Psychological treatment may be effective in reducing self-harm

A new review, published in The Lancet Psychiatry, investigates the effectiveness of a number of different forms of psychological, or 'talking' therapies, for adults who self-harm.

Self-harm, which includes all intentional self-poisoning or self-injury irrespective of suicidal or other motives, is often repeated and is strongly associated with an increased risk of suicide. It is a major problem in many countries and places large demands on health care services worldwide.

Interventions investigated in a minimum of three independent randomised controlled trials (RCTs) were included in the report. There were 29 RCTs in the review, involving a total of 8,480 participants.

Most of the RCTs (18 trials) investigated the effectiveness of cognitive behavioural therapy (CBT), a type of 'talking' therapy that helps people change the way they deal with problems through a focus on how a patient's beliefs and attitudes affect their feelings and behaviour. CBT-based psychological therapies combine cognitive therapy (helping patients with their thoughts) and behavioural therapy (helping patients change their behavioural responses). By the end of the follow-up period in these trials, people who had received CBT-based psychological therapy were less likely to self-harm. Following CBT, 6% fewer people self-harmed when compared with those who did not get CBT. Benefits of CBT-based psychological therapy were also found for depressed mood, hopelessness about the future, and suicidal thoughts.

Other RCTs included in the review investigated the effectiveness of dialectical behaviour therapy (3 trials), case management (4 trials), and receiving regular postcards from clinical service personnel (4 trials). Dialectical behaviour therapy may reduce frequency of self-harm following treatment for people with a history of multiple episodes of self-harm. No major evidence of effectiveness was found for case management and postcards.

Lead author, Professor Keith Hawton from the Centre for Suicide Research at the University of Oxford said: 'While most of the studies were small, taken together we found that CBT-based psychological therapy may have led to a small-to-modest reduction in the number of patients repeating self-harm behaviours. We found some variation between the results of the studies. Also, a difficulty with trials in this area is that patients will be aware that they received either the specific psychological therapy or the care they would normally have received (unlike in placebo-controlled trials of medication). This expectation could have influenced the results. It is important to bear these points in mind when considering the implications of these findings. However there were indications that CBT-based psychological therapy also helped patients' emotional well-being.

'The effects of other therapeutic approaches are less clear because they were mostly evaluated in small single trials. Future studies will help us understand which patients are likely to benefit from these types of interventions for self-harm. It’s important that people who self-harm are aware of this, so that they can make more informed choices about their treatment.'

The paper, Psychosocial interventions following self-harm in adults: A systematic review and meta-analysis is published in The Lancet Psychiatry (doi:10.1016/S2215-0366(16)30070-0).