Psychosocial interventions for self-harm in adults

Area of Science:

• Psychiatry and Mental Health
• Psychological Interventions
• Evidence-Based Medicine

Background:

• Self-harm (SH) is a prevalent and often repeated behavior associated with suicide risk.
• This review focuses on psychosocial interventions for adults who engage in self-harm.
• It is an update of a broader Cochrane review, now divided into three separate reviews.

Purpose of the Study:

• To evaluate the effectiveness of specific psychosocial treatments compared to usual care or other therapies for adults following self-harm.
• To assess interventions aimed at reducing the repetition and frequency of self-harm.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) identified through extensive database searches (Cochrane Library, MEDLINE, EMBASE, PsycINFO) up to April 2015.
• Included RCTs compared psychosocial treatments with treatment as usual (TAU), enhanced usual care (EUC), or alternative psychological therapies.
• Participants were adults with a recent episode of self-harm (within six months) presenting to clinical services.

Main Results:

• Cognitive-behavioural-based psychotherapy (CBT-based psychotherapy) showed a significant effect in reducing the repetition of self-harm compared to TAU (low quality evidence).
• For individuals with multiple self-harm episodes/probable personality disorder, emotion-regulation psychotherapy and mentalisation significantly reduced repetition (low to moderate quality evidence).
• Dialectical behaviour therapy (DBT) showed a significant reduction in self-harm frequency but not repetition compared to TAU (low quality evidence). Case management and remote contact interventions showed no significant benefit in reducing self-harm repetition.

Conclusions:

• CBT-based psychotherapy may reduce self-harm repetition, though evidence quality is moderate to low.
• DBT may reduce self-harm frequency in specific populations, but this is based on low-quality evidence.
• Case management and remote interventions were not found to be beneficial for reducing self-harm repetition; evidence for other approaches is inconclusive.