Relational Approach to Treating Self-Harm: A Feasibility Randomised Controlled Trial of Cognitive Analytic Therapy for Adults who Self-Harm versus Treatment at Usual, 2023-2024

Self-harm is a significant clinical concern given the association with distress, and subsequent risk of emotional difficulties and suicide. The prevalence of self-harm in the UK is also increasing. Despite this, current services, and support for people who self-harm is lacking. Many people receive no treatment, or interventions that do not meet their needs. Cognitive Analytic Therapy (CAT) is a widely used relational approach that has potential as an intervention for people who self-harm. Unlike other approaches for self-harm it is a trans-diagnostic model that can be delivered in a brief 8 session format. Whilst research so far supports CAT as a treatment for a variety of mental health difficulties, research into its suitability for adults who self-harm is still preliminary.

The primary aim of this project was to ascertain the feasibility of evaluating an 8-session CAT intervention for adults (aged 18 years and older) who self-harm within community mental health services using a randomised controlled trial (RCT) design. Key feasibility uncertainties were resolved concerning recruitment, attrition, definition of Treatment As Usual (TAU), trial design and assessment. Secondary aims included i) determining the feasibility of conducting a full economic evaluation of CAT for self-harm, and ii) further determining the initial clinical promise of CAT for adults who self-harm.

RELATE was a assessor-blind feasibility RCT comparing 8 session CAT plus TAU to TAU alone (1:1 allocation).

Adults (aged 18 years and older) who had experienced three or more episodes of self-harm in the past year were recruited from community mental health services, including stepped care and psychotherapy services, in Manchester and South Yorkshire (Rotherham, Doncaster, South Humber). Following a baseline assessment, participants were randomly allocated to receive CAT plus TAU or TAU alone. There were follow-up assessment at 12 weeks and 18 weeks post-randomisation. Information on engagement with therapy, attrition, and safety was recorded throughout.

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