A feasibility study highlighting challenges in evaluating a structured, psychological treatment for self-harm in adult psychiatric inpatient settings

Abstract

Background: Despite being the most common reason for admission to psychiatric inpatient services, no evidence-based treatment currently exists for self-harm in this setting. Dialectical Behavioural Therapy (DBT) trials have found promising results in treating self-harm in outpatient settings; however findings for inpatient settings are still limited.

Method: A single-arm feasibility trial was conducted examining a DBT-informed 'Coping with Crisis' (CwC) group protocol, which focused on self-harm and crisis management strategies. Twenty-four participants were recruited from an inpatient ward in a National Health Service (NHS) Trust in the UK. The Inventory of Statements about Self-Injury and Distress Tolerance Scale were administered at baseline and post-therapy. Data was collected on the rates of recruitment, retention, session attendance, outcome measure completion, adverse events and participant feedback, in order to inform the design of a main study.

Results: Findings indicated that it was feasible to run the CWC group and research study on an inpatient ward. However, there were several challenges in recruiting to target (80% achieved) and retaining participants (38% of consented participants completed). A number of implementation issues were identified and recommendations have been made to inform future group and study designs.

Keywords: Dialectical-behavioural therapy; Feasibility; Self-har.