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

Published online by Cambridge University Press:  31 July 2003

P. TYRER
Affiliation:
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
S. THOMPSON
Affiliation:
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
U. SCHMIDT
Affiliation:
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
V. JONES
Affiliation:
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
M. KNAPP
Affiliation:
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
K. DAVIDSON
Affiliation:
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
J. CATALAN
Affiliation:
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
J. AIRLIE
Affiliation:
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
S. BAXTER
Affiliation:
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
S. BYFORD
Affiliation:
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
G. BYRNE
Affiliation:
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
S. CAMERON
Affiliation:
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
R. CAPLAN
Affiliation:
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
S. COOPER
Affiliation:
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
B. FERGUSON
Affiliation:
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
C. FREEMAN
Affiliation:
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
S. FROST
Affiliation:
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
J. GODLEY
Affiliation:
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
J. GREENSHIELDS
Affiliation:
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
J. HENDERSON
Affiliation:
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
N. HOLDEN
Affiliation:
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
P. KEECH
Affiliation:
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
L. KIM
Affiliation:
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
K. LOGAN
Affiliation:
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
C. MANLEY
Affiliation:
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
A. MacLEOD
Affiliation:
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
R. MURPHY
Affiliation:
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
L. PATIENCE
Affiliation:
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
L. RAMSAY
Affiliation:
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
S. DE MUNROZ
Affiliation:
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
J. SCOTT
Affiliation:
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
H. SEIVEWRIGHT
Affiliation:
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
K. SIVAKUMAR
Affiliation:
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
P. TATA
Affiliation:
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
S. THORNTON
Affiliation:
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
O. C. UKOUMUNNE
Affiliation:
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
S. WESSELY
Affiliation:
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

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.

Type
Research Article
Copyright
© 2003 Cambridge University Press

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