Managing the unmanageable: Cognitive behaviour therapy for deliberate self-harm

Abstract

Deliberate non-fatal acts of self-harm, including self-poisoning and self-injury are a significant public health challenge: the incidence of self-harm in young people is in the region of 7–14%. This paper considers the application of cognitive behaviour therapy to people who harm themselves through attempted suicide or self-injury. Models and interventions for self-harm based on problem-solving, Beck's cognitive therapy and other cognitive behaviour therapies are considered, as well as interventions for this behaviour used within the context of treatments for borderline personality disorder. A model of coping with adversity, based on a combination of Lazarus & Folkman's theory of stress and coping and Beck's cognitive therapy is presented. The model is then used to consider how people who self-harm may be helped to better manage the consequences of affective arousal in stressful situations.

Keywords:

• deliberate self-harm
• attempted suicide
• self-injury, cognitive behaviour therapy
• coping with adversity
• problem-solving

Acknowledgements

I am grateful to Professor Ulrike Schmidt for her helpful comments and suggestions on an earlier draft of this paper. Dr Moorey's research is supported by the NIHR Specialist Biomedical Research Centre for Mental Health.