolar affective disorder, substance misuse problems, anxiety disorders, schizophrenia and different permutations of personality disorders and traits, or those with no diagnosis at all.…”

“…behaviour that have produced negative findings, 11,[13][14][15][16][17][18] although clearly another explanation is that the interventions were simply ineffective. A small number of trials have shown positive findings, but such trials are often dismissed as being of limited generalizability.…”