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Affiliation
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Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute for Neuroscience and Behavior, University of California Los Angeles, Los Angeles, CA, USA. |
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Abstract
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Another randomised trial, the Self-Harm Intervention: Family Therapy (SHIFT) trial,1 has shown no benefit for another psychological therapy versus treatment as usual in adolescents who have self-harmed. Furthermore, in the study by David Cottrell and colleagues1 in The Lancet Psychiatry, rates of self-harm repetition were high across the family therapy and treatment as usual groups. These disappointing results have notable implications for future research in the field of adolescent self-harm.
The SHIFT trial1 was one of the largest and most expensive studies ever done in the field of adolescent self-harm. Some might argue that this study should never have been proposed by the National Institute for Health Research or funded, since no randomised trial has ever shown convincing benefits of family therapy2 in reducing self-harm in young people. Arguably, an initial trial showing efficacy would be an essential first step before beginning extensive pragmatic trials, particularly because treatment effects tend to be weaker when treatments are analysed in pragmatic trials in which treatment is delivered under less controlled conditions than in tightly controlled efficacy trials.3 The SHIFT intervention included only 6–8 monthly sessions of family therapy. This contrasts sharply with the treatment dose offered in dialectical behaviour therapy, which has been shown to be more effective than treatment as usual in reducing self-harm in adolescents.4 Dialectical behaviour therapy for adolescents includes weekly individual sessions, 2-h weekly multifamily group treatment, plus availability of 24-h daily phone coaching. Hence, the SHIFT intervention seems unlikely to yield substantial benefits in terms of reduction of self-harm in young people whose risk, skills, and crises might fluctuate a great deal on a daily basis.
Hospital attendance for self-harm might also have been a poor choice of primary outcome measure, because increased contact with family therapists might have resulted in more high-risk self-harm...
Language: en |