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Manual-assisted cognitive-behaviour therapy (MACT): a randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm

Published online by Cambridge University Press:  01 January 1999

K. EVANS
Affiliation:
Departments of Psychiatry and Medical Statistics and Evaluation, Imperial College School of Medicine and Psychological Medicine Unit, Chelsea and Westminster Hospital, London; and Department of Psychological Medicine, Gartnavel Royal Hospital, Glasgow
P. TYRER
Affiliation:
Departments of Psychiatry and Medical Statistics and Evaluation, Imperial College School of Medicine and Psychological Medicine Unit, Chelsea and Westminster Hospital, London; and Department of Psychological Medicine, Gartnavel Royal Hospital, Glasgow
J. CATALAN
Affiliation:
Departments of Psychiatry and Medical Statistics and Evaluation, Imperial College School of Medicine and Psychological Medicine Unit, Chelsea and Westminster Hospital, London; and Department of Psychological Medicine, Gartnavel Royal Hospital, Glasgow
U. SCHMIDT
Affiliation:
Departments of Psychiatry and Medical Statistics and Evaluation, Imperial College School of Medicine and Psychological Medicine Unit, Chelsea and Westminster Hospital, London; and Department of Psychological Medicine, Gartnavel Royal Hospital, Glasgow
K. DAVIDSON
Affiliation:
Departments of Psychiatry and Medical Statistics and Evaluation, Imperial College School of Medicine and Psychological Medicine Unit, Chelsea and Westminster Hospital, London; and Department of Psychological Medicine, Gartnavel Royal Hospital, Glasgow
J. DENT
Affiliation:
Departments of Psychiatry and Medical Statistics and Evaluation, Imperial College School of Medicine and Psychological Medicine Unit, Chelsea and Westminster Hospital, London; and Department of Psychological Medicine, Gartnavel Royal Hospital, Glasgow
P. TATA
Affiliation:
Departments of Psychiatry and Medical Statistics and Evaluation, Imperial College School of Medicine and Psychological Medicine Unit, Chelsea and Westminster Hospital, London; and Department of Psychological Medicine, Gartnavel Royal Hospital, Glasgow
S. THORNTON
Affiliation:
Departments of Psychiatry and Medical Statistics and Evaluation, Imperial College School of Medicine and Psychological Medicine Unit, Chelsea and Westminster Hospital, London; and Department of Psychological Medicine, Gartnavel Royal Hospital, Glasgow
J. BARBER
Affiliation:
Departments of Psychiatry and Medical Statistics and Evaluation, Imperial College School of Medicine and Psychological Medicine Unit, Chelsea and Westminster Hospital, London; and Department of Psychological Medicine, Gartnavel Royal Hospital, Glasgow
S. THOMPSON
Affiliation:
Departments of Psychiatry and Medical Statistics and Evaluation, Imperial College School of Medicine and Psychological Medicine Unit, Chelsea and Westminster Hospital, London; and Department of Psychological Medicine, Gartnavel Royal Hospital, Glasgow

Abstract

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.

Type
Research Article
Copyright
© 1999 Cambridge University Press

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