Cognitive Behavioural Therapy Offers Significant Help To People Who Self-Harm

Main Category: Psychology / Psychiatry
Also Included In: Depression;  Anxiety / Stress
Article Date: 29 Feb 2008 - 1:00 PDT

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12 sessions of cognitive behavioural therapy (CBT) can be of significant help to people who self-harm, a new study from the Netherlands has found.

Published in the March 2008 issue of the British Journal of Psychiatry, the research showed that patients who received CBT in addition to treatment as usual (TAU) were found to have significantly greater reductions in self-harm, suicidal thoughts and symptoms of depression and anxiety, compared with a control group who received TAU only.

The CBT group also showed significantly greater improvements in self-esteem and problem-solving ability.

Self-harm by young people is increasing in frequency. Although in-patient treatment (hospital admission, medication and psychotherapy) is the usual treatment for people who self-harm, it has never been found to be effective in a controlled clinical trial.

90 patients aged between 15 and 35 who had recently self-harmed (taken an overdose or injured themselves) took part in this study. They were randomly assigned to CBT plus TAU, or TAU only, and were assessed at the beginning of the study and at 3-month, 6-month and 9-month follow-up.

The researchers comment that the positive effect of CBT on self-harm is important, given the high suicide risk following self-harm. It is especially important that these results are found for people who repeatedly self-harm and are also mentally ill.

The significant decrease in suicidal thoughts found in the CBT group is important, they say, because these thoughts are considered to be the main triggers for repeated self-harm.

The CBT was designed to tackle patients' perceptions of themselves as being a burden to others, as well as their feelings of helplessness, of being unlovable, and their inability to tolerate distress.

Whilst acknowledging the validity of patients' emotions, the CBT therapists emphasised hopefulness, and showed them that they could improve the current situation by identifying and addressing unhelpful thoughts.

Helping patients with their current problems was another important element of treatment, as people who self-harm have poor problem-solving skills that are independent of their mood.

By identifying effective strategies that patients already used, they were encouraged to see that they had some control over their problems. In addition, patients were encouraged to develop and use new strategies. As expected, their problem-solving skills improved significantly during treatment.

The effects of CBT on depression, suicidal thoughts and problem-solving were stronger than on self-harm at 3-month and 6-month follow-up. Changes in these factors seemed to precede changes in self-harm.

This suggests, say the researchers, that CBT primarily targeted depression, suicidal thoughts and problem-solving, and that the specific self-harm effect - which was apparent only at 9-month follow-up - was a secondary effect.

They conclude that adding this short cognitive behavioural intervention to usual care could provide clinicians with an important tool to prevent repetition of self-harm in people who are at high risk.

These findings should be replicated, using a longer follow-up period. Further investigation is needed into how CBT brings about these changes.

Reference

Cognitive-behavioural intervention for self-harm: randomised controlled trial.
Slee N, Garnefski N, van der Leeden R, Arensman E and Spinhoven P
British Journal of Psychiatry, 192, 202-211.

Royal College of Psychiatrists