Psychological Medicine



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


P. TYRER a1c1, S. THOMPSON a1, U. SCHMIDT a1, V. JONES a1, M. KNAPP a1, K. DAVIDSON a1, J. CATALAN a1, J. AIRLIE a1, S. BAXTER a1, S. BYFORD a1, G. BYRNE a1, S. CAMERON a1, R. CAPLAN a1, S. COOPER a1, B. FERGUSON a1, C. FREEMAN a1, S. FROST a1, J. GODLEY a1, J. GREENSHIELDS a1, J. HENDERSON a1, N. HOLDEN a1, P. KEECH a1, L. KIM a1, K. LOGAN a1, C. MANLEY a1, A. MacLEOD a1, R. MURPHY a1, L. PATIENCE a1, L. RAMSAY a1, S. DE MUNROZ a1, J. SCOTT a1, H. SEIVEWRIGHT a1, K. SIVAKUMAR a1, P. TATA a1, S. THORNTON a1, O. C. UKOUMUNNE a1 and S. WESSELY a1
a1 Department of Psychological Medicine, Imperial College, King's College and Maudsley Hospitals and the Centre for the Economics of Mental Health, Institute of Psychiatry, London; Gartnavel Royal and Southern General Hospital, Glasgow; Royal Edinburgh Hospital, Edinburgh; Stonebridge Research Centre and Queen's Medical Centre, Nottingham; Maidstone General Hospital, Maidstone; and MRC Biostatistics Unit, Cambridge

Article author query
tyrer p   [PubMed][Google Scholar] 
thompson s   [PubMed][Google Scholar] 
schmidt u   [PubMed][Google Scholar] 
jones v   [PubMed][Google Scholar] 
knapp m   [PubMed][Google Scholar] 
davidson k   [PubMed][Google Scholar] 
catalan j   [PubMed][Google Scholar] 
airlie j   [PubMed][Google Scholar] 
baxter s   [PubMed][Google Scholar] 
byford s   [PubMed][Google Scholar] 
byrne g   [PubMed][Google Scholar] 
cameron s   [PubMed][Google Scholar] 
caplan r   [PubMed][Google Scholar] 
cooper s   [PubMed][Google Scholar] 
ferguson b   [PubMed][Google Scholar] 
freeman c   [PubMed][Google Scholar] 
frost s   [PubMed][Google Scholar] 
godley j   [PubMed][Google Scholar] 
greenshields j   [PubMed][Google Scholar] 
henderson j   [PubMed][Google Scholar] 
holden n   [PubMed][Google Scholar] 
keech p   [PubMed][Google Scholar] 
kim l   [PubMed][Google Scholar] 
logan k   [PubMed][Google Scholar] 
manley c   [PubMed][Google Scholar] 
macleod a   [PubMed][Google Scholar] 
murphy r   [PubMed][Google Scholar] 
patience l   [PubMed][Google Scholar] 
ramsay l   [PubMed][Google Scholar] 
de munroz s   [PubMed][Google Scholar] 
scott j   [PubMed][Google Scholar] 
seivewright h   [PubMed][Google Scholar] 
sivakumar k   [PubMed][Google Scholar] 
tata p   [PubMed][Google Scholar] 
thornton s   [PubMed][Google Scholar] 
ukoumunne o   [PubMed][Google Scholar] 
wessely s   [PubMed][Google Scholar] 

Abstract

Background. We carried out a large randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behaviour therapy (MACT) versus treatment as usual (TAU) for deliberate self-harm.

Method. Patients presenting with recurrent deliberate self-harm in five centres were randomized to either MACT or (TAU) and followed up over 1 year. MACT patients received a booklet based on cognitive behaviour therapy (CBT) principles and were offered up to five plus two booster sessions of CBT from a therapist in the first 3 months of the study. Ratings of parasuicide risk, anxiety, depression, social functioning and global function, positive and negative thinking, and quality of life were measured at baseline and after 6 and 12 months.

Results. Four hundred and eighty patients were randomized. Sixty per cent of the MACT group had both the booklet and CBT sessions. There were seven suicides, five in the TAU group. The main outcome measure, the proportion of those repeating deliberate self-harm in the 12 months of the study, showed no significant difference between those treated with MACT (39%) and treatment as usual (46%) (OR 0·78, 95% CI 0·53 to 1·14, P=0·20).

Conclusion. 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.


Correspondence:
c1 Professor Peter Tyrer, Imperial College, (Charing Cross Campus), St Dunstan's Road, London W6 8RP.


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