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

Background. The treatment of deliberate self-harm (parasuicide) remains lim ited in efficacy. Despite a range of psychosocial, educational and pharmaco logical interventions only one approach, dialectical behaviour therapy, a f orm of cognitive-behaviour therapy (CBT), has been shown to reduce repeat e pisodes, but this is lengthy and intensive and difficult to extrapolate to busy clinical practice. We investigated the effectiveness of a new manual-b ased 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 episod e of deliberate self-harm, with personality disturbance within the flamboya nt cluster and a previous parasuicide episode within the past 12 months, we re randomly assigned to treatment with manual-assisted cognitive-behaviour therapy (MACT N = 18) or treatment as usual (TAU N = 16). Assessment of cli nical symptoms and social function were made at baseline and repeated by an independent assessor masked to treatment allocation at 6 months. The numbe r and rate of all parasuicide attempts, time to next episode and costs of c are were also determined. Results. Thirty-two patients (18 MACT; 14 TAU) were seen at follow-up and 1 0 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 (med ian 0.17/month MACT; 0.37/month TAU; P = 0.11) and self-rated depressive sy mptoms also improved (P = 0.03). The treatment involved a mean of 2.7 sessi ons 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 pilo t study suggest that this new form of cognitive-behaviour therapy is promis ing in its efficacy and feasible in clinical practice.