Manual-assisted cognitive-behaviour therapy (MACT) : a randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm
1999
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.
Keywords:
- Correction
- Source
- Cite
- Save
- Machine Reading By IdeaReader
13
References
217
Citations
NaN
KQI