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CBT most effective treatment for repeat self-harm

Recent findings showed cognitive behavioral therapy after self-harm was effective while dialectical behavior therapy did not reduce repeat self-harm but reduced frequency of self-harm.

“Self-harm (intentional acts of non-fatal self-poisoning or self-injury) is common, particularly in young adults aged 15 to 35 years, often repeated, and strongly associated with suicide. Effective aftercare of individuals who self-harm is therefore important,” Keith Hawton, FMedSci, of the University of Oxford, and colleagues wrote.

Keith Hawton

To assess efficacy of psychosocial interventions for self-harm in adults, researchers conducted a Cochrane systematic review and meta-analysis of 29 randomized controlled trials with three independent trials of the same intervention for adults with recent self-harm.

CBT, which was comprised of cognitive behavioral and problem solving therapy, was associated with fewer participants repeating self-harm at 6 months (OR = 0.54; 95% CI, 0.34-0.85) and at 12 months (OR = 0.8; 95% CI, 0.65-0.98).

Secondary outcomes, including depression, hopelessness, suicidal ideation and problem solving did not significantly improve.

Compared with treatment as usual, dialectical behavior therapy did not decrease risk for repeat self-harm at 6 months (OR = 0.59; 95% CI, 0.16-2.15) or at 12 months (OR = 0.36; 95% CI, 0.05-2.47).

However, frequency of self-harm was significantly reduced among participants receiving dialectical behavior therapy, with a mean difference of –18.82 (95% CI, –36.68 to –0.95).

Four trials assessing case management (OR = 0.78; 95% CI, 0.47-1.3) and sending regular postcards (OR = 0.87; 95% CI, 0.62-1.23) did not reduce repeat self-harm.

“CBT seems to be effective in patients after self-harm. Dialectical behavior therapy did not reduce the proportion of patients repeating self-harm but did reduce the frequency of self-harm. However, aside from CBT, there were few trials of other promising interventions, precluding firm conclusions as to their effectiveness,” the researchers concluded. – by Amanda Oldt

Disclosure: The study was supported by the National Institute for Health Research. Please see the full study for a list of all authors’ relevant financial disclosures.