scholarly journals Manual assisted cognitive behaviour therapy is as effective as treatment as usual for deliberate self harm, but is more cost effective

2004 ◽  
Vol 7 (1) ◽  
pp. 15-15 ◽  
Author(s):  
R. Goldney
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Cost Effective ◽  
Behaviour Therapy ◽  
Treatment As Usual ◽  
Deliberate Self Harm ◽  
Cognitive Behaviour ◽  
Self Harm

Cost-effectiveness of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: a decision-making approach

2003 ◽  
Vol 33 (6) ◽  
pp. 977-986 ◽  
Author(s):  
S. BYFORD ◽  
M. KNAPP ◽  
J. GREENSHIELDS ◽  
O. C. UKOUMUNNE ◽  
V. JONES ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Cognitive Behaviour Therapy ◽  
Service Providers ◽  
Behaviour Therapy ◽  
Treatment As Usual ◽  
Deliberate Self Harm ◽  
Cognitive Behaviour ◽  
Self Harm

Background. Deliberate self-harm can be costly, in terms of treatment and subsequent suicide. Any intervention that reduces episodes of self-harm might therefore have a major impact on the costs incurred by service providers and the productivity losses due to illness or premature death.Method. Four hundred and eighty patients with a history of recurrent deliberate self-harm were randomized to manual-assisted cognitive behaviour therapy (MACT) or treatment as usual. Economic data were collected from patients at baseline, 6 and 12 months, and these data were complete for 397 patients. Incremental cost-effectiveness was explored using the primary outcome measure, proportion of patients having a repeat episode of deliberate self-harm, and quality of life. The uncertainty surrounding costs and effects was represented using cost-effectiveness acceptability curves.Results. Differences in total cost per patient were statistically significant at 6 months in favour of MACT (−£897, 95% CI −1747 to −48, P=0·04), but these differences did not remain significant at 12 months (−£838, 95% CI −2142 to 466, P=0·21). Nevertheless, exploration of the uncertainty surrounding these estimates suggests there is >90% probability that MACT is a more cost-effective strategy for reducing the recurrence of deliberate self-harm in this population over 1 year than treatment as usual. The results for quality of life were not conclusive.Conclusion. Cost-effectiveness acceptability curves demonstrate that, based on the evidence currently available, to reject MACT on traditional grounds of statistical significance and to continue funding current practice has <10% chance of being the correct decision in terms of cost-effectiveness.

Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: the POPMACT study

2003 ◽  
Vol 33 (6) ◽  
pp. 969-976 ◽  
Author(s):  
P. TYRER ◽  
S. THOMPSON ◽  
U. SCHMIDT ◽  
V. JONES ◽  
M. KNAPP ◽  
...  
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Controlled Trial ◽  
Behaviour Therapy ◽  
Treatment As Usual ◽  
Deliberate Self Harm ◽  
Cognitive Behaviour ◽  
Significant Difference ◽  
Self Harm ◽  
Therapy Manual ◽  
Anxiety Depression

Background. We carried out a large randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behaviour therapy (MACT) versus treatment as usual (TAU) for deliberate self-harm.Method. Patients presenting with recurrent deliberate self-harm in five centres were randomized to either MACT or (TAU) and followed up over 1 year. MACT patients received a booklet based on cognitive behaviour therapy (CBT) principles and were offered up to five plus two booster sessions of CBT from a therapist in the first 3 months of the study. Ratings of parasuicide risk, anxiety, depression, social functioning and global function, positive and negative thinking, and quality of life were measured at baseline and after 6 and 12 months.Results. Four hundred and eighty patients were randomized. Sixty per cent of the MACT group had both the booklet and CBT sessions. There were seven suicides, five in the TAU group. The main outcome measure, the proportion of those repeating deliberate self-harm in the 12 months of the study, showed no significant difference between those treated with MACT (39%) and treatment as usual (46%) (OR 0·78, 95% CI 0·53 to 1·14, P=0·20).Conclusion. Brief cognitive behaviour therapy is of limited efficacy in reducing self-harm repetition, but the findings taken in conjunctin with the economic evaluation (Byford et al. 2003) indicate superiority of MACT over TAU in terms of cost and effectiveness combined.

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

1999 ◽  
Vol 29 (1) ◽  
pp. 19-25 ◽  
Author(s):  
K. EVANS ◽  
P. TYRER ◽  
J. CATALAN ◽  
U. SCHMIDT ◽  
K. DAVIDSON ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cognitive Behaviour Therapy ◽  
Controlled Trial ◽  
Small Sample ◽  
Cost Of Care ◽  
Behaviour Therapy ◽  
Deliberate Self Harm ◽  
Dialectical Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Self Harm

Background. The treatment of deliberate self-harm (parasuicide) remains limited in efficacy. Despite a range of psychosocial, educational and pharmacological interventions only one approach, dialectical behaviour therapy, a form of cognitive-behaviour therapy (CBT), has been shown to reduce repeat episodes, but this is lengthy and intensive and difficult to extrapolate to busy clinical practice. We investigated the effectiveness of a new manual-based 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 episode of deliberate self-harm, with personality disturbance within the flamboyant cluster and a previous parasuicide episode within the past 12 months, were randomly assigned to treatment with manual-assisted cognitive-behaviour therapy (MACT N=18) or treatment as usual (TAU N=16). Assessment of clinical symptoms and social function were made at baseline and repeated by an independent assessor masked to treatment allocation at 6 months. The number and rate of all parasuicide attempts, time to next episode and costs of care were also determined.Results. Thirty-two patients (18 MACT; 14 TAU) were seen at follow-up and 10 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 (median 0·17/month MACT; 0·37/month TAU; P=0·11) and self-rated depressive symptoms also improved (P=0·03). The treatment involved a mean of 2·7 sessions 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 pilot study suggest that this new form of cognitive-behaviour therapy is promising in its efficacy and feasible in clinical practice.

scholarly journals Self-guided mindfulness and cognitive behavioural practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools

Autism ◽  
2020 ◽  
Vol 24 (4) ◽  
pp. 867-883 ◽  
Author(s):  
Sebastian B Gaigg ◽  
Paul E Flaxman ◽  
Gracie McLaven ◽  
Ritika Shah ◽  
Dermot M Bowler ◽  
...  
Keyword(s):  
Mental Health ◽  
Cognitive Behaviour Therapy ◽  
Controlled Trial ◽  
Cost Effective ◽  
Well Being ◽  
Behaviour Therapy ◽  
Self Help ◽  
Online Tools ◽  
Cognitive Behaviour ◽  
Autistic Adults

Anxiety in autism is an important treatment target because of its consequences for quality of life and well-being. Growing evidence suggests that cognitive behaviour therapies and mindfulness-based therapies can ameliorate anxiety in autism but cost-effective delivery remains a challenge. This pilot randomised controlled trial examined whether online cognitive behaviour therapy and mindfulness-based therapy self-help programmes could help reduce anxiety in 54 autistic adults who were randomly allocated to either an online cognitive behaviour therapy (n = 16) or mindfulness-based therapy (n = 19) programme or a waitlist control group (n = 19). Primary outcome measures of anxiety, secondary outcome measures of broader well-being and potential process of change variables were collected at baseline, after programme completion, and then 3 and 6 months post-completion. Baseline data confirmed that intolerance of uncertainty and emotional acceptance accounted for up to 61% of self-reported anxiety across all participants. The 23 participants who were retained in the active conditions (14 mindfulness-based therapies, 9 cognitive behaviour therapies) showed significant decreases in anxiety that were maintained over 3, and to some extent also 6 months. Overall, results suggest that online self-help cognitive behaviour therapy and mindfulness-based therapy tools may provide a cost-effective method for delivering mental health support to those autistic adults who can engage effectively with online support tools. Lay abstract Anxiety in autism is an important target for psychological therapies because it is very common and because it significantly impacts upon quality of life and well-being. Growing evidence suggests that cognitive behaviour therapies and mindfulness-based therapies can help autistic individuals learn to manage feelings of anxiety but access to such therapies remains problematic. In the current pilot study, we examined whether existing online cognitive behaviour therapy and mindfulness-based therapy self-help tools can help reduce anxiety in autistic adults. Specifically, 35 autistic adults were asked to try either an existing online cognitive behaviour therapy (n = 16) or mindfulness-based therapy (n = 19) programme while a further 19 autistic adults served as a waitlist comparison group. A first important finding was that 23 of the 35 (66%) participants who tried the online tools completed them, suggesting that such tools are, in principle, acceptable to many autistic adults. In addition, adults in the cognitive behaviour therapy and mindfulness-based therapy conditions reported significant decreases in anxiety over 3 and to some extent also 6 months that were less apparent in the waitlist group of participants. On broader measures of mental health and well-being, the benefits of the online tools were less apparent. Overall, the results suggest that online self-help cognitive behaviour therapy and mindfulness-based therapy tools should be explored further as a means of providing cost-effective mental health support to at least those autistic individuals who can engage effectively with such online tools.

Therapist competence and clinical outcome in the Prevention of Parasuicide by Manual Assisted Cognitive Behaviour Therapy Trial: the POPMACT study

2004 ◽  
Vol 34 (5) ◽  
pp. 855-863 ◽  
Author(s):  
K. DAVIDSON ◽  
J. SCOTT ◽  
U. SCHMIDT ◽  
P. TATA ◽  
S. THORNTON ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Cognitive Behaviour Therapy ◽  
Behaviour Therapy ◽  
Therapist Competence ◽  
Cognitive Behaviour ◽  
Self Harm ◽  
Therapy Trial

Background. Therapist competence may be an important factor in determining clinical outcome in psychological therapies. However, there are few published studies of therapist competence v. patient outcome from randomized controlled trials. We tested the hypothesis that higher levels of therapist competence would lead to better clinical outcomes in both patient- and observer-rated measures at 6- and 12-month follow-up.Method. A random sample of 49 audiotapes of manual assisted cognitive therapy sessions delivered by 21 therapists involved in the Prevention of Parasuicide by Manual Assisted Cognitive Behaviour Therapy trial was rated to assess the level of therapist competence. Patient outcome was assessed using self and observer ratings of depressive and anxiety symptoms, social functioning, global functioning and number of episodes of deliberate self-harm.Results. At 6-month follow-up, there was a statistically significant association between therapist level of competence and observer-rated depression only. At 12-month follow-up, significant associations were noted between therapist competence and all observer-rated clinical outcomes but not for self-rated outcome measures. However, there was no association between therapist competence and the number of self-harm episodes during follow-up.Conclusions. When treated by therapists rated as more competent than other therapists who received equivalent brief training, patients with recurrent self-harm show significant clinical improvements. However, this benefit is not identified across all outcome measures and is not fully apparent until 12-month follow-up.

scholarly journals Increasing access to CBT for psychosis patients: a feasibility, randomized controlled trial evaluating brief, targeted CBT for distressing voices delivered by Assistant Psychologists (GiVE2)

2020 ◽  
Author(s):  
Mark Hayward ◽  
Clio Berry ◽  
Ben Cameron ◽  
Kate Arnold ◽  
Katherine Berry ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Controlled Trial ◽  
Cost Effective ◽  
Service Level ◽  
Preliminary Evidence ◽  
Economic Benefits ◽  
Randomised Control Trial ◽  
Behaviour Therapy ◽  
Treatment As Usual ◽  
Cognitive Behaviour

Abstract Background The National Institute for Health and Care Excellence (NICE) recommends that Cognitive Behaviour Therapy for psychosis (CBTp) is offered to all patients with a psychosis diagnosis. However, only a minority of psychosis patients in England and Wales are offered CBTp. This is attributable, in part, to the resource-intensive nature of CBTp. One response to this problem has been the development of CBTp in brief formats that are targeted at a single symptom and the mechanisms that maintain distress. We have developed a brief form of CBTp for distressing voices and reported preliminary evidence for its effectiveness when delivered by highly trained therapists (Clinical Psychologists). This study will investigate the delivery of this intervention by a cost-effective workforce of Assistant Psychologists following a brief training and evaluate the acceptability and feasibility of conducting a future, definitive, randomised control trial (RCT).Methods This is a feasibility study for a pragmatic three-arm parallel group superiority 1:1:1 RCT comparing a Guided self-help CBT intervention for voices and treatment as usual (GiVE) to Supportive Counselling and treatment as usual (SC) to Treatment as usual alone (TAU), recruiting across two sites, with blinded post-treatment and follow-up assessments. A process evaluation will quantitatively and qualitatively explore stakeholder experience.Discussion Expected outcomes will include an assessment of the feasibility of conducting a definitive RCT and data to inform the calculation of its sample size. If evidence from a subsequent fully powered RCT suggests that GiVE is clinically and cost effective when delivered by briefly trained Assistant Psychologists, CBTp offered in these less resource-intensive forms has the potential to generate benefits for individual patients (reduced distress, enhanced recovery and enhanced quality of life), service-level patient benefit (increased access to evidence-based psychological therapies) and economic benefits to the NHS (in terms of the reduced use of mental health inpatient services).

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