Cheap and cheerful treatment for people who deliberately harm themselves more effective than long-term expensive therapies

Jul 10 2004

A ‘cheap and cheerful’ treatment for people who deliberately harm themselves has been shown to be more effective than long-term, far more expensive therapies – as long as the therapists are good at their job.

Such a treatment is badly needed, Peter Tyrer, Professor of Psychiatry at Imperial College, London, told the annual conference of the Royal College of Psychiatrists. Over 100,000 people require medical care after deliberate self-harm every year, of whom one per cent kill themselves within a year and 10 per cent kill themselves eventually.

Yet no evidence-based treatment has been shown to be effective. “As half the people who harm themselves don’t return for further treatment, there’s a desperate need for a brief intervention that can be offered on a wide scale,” Professor Tyrer explained.

A major study involving 480 people who have deliberately harmed themselves at least once, due to be published later this year in the journal, Psychological Medicine, is showing major benefits from handing out a carefully written booklet, offering ‘manualised cognitive therapy’. At the same time, participants were offered five to seven sessions of cognitive behavioural therapy from either social workers, nurses, clinical psychologists or psychiatrists.

“The study showed that the frequency of self-harm in the group that received the booklet and the brief therapy was about half that of people getting ‘treatment as usual”, Professor Tyrer told the meeting.

But co-researcher, Kate Davidson, Professor of Psychology at Gartnavel Royal Hospital in Glasgow, said that the quality of therapists had to be taken into account. This emerged when the team had analysed 49 tapes of clinical sessions that were intended to be based around the booklet.

“The best therapists were able to structure the therapy around the booklet and do it very well, at the same time as being empathetic and being skilful at listening to the patient’s story. After six months, there was very little difference between the outcomes for patients treated by the poorest therapists and the best. But after a year, those patients who were treated by the best therapists had significantly less depression, anxiety and higher social functioning.”