NICE 2011
15-16 year-olds self-harming • More than 10% of girls
in previous year • More than 3% of boys
All age groups • 0.5%
annual prevalence
Self-harm • Increases likelihood of completed suicide by 50/100 fold above
the rest of the population
(12 month period)
• Highly correlated with:
Depression
Borderline personality disorder
Psychosis
Bi-polar disorder
Drug and alcohol conditions
NICE Pathways - Bring together all NICE guidance
an interactive tool for health and social - Quality standards
care professionals providing fast ac-
cess to NICE guidance and associated - Other NICE information on a specific topic
products - Interactive and designed to be used online
- Guidance are updated regularly
SELF-HARM
Strongest risk factor for suicide
- once one has self-harmed= x 50-100 more likely to die committing suicide
- 1/15 dying within 9 years from the first episode
- About 1/5 people who attend an emergency department following self-harm will harm themselves again
in the following year
- small minority keeps on harming repeatedly
- no good evidence to support the widely voiced opinion that people who harm themselves repeatedly
(eg. Cutting) are less likely to kill themselves than those who harm themselves in different ways
• Hospital based study: self-cutting increased suicide risk
- Repetition of self-harm may occur quickly with up to 1/10 repeat episodes occurring within 5 days of the
index attempt (NICE 2011)
- NICE Guidance 2011
Unclear evidence
“Despite the range of treatments and service provision, the evidence to date in terms of the effectiveness
of psychological or psychosocial interventions remains unclear”
ASSESSMENT OF RISK AND NEED
Bio-Med
Psychological
Sociological
Socio-cultural
Formulation of assessment is based on subcategories on these 4 criteria
ASSESSMENT OF SELF-HARM
, - Therapeutic engagement
- what happened
- When, where and how
- In-depth interviewing
- asking open-questions
- being curious
- Ferreting out intent
- Clarifying motivation
- Rating intention
- understanding context
- Identifying triggers
- Reducing risk
- observing patterns
- Agree a safety plan
WHAT IS DBT?
Dialectical behavior therapy (DBT) is an evidence-based[1] treatment ther-
apy designed by Dr. Marsha Linehan to help people suffering from borderline
personality disorder. It has also been used to treat mood disorders as well as
those who need to change patterns of behavior that are not helpful, such as
self-harm, suicidal ideation, and substance abuse. This approach works to-
wards helping people increase their emotional and cognitive regulation by
learning about the triggers that lead to reactive states and helping to assess
which coping skills to apply in the sequence of events, thoughts, feelings, and
behaviors to help avoid undesired reactions. DBT assumes that people are
doing their best but lack the skills needed to succeed, or are influenced by
positive reinforcement or negative reinforcement that interferes with their abil-
ity to function appropriately.
Dialectical Behavioural Therapy - Set of treatment principles within the context of highly structured
(DBT) programme
Psychotherapeutic approach - branches from CBT
designed to treat the problems of
chronically suicidal individuals with
BPD (Swales & Heard, 2009)
“Dialectical” - Process by which conflicts that impede the therapy are resolved
- Defined as the contradiction of opposites and their continual res-
olution
Philosophy of DBT “Dialectics” - Method of philosophical argument that involves some sort of
contradictory process between opposing sides
e.g. Socrates back and forth; the Hegelian Method of Reasoning
Who is DBT for? • Patients with severe and chronic multi-diagnostic profile
• Adolescents with emotional-behavioural problems
• Adults with Borderline Personality Disorder
• Markers are (dysfunctions):
- emotional
- Interpersonal
- Cognitive
- Behavioural dysfunction
15-16 year-olds self-harming • More than 10% of girls
in previous year • More than 3% of boys
All age groups • 0.5%
annual prevalence
Self-harm • Increases likelihood of completed suicide by 50/100 fold above
the rest of the population
(12 month period)
• Highly correlated with:
Depression
Borderline personality disorder
Psychosis
Bi-polar disorder
Drug and alcohol conditions
NICE Pathways - Bring together all NICE guidance
an interactive tool for health and social - Quality standards
care professionals providing fast ac-
cess to NICE guidance and associated - Other NICE information on a specific topic
products - Interactive and designed to be used online
- Guidance are updated regularly
SELF-HARM
Strongest risk factor for suicide
- once one has self-harmed= x 50-100 more likely to die committing suicide
- 1/15 dying within 9 years from the first episode
- About 1/5 people who attend an emergency department following self-harm will harm themselves again
in the following year
- small minority keeps on harming repeatedly
- no good evidence to support the widely voiced opinion that people who harm themselves repeatedly
(eg. Cutting) are less likely to kill themselves than those who harm themselves in different ways
• Hospital based study: self-cutting increased suicide risk
- Repetition of self-harm may occur quickly with up to 1/10 repeat episodes occurring within 5 days of the
index attempt (NICE 2011)
- NICE Guidance 2011
Unclear evidence
“Despite the range of treatments and service provision, the evidence to date in terms of the effectiveness
of psychological or psychosocial interventions remains unclear”
ASSESSMENT OF RISK AND NEED
Bio-Med
Psychological
Sociological
Socio-cultural
Formulation of assessment is based on subcategories on these 4 criteria
ASSESSMENT OF SELF-HARM
, - Therapeutic engagement
- what happened
- When, where and how
- In-depth interviewing
- asking open-questions
- being curious
- Ferreting out intent
- Clarifying motivation
- Rating intention
- understanding context
- Identifying triggers
- Reducing risk
- observing patterns
- Agree a safety plan
WHAT IS DBT?
Dialectical behavior therapy (DBT) is an evidence-based[1] treatment ther-
apy designed by Dr. Marsha Linehan to help people suffering from borderline
personality disorder. It has also been used to treat mood disorders as well as
those who need to change patterns of behavior that are not helpful, such as
self-harm, suicidal ideation, and substance abuse. This approach works to-
wards helping people increase their emotional and cognitive regulation by
learning about the triggers that lead to reactive states and helping to assess
which coping skills to apply in the sequence of events, thoughts, feelings, and
behaviors to help avoid undesired reactions. DBT assumes that people are
doing their best but lack the skills needed to succeed, or are influenced by
positive reinforcement or negative reinforcement that interferes with their abil-
ity to function appropriately.
Dialectical Behavioural Therapy - Set of treatment principles within the context of highly structured
(DBT) programme
Psychotherapeutic approach - branches from CBT
designed to treat the problems of
chronically suicidal individuals with
BPD (Swales & Heard, 2009)
“Dialectical” - Process by which conflicts that impede the therapy are resolved
- Defined as the contradiction of opposites and their continual res-
olution
Philosophy of DBT “Dialectics” - Method of philosophical argument that involves some sort of
contradictory process between opposing sides
e.g. Socrates back and forth; the Hegelian Method of Reasoning
Who is DBT for? • Patients with severe and chronic multi-diagnostic profile
• Adolescents with emotional-behavioural problems
• Adults with Borderline Personality Disorder
• Markers are (dysfunctions):
- emotional
- Interpersonal
- Cognitive
- Behavioural dysfunction
