Psychological Medicine

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

K. EVANS a1, P. TYRER a1c1, J. CATALAN a1, U. SCHMIDT a1, K. DAVIDSON a1, J. DENT a1, P. TATA a1, S. THORNTON a1, J. BARBER a1 and S. THOMPSON a1
a1 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


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.

c1 Address for correspondence: Professor Peter Tyrer, Academic Department of Psychiatry, Paterson Centre, 20 South Wharf Road, London W2 1PD.