Results of a feasibility study of the FReSH START intervention to improve quality of life and other outcomes in people who repeatedly self-harm (Function REplacement in repeated Self-Harm: Standardising Therapeutic Assessment and the Related Therapy)

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Copsey, Bethan and Wright-Hughes, Alexandra and Farrin, Amanda and Gates, Cara and Farley, Kate and Brennan, Cathy and McMillan, Dean and Graham, Christopher Darryl and Bojke, Chris and Mattock, Richard and Martin, Adam and Bijsterveld, Petra and Horrocks, Judith and Hartley, Suzanne and McAdam, Marsha and Hammond-Jones, Dafydd and Bryant, Louise D. and House, Allan and Guthrie, Elspeth, FReSH START lived experience group (2025) Results of a feasibility study of the FReSH START intervention to improve quality of life and other outcomes in people who repeatedly self-harm (Function REplacement in repeated Self-Harm: Standardising Therapeutic Assessment and the Related Therapy). Pilot and Feasibility Studies, 11. 67. ISSN 2055-5784 (https://doi.org/10.1186/s40814-025-01644-2)

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Abstract

Background Self-harm is a major public health challenge with estimated lifetime prevalence of 5–6% and 220,000 hospital attendances annually in England and Wales. Repetition of self-harm is common with 70% of hospital attenders reporting previous self-harm. Multiple repetition bears a significant cost to individuals and healthcare systems. A recent Cochrane review showed little evidence for the benefit of existing psychological therapies for people who repeatedly self-harm. Considering multiple possible functions of self-harm, we modified three existing psychological therapies for use with people who self-harm multiple times. To inform the design of a definitive multi-centre randomised controlled trial (RCT) and assess the feasibility of an RCT, this mixed-methods feasibility study assessed intervention delivery and acceptability. Methods A single arm (comprising three modalities), non-controlled, multi-centre feasibility trial aimed to recruit 30 participants aged 16 years or older and reporting both recent and recurring self-harm episodes. The FReSH START intervention included 12 individual sessions over a maximum 6 months comprising one of three psychological therapies, each modified specifically for use with people who have self-harmed multiple times: Cognitive Behavioural Therapy, Acceptance and Commitment Therapy, and Psychodynamic Interpersonal Therapy. Follow-up was via participant reported outcomes using postal questionnaires at 6 months and monthly text messages. A parallel qualitative study interviewed a sample of therapists and participants to refine the intervention and logic model ahead of a definitive RCT. Results We reached our target of 30 recruited participants and 15 therapists delivered the intervention in a way that was acceptable to participants. However, follow-up rates for the 6-month questionnaire were lower than expected at 53.3% (n = 16/30). To improve follow-up, in the definitive RCT, we plan to use online questionnaires, provide vouchers and behaviourally-informed letters to incentivise questionnaire return, and include follow-up via routinely collected data. Intervention fidelity also requires some improvement in specific areas; thus we plan to amend the intervention therapist training accordingly. Conclusions Despite disruption due to the COVID-19 pandemic, we conclude that delivery of a definitive trial of adapted psychological therapies for people who repeatedly self-harm is feasible with modifications to study processes to improve intervention fidelity and participant retention. Trial registration. ISRCTN16049211.

ORCID iDs

Copsey, Bethan, Wright-Hughes, Alexandra, Farrin, Amanda, Gates, Cara, Farley, Kate, Brennan, Cathy, McMillan, Dean, Graham, Christopher Darryl ORCID logoORCID: https://orcid.org/0000-0001-8456-9154, Bojke, Chris, Mattock, Richard, Martin, Adam, Bijsterveld, Petra, Horrocks, Judith, Hartley, Suzanne, McAdam, Marsha, Hammond-Jones, Dafydd, Bryant, Louise D., House, Allan and Guthrie, Elspeth;
CORE (COnnecting REpositories)