Citation
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^XVaXdchjbei^dcVbdc\i]ZY^[[ZgZciXVgZ\^kZgh^cI6J#I]ZgZ[dgZ!^i^hjcXaZVg^[i]Z
XdcY^i^dchlZgZZfj^kVaZci^ci]^hgZheZXi#>cVYY^i^dc!^i^hjcXaZVgl]Zi]Zgi]ZigZVibZci
Z[[ZXihVgZViig^WjiVWaZidheZX^ÒX^c\gZY^Zcihd[i]Z87Idgidi]ZidiVaeVX`V\Zd[i]Z87I
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hijY^ZhVbdc\9H=eVi^Zcih#=dlZkZg!VheZX^ÒZYI6JXdcY^i^dcb^\]i]ZaeidYZiZXii]Z
VXi^kZ^c\gZY^Zcihd[i]Z87I#
6cdi]Zg^hhjZl^i]gZ\VgYid^ciZgcVakVa^Y^in^hi]ZlVnhijYnl^i]YgVlVahlZgZ]VcYaZY#
Bjai^aZkZa VcVanh^h BA6 jhZh Vaa VkV^aVWaZ YViV! Wji VhhjbZh i]Vi l^i]YgVlVah dXXjg Vi
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I]ZhZY^[[ZgZciVcVanhZhaZYidh^b^aVgÒcY^c\hhZZ8]VeiZg)#I]ZhZXdckZg\ZciÒcY^c\h
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EVi^Zcihl]dZciZgZYi]ZhijYnlZgZ^cXg^h^h#6ii]Vii^bZ!i]Zg^h`d[9H=lVhZaZkViZY!
i]Z^gbddYlVheVgi^XjaVganadl!hj^X^YVaXd\c^i^dchlZgZeZgh^hiZci!VcYi]Zn]VY\gZVi
Y^[ÒXjain hdak^c\ i]Z egdWaZbh i]Zn lZgZ [VX^c\# >i ]Vh WZZc Vg\jZY i]Vi Xg^hZh VgZ Wn
i]ZbhZakZhi^bZ"a^b^iZY!ZkZc[dgi]dhZZm]^W^i^c\gZXjggZciVcYX]gdc^X9H=GjYYZiVa#!
'%%&# IV`^c\ ^cid VXXdjci i]Z hiVi^hi^XVa e]ZcdbZcdc d[ gZ\gZhh^dc idlVgYh i]Z bZVc!
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i]Z ^ciZgVXi^dc Z[[ZXih ^c i]Z BA6 XaZVgan h]dl i]Z jc^fjZ VYY^i^dcVa Z[[ZXi d[ 87I hZZ
8]VeiZg)#
External validity
:miZgcVa kVa^Y^in gZ[Zgh id i]Z ZmiZci i]Vi i]Z gZhjaih XVc WZ \ZcZgVa^oZY WZndcY i]Z
XdcY^i^dch d[ i]Z hijYn id di]Zg edejaVi^dch! hZii^c\h VcY XdcY^i^dch @VoY^c! &..-# Id
bVm^b^oZZmiZgcVakVa^Y^in!i]ZhVbeaZhZaZXi^dcegdXZYjgZhd[i]ZhijYn]VYeg^dg^i^oZYV
ehnX]dad\^XVaanVcYhdX^dZXdcdb^XVaanY^kZghZhVbeaZd[9H=eVi^Zcih!gZ[aZXi^c\Xa^c^XVa
egVXi^XZ# I]Z egZY^Xi^dc hijYn YZhXg^WZY ^c 8]VeiZg + h]dlZY i]Vi cd kVg^VWaZh XdjaY
egZY^XiaVX`d[igZVibZciZ[[ZXid[i]Z87I^ciZgkZci^dc#=dlZkZg!bdhianndjc\ldbZc
d[9jiX]cVi^dcVa^ineVgi^X^eViZY^ci]ZhijY^Zh^ci]Zi]Zh^h#KVg^djhhdjgXZhd[gZhZVgX]
^cY^XViZ i]Vi eViiZgch d[ 9H= kVgn Wn V\Z 8]Vc! 7VcZg_ZZ! 9gVeZg! '%%,0 =Vlidc
=Vgg^hh!'%%+0=VlidcZiVa#!'%%,!\ZcYZg<gVio!8dcgVY!GdZbZg!'%%'0Gdn?VcVa!
'%%+ VcY XjaijgZ kVc 7Zg\Zc! HV]Vghd! Hb^i! @Zg`]d[! '%%,# I]ZgZ[dgZ! i]Z gZhjaih
d[ i]Z egZhZci hijY^Zh XVccdi ZVh^an WZ \ZcZgVa^oZY id Vc daYZg! bVaZ! XjaijgVaan Y^kZghZ
edejaVi^dc#=dlZkZg!]Vk^c\VhVbeaZl^i]bdhian[ZbVaZhVahdgZYjXZY]ZiZgd\ZcZ^in!
l]^X] bVn WZ jhZ[ja \^kZc i]Z a^iZgVijgZ dc hZm Y^[[ZgZcXZh ^c! [dg ZmVbeaZ! Zbdi^dc
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]VY\^kZcVY^[[ZgZcie^XijgZd[i]ZeVi^ZciedejaVi^dc6gZchbVc!&..,#8]Vc\Zh^ci]Z
Xa^c^XVaegdÒaZd[9H=eVi^Zcih]VkZVahdWZZccdi^XZY^cdi]ZgXdjcig^Zh#;dgZmVbeaZ!V
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[djgi^bZhi]ZgViZd[i]ZZVga^ZgXd]dgi^ci]ZnZVg[daadl^c\i]Z^cYZmZe^hdYZ=Zcg^fjZh!
&(*
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^cXgZVhZYVaXd]daVcYYgj\jhZ!YZXgZVhZh^ci]ZaZkZahd[hdX^VaXd]Zh^dc^chdX^ZinVcY
X]Vc\Zh^c]ZVai]XVgZhnhiZbh#
6ai]dj\]i]ZhVbeaZhZaZXi^dcegdXZYjgZd[i]ZegZhZcihijYnlVhh^b^aVgidi]Vid[
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adc\]^hidgnd[9H=!VcZmiZch^kZVWjhZ]^hidgn!VcYhZkZgZehnX]dad\^XVaVcYehnX]^Vig^X
egdWaZbh# I]ZhZ X]VgVXiZg^hi^Xh d[ i]Z hijYn hVbeaZ VgZ gZaZkVci id i]Z ^ciZgegZiVi^dc
d[bVcn[^cY^c\h^ci]^hi]Zh^h#I]ZnVgZeVgi^XjaVgangZaZkVciidi]ZdjiXdbZd[i]Z87I
ig^Va hZZ 8]VeiZg )! h^cXZ ^cY^k^YjVah l^i] V ]^\] gViZ d[ gZeZi^i^dc VgZ eZg]Veh bdgZ
a^`Zan id h]dl V gZYjXi^dc ^c dkZgVaa gZeZi^i^dc gViZh i]Vc ^cY^k^YjVah l]ZgZ gZeZi^i^dc
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[dg igZVibZci# ;dg ZmVbeaZ! ^c 8]VeiZg ) ^i ^h hiViZY i]Vi Æ^ceVi^Zci igZVibZci ^h i]Z
hiVcYVgY XVgZ [dg 9H= eVi^ZcihÇ! Wji i]^h ^h dcan igjZ [dg eVi^Zcih l^i] X]gdc^X 9H= l]d
VgZ^cXg^h^h#Bdhi9H=eVi^ZcihVgZigZViZY^ci]ZXdbbjc^inWni]Z^g<EdgbZciVa]ZVai]
egd[Zhh^dcVah#;jgi]ZgbdgZ!i]ZX]VgVXiZg^hi^Xhd[i]ZhijYnhVbeaZbVnZmeaV^cl]ni]Z
egZkVaZcXZ gViZh [dg V ]^hidgn d[ VWjhZ VgZ hd ]^\] VcY i]Z VhhdX^Vi^dc WZilZZc VWjhZ
]^hidgnVcYehnX]deVi]dad\n^hhdhigdc\hZZ8]VeiZg+#=dlZkZg!^i^hcdiXaZVg]dli]Z
hVbeaZhZaZXi^dcegdXZYjgZ]VhaZYidi]Z^cXajh^dcd[i]^hheZX^[^X\gdjed[9H=eVi^Zcih#
I]ZgZVgZVcjbWZgd[kVg^VWaZh!l]^X]XdjaYWZXdch^YZgZYVhediZci^Va^c[ajZcXZh!hjX]
Vh i]Z gZ[ZggVa eda^Xn d[ i]Z <ZcZgVa EgVXi^i^dcZg <E VcY gZXgj^ibZci l^i]^c BZciVa
=ZVai] 8ZciZg G^k^ZgYj^cZc# :mXZei ^c V bZY^XVa ZbZg\ZcXn! i]Z <E ^h jhjVaan i]Z [^ghi
eZghdc l]d aZVgch VWdji Vc Ze^hdYZ d[ 9H=# EVi^Zcih XVc cdi XdciVXi bZciVa ]ZVai]
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egVXi^i^dcZg#>cb^aYZgXVhZhd[9H=!<EÉhbVnYZX^YZidegdk^YZhjeedgii]ZbhZakZhZ#\#
l^i] gZ\jaVg Veed^cibZcih VcY$dg ehnX]digde^X bZY^XVi^dc# >c VYY^i^dc! ^c i]Z egZhZci
hijYn!eVi^ZcihlZgZcdidcangZXgj^iZY[gdbV\ZcZgVa]dhe^iVaedejaVi^dc!WjiVahd[gdbV
bZciVa]ZVai]XZciZgedejaVi^dc#6hVgZhjai!i]ZhVbeaZbVnY^[[Zg[gdbV\ZcZgVa]dhe^iVa
9H=edejaVi^dc#GZXgj^ibZcil^i]^cBZciVa=ZVai]8ZciZgG^k^ZgYj^cZcbVn]VkZaZYidV
hZaZXi^dcd[bdgZX]gdc^X9H=eVi^Zcih#I]ZgVe^hihbVn]VkZWZZcbdgZa^`Zanid^c[dgb
X]gdc^X 9H= eVi^Zcih i]dhZ l]d ]VY cdi gZhedcYZY id egZk^djh igZVibZcih VWdji i]Z
edhh^W^a^inideVgi^X^eViZ^ci]ZegZhZciig^Vai]VceVi^Zcihl^i]b^aYZg[dgbhd[9H=#
Construct validity
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YdZhcdiiZaal]Zi]Zgi]ZhijYn^c[ajZcXZYl]VilVh^ciZcYZY"i]^h^hVXdchigjXikVa^Y^in
^hhjZ@VoY^c!&..-#IdbVm^b^oZXdchigjXikVa^Y^in!^ilVh^bedgiVciidi]^c`i]gdj\]i]Z
XdcXZeihjcYZghijYn!hdi]Vii]Z87I^ciZgkZci^dclVhV\ddYdeZgVi^dcVa^oVi^dcd[l]Vi
lZ lVciZY VcY i]Vi i]Z djiXdbZ bZVhjgZh gZ[aZXiZY l]Vi lZ lVciZY i]Zb id gZ[aZXi#
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aVg\ZgZ[[ZXiWdi]dc9H=VcYegZhjbZYbZY^Vi^c\kVg^VWaZhhjX]VhZbdi^dcgZ\jaVi^dc
Y^[[^Xjai^Zhi]VcI6JdcanldjaY#I]Z[^ghi]nedi]Zh^hl^i]gZ\VgYidY^[[ZgZci^VaigZVibZci
Z[[ZXih lVh Xdc[^gbZY hZZ 8]VeiZg )# ;jgi]ZgbdgZ! bZY^Vi^dc VcVanhZh gZkZVaZY i]Vi
Zbdi^dcgZ\jaVi^dcY^[[^Xjai^ZheVgi^VaanbZY^ViZYigZVibZcidjiXdbZ!l]ZgZVhhnbeidb
hZkZg^in Y^Y cdi hZZ 8]VeiZg *# I]ZhZ gZhjaih Xdcig^WjiZ id V WZiiZg jcYZghiVcY^c\ d[
heZX^[^X bZY^Vidgh d[ igZVibZci X]Vc\Z# ;jgi]ZgbdgZ! i]Z gZhjaih VgZ Xdch^hiZci l^i]
i]ZdgZi^XVa Vhhjbei^dch gZ\VgY^c\ i]Z VYkVciV\Zh d[ V 9H="heZX^[^X igZVibZci dkZg V
igZVibZci[dXjh^c\dcbZciVaY^hdgYZgh#
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V\gZZ i]Vi ^bedgiVci Y^[[ZgZcXZh Zm^hi WZilZZc eZdeaZ l]d Xdch^YZg 9H=! eZdeaZ l]d
]VkZdcXZZc\V\ZY^c9H=!VcYeZdeaZl^i]X]gdc^X9H=#=dlZkZg!hdbZhijY^ZhYdcdi
egdk^YZVYZÒc^i^dcd[i]ZXdcXZeijcYZghijYndgjhZiZgbh^ciZgX]Vc\ZVWan#>cVYY^i^dc!
bVcn d[ i]ZhZ hijY^Zh Yd cdi egdk^YZ Zcdj\] ^c[dgbVi^dc dc i]Z hijYn edejaVi^dc#
>c dgYZg id jcYZghiVcY! igZVi VcY egZkZci 9H=! ^i ^h ^bedgiVci id VXXjgViZan heZX^[n i]Z
hjWineZhd[9H=#=dlZkZg!i]ZgZVgZbVcndWhiVXaZhidXdb^c\idXdchZchjh!^cXajY^c\
XdcXZeihhjX]Vh^ciZci!bdi^kVi^dcVcYaZi]Va^inA^cZ]Vc!&..,0A^cZ]Vc!8dbid^h!7gdlc!
=ZVgY!LV\cZg!'%%+0H^akZgbVc!'%%+#Hi^aa!hj\\Zhi^dchVgZbVYZidZajX^YViZi]ZhZ
^hhjZhA^cZ]VcZiVa#!'%%+0H^akZgbVc!'%%+08aVZhKVcYZgZnX`Zc!'%%,#;dgZmVbeaZ!
8aVZh VcY KVcYZgZnX`Zc '%%, egdedhZ V [jcXi^dcVa^hi VeegdVX]! l]^X] hiVgih l^i] V
b^XgdVcVanh^h d[ i]Z bZVc^c\ bdi^kZh! [jcXi^dch d[ V eVgi^XjaVg Ze^hdYZ d[ 9H= [dg V
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
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i]ZgVeZji^XbVcV\ZbZciVcYegZkZci^dcd[9H=#
6gZaViZY^hhjZ^hi]Z[gZfjZcXnd[9H=!VcY]dli]^hXVcWZVhhZhhZY#7di]^c[gZfjZci
hZa["]Vgb VcY ]VW^ijVa hZa["]Vgb VgZ ^bejah^kZ VXih! VcY i]Z Y^[[ZgZcXZ WZilZZc i]Zb
hZZbh id WZ V bViiZg d[ YZ\gZZ# ;dg gZhZVgX] ejgedhZh! ^i ^h ^bedgiVci id heZX^[n ]dl
]VW^ijVa hZa["]Vgb^c\ WZ]Vk^djg ^h VhhZhhZY# >c i]^h hijYn! gZeZi^i^kZ VXih d[ hZa["]Vgb
lZgZgZXdgYZYVhVh^c\aZZe^hdYZd[9H=^[i]ZndXXjggZYl^i]^cVXaZVgi^bZ[gVbZZ#\#
dcZZkZc^c\#LZ[djcYi]VieZdeaZ]VkZV]VgYi^bZgZbZbWZg^c\i]ZZmVXicjbWZgd[
VXihd[hZa["]Vgbl^i]^cVh^c\aZZe^hdYZd[9H=!h^cXZi]Znd[iZcjhZbjai^eaZbZi]dYh
d[ 9H= Z#\# dkZgYdh^c\! Xjii^c\! i^aa i]Z VXih ]VkZ Wgdj\]i VWdji V gZaZVhZ d[ iZch^dc#
GZXdgY^c\Ze^hdYZhd[9H=^chiZVYd[Xdjci^c\VXihd[hZa["]VgbbVn\^kZbdgZgZa^VWaZ
gZhjaih#6cdi]ZgVYkVciV\Zd[gZXdgY^c\Ze^hdYZhd[9H=^hi]Vii]ZnXVcjhjVaanWZa^c`ZY
idVegZX^e^iVi^c\ZkZci#
Statistical conclusion validity
HiVi^hi^XVa XdcXajh^dc kVa^Y^in gZ[Zgh id i]Z ZmiZci id l]^X] V gZaVi^dc ^h h]dlc!
YZbdchigViZY!dgZk^YZci!VcY]dllZaai]Z^ckZhi^\Vi^dcXVcYZiZXiZ[[ZXih^[i]ZnZm^hi
@VoY^c!&..-#
I]Z hijYn egdYjXZY V lZVai] d[ YViV VcY d[[ZgZY bVcn edhh^W^a^i^Zh [dg hiVi^hi^XVa
VcVanh^h#Bjai^aZkZaVcVanh^hBA6lVhX]dhZcidhijYni]ZYZkZadebZcid[9H=dkZgi^bZ
hZZ 8]VeiZg )# 6cdi]Zg edhh^W^a^in ^h id XVaXjaViZ VXijVa egdedgi^dch d[ eVi^Zcih l]d
Y^YVcYY^YcdihZa["]VgbYjg^c\i]ZeZg^dY[daadl^c\gZXZ^eid[87I^cVYY^i^dcidI6J
dg I6J dcan ^c i]Z eZg^dY WZilZZc +"bdci] [daadl"je VcY ."bdci] [daadl"je# I]ZhZ
YZhXg^ei^kZYViVh]dll]Zi]Zgbdhi^cY^k^YjVahXdci^cjZidhZa["]Vgb!VcY^i^h_jhii]Z
[gZfjZcXnd[hZa["]Vgbi]Vi^hgZYjXZY!dgl]Zi]Zgbdhi^cY^k^YjVahcdadc\ZgZc\V\Z^c
9H=!l]^X]bVn]VkZY^[[ZgZci^bea^XVi^dch[dgi]Zadc\ZgiZgbegd\cdh^hgZ\VgY^c\9H=#
IVWaZ&h]dlhi]VidkZgi]gZZ"fjVgiZghd[eVi^Zcihl]d]VYgZXZ^kZY87I,,#*!c2(&]VY
cdi]VgbZYi]ZbhZakZhYjg^c\[daadl"je#>cVYY^i^dc!i]ZbV_dg^ind[i]dhZeVi^Zcihl]d
]VY]VgbZYi]ZbhZakZh]VYYdcZi]^hdcZdgildi^bZh^cVi]gZZbdci]eZg^dY!l]^X]
^hVbVg`ZYgZYjXi^dcXdch^YZg^c\i]Z]^\]gViZd[gZeZi^i^dcd[9H=[djcYViWVhZa^cZ#
D[cdiZ^hi]Vidcan'eVi^Zcih%#*gZedgiZY)dgbdgZZe^hdYZhd[9H=#>ihZZbhi]Vi
i]ZaVg\ZbV_dg^ind[i]ZeVi^Zcihl]dgZXZ^kZY87I]VhV\ddYegd\cdh^hgZ\VgY^c\9H=#
IVWaZ & Vahd h]dlh i]Vi bdgZ i]Vc ]Va[ d[ i]Z eVi^Zcih ^c I6J *,#&! c2(& Y^Y cdi hZa["
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