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Cognitive-behavioural therapy for deliberate self-harm Slee, N.

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Slee, N. (2008, April 24). Cognitive-behavioural therapy for deliberate self-harm. Retrieved from https://hdl.handle.net/1887/12835

Version: Not Applicable (or Unknown)

License: Leiden University Non-exclusive license Downloaded from: https://hdl.handle.net/1887/12835

Note: To cite this publication please use the final published version (if applicable).

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bZY^XVi^dci]ZZmeZg^bZciVaXdcY^i^dcgZXZ^kZYcZmiidi]Z9H="[dXjhZY87I!i]ZbV^c

gZVhdcWZ^c\i]VilZY^Ycdi]VkZi]ZgZhZVgX]XVeVX^inidXdaaZXibdgZheZX^ÒXYViVdc

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^cVYY^i^dcidI6J#;dgZi]^XVagZVhdch!Vcd"igZVibZciXdcigdaXdcY^i^dc^hcdiedhh^WaZ^c

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VXi^kZ^c\gZY^Zcihd[i]Z87I#

6cdi]Zg^hhjZl^i]gZ\VgYid^ciZgcVakVa^Y^in^hi]ZlVnhijYnl^i]YgVlVahlZgZ]VcYaZY#

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(8)

&()

gVcYdb! l]^X] ^h fjZhi^dcVWaZ ^c i]^h edejaVi^dc# 6h i]Z Vhhjbei^dc d[ gVcYdbcZhh ^h

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i]ZhVbeaZl^i]djii]Z-ZVganl^i]YgVlVahc2-'VcYi]Z^ciZci"id"igZVihVbeaZc2.%#

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\^kZXgZY^W^a^iniddjgYViV#

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i]Z^gbddYlVheVgi^XjaVganadl!hj^X^YVaXd\c^i^dchlZgZeZgh^hiZci!VcYi]Zn]VY\gZVi

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'%%&# IV`^c\ ^cid VXXdjci i]Z hiVi^hi^XVa e]ZcdbZcdc d[ gZ\gZhh^dc idlVgYh i]Z bZVc!

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8]VeiZg)#

External validity

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d[9jiX]cVi^dcVa^ineVgi^X^eViZY^ci]ZhijY^Zh^ci]Zi]Zh^h#KVg^djhhdjgXZhd[gZhZVgX]

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(9)

&(*

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Construct validity

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(10)

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Table 1. Proportions of patients who did and did not self-harm during the follow-up period (between 6 and 9-month assessment)

CBT (n=40) TAU (n=42)

Valid N Percent N Percent

0 31 77.5 24 57.5 1 4 10.0 1 2.4 2 2 5.0 1 2.4 3 1 2.5 - -

>4 2 5.0 16 37.7 Total 40 100 42 100

(11)

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Statistical conclusion validity

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(14)

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(15)

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(22)

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