The relational approach to treating self-harm (RELATE): A feasibility randomised controlled trial of cognitive...

There is currently a dearth of psychological support available to clients who self-harm in the NHS and there is a need to develop brief, targeted interventions to better fill this treatment gap. Cognitive analytic therapy (CAT) is a relational psychotherapy that holds promise for helping people who self-harm. A brief version of CAT has been developed and now requires evaluation.

To evaluate the feasibility of evaluating 8-session CAT to adult outpatients accessing community services who self-harm in a subsequent definitive trial.

A feasibility randomised controlled trial evaluating 8-session CAT for self-harm in adult outpatients. Participants were randomly allocated (1:1) to brief CAT plus treatment as usual (TAU) or TAU alone. Rater-blind assessments occurred at baseline, 12-weeks and 18-weeks.

Pre-specified study progression criteria concerning recruitment (n = 60 recruited over 12 months), retention (92 %), missing data on clinical outcomes (< 7 %) and engagement with therapy (90 % attended ≥ 4 sessions within a 10-week window) were all met. Urges to self-harm and psychological distress declined in the CAT arm and to a greater extent than the TAU arm (self-harm urges: 80 % CI:6.22 -1.68; psychological distress: 80 % CI:5.95, -2.22).

The results support the feasibility of evaluating brief CAT for self-harm and so progression to larger-scale definitive efficacy trial is warranted. CAT shows initial promise as a treatment for self-harm in adults but this now requires evaluation within a definitive trial.

The trial was pre-registered (21/10/22) on ISRCTN (ISRCTN code: ISRCTN75661422).