Manual Assisted Cognitive Treatment for Deliberate Self-Harm in Borderline Personality Disorder Patients

Harvard University, Cambridge, Massachusetts, United States
Journal of Personality Disorders (Impact Factor: 2.31). 11/2006; 20(5):482-92. DOI: 10.1521/pedi.2006.20.5.482
Source: PubMed


This study examines the efficacy of a short-term individual therapy, Manual Assisted Cognitive Treatment (MACT), which was developed to treat parasuicidal (suicidal or self-harming) patients. In this trial, MACT was modified to focus on deliberate self-harm (DSH) in patients with borderline personality disorder (BPD). Thirty BPD patients who were engaged in DSH while in ongoing treatments, i.e., treatment-as-usual (TAU), were randomly assigned to receive MACT (N = 15) or not. DSH and level of suicide ideation were assessed at the baseline, at completion of the MACT intervention, and six months later. Results indicated that MACT was associated with significantly less frequent DSH upon completion of the intervention and with significantly decreased DSH frequency and severity at the six months follow-up. Moreover, MACT's contribution to reducing DSH frequency and severity was greater than the contribution by the amount of concurrent treatments. In contrast, MACT did not affect the level of suicide ideation and time-to-repeat of DSH. In conclusion, MACT seems to be a promising intervention for DSH in patients with BPD. More definitive studies are needed.

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    • "It has been used successfully in those with personality disturbance and has been shown to significantly reduce the number of repeated self-harm episodes.5 When specifically adapted for a personality disorder population, MACT resulted in a significant decrease in the frequency and severity of self-harm.6 "
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    ABSTRACT: Aims and method To assess the feasibility of conducting a larger, definitive randomised controlled trial of manual-assisted cognitive therapy (MACT), a brief focused therapy to address self-harm and promote engagement in services. We established recruitment, randomisation and assessment of outcome within a sample of these complex patients admitted to a general hospital following self-harm. We assessed symptoms of depressed mood, anxiety and suicidality at baseline and at 3 months’ follow-up. Results Twenty patients were randomised to the trial following an index episode of self-harm, and those allocated to MACT demonstrated improvement in anxiety, depression and suicidal ideation. Clinical implications It is feasible to recruit a sample of these complex patients to a randomised controlled trial of MACT following an index episode of self-harm. There is preliminary support that MACT could be an acceptable and effective intervention in patients with personality disorder and substance misuse.
    Full-text · Article · Jun 2014
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    • "Two randomised controlled trials have demon­ strated that CBT is an effective treatment for patients with avoidant and Cluster B personality disorder (Evans 1999;Emmelkamp 2006). Other trials have shown similar indications of promise in the treatment of borderline and mixed personality disorder but methodological difficulties and small treatment samples have limited potential outcomes (Tyrer 2003;Davidson 2006;Weinberg 2006). A recent pilot trial suggested that CBT may also be a promising treatment for men with antisocial personality (Davidson 2008b). "
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    ABSTRACT: A variety of therapies have been developed or adapted to treat personality disorder over recent years. This article will review skills-based treatments (as opposed to insight-based treatments). Two approaches are outlined: cognitive-behavioural therapy and dialectical behaviour therapy. The article details the underpinning theory and the model of personality disorder utilised by the two approaches, and describes how the therapy is applied. Evidence of therapeutic efficacy is presented along with information about accessing training and therapy materials.
    Preview · Article · May 2011 · Advances in Psychiatric Treatment
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    • "The current research sought to extend previous evidence regarding MACT in a number of ways. First, the study sought to explore the utility of MACT as a stand-alone outpatient treatment for BPD and BPD-related suicidality, in contrast to previous studies where MACT was often part of an inpatient treatment or a more extensive outpatient treatment regimen (e.g., Weinberg et al., 2006), or in which multiple diagnoses were sampled (e.g., Tyrer et al., 2003). Although this is not a controlled clinical trial in that we do not compare MACT to a control condition here, we are able to compare the effects of MACT without concurrent treatments in this study to the effects of MACT with concurrent treatments from previous research. "
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    ABSTRACT: This study examined the efficacy of Manual Assisted Cognitive Therapy (MACT) as a stand-alone treatment for Borderline Personality Disorder (BPD) with suicidal ideation, and piloted a Therapeutic Assessment (TA) intervention among 16 patients randomly assigned to MACT or MACT+TA. Although MACT was associated with significant reductions in BPD features and suicidal ideation, less than half of the sample completed the treatment. The TA augmentation did not improve treatment retention but it was associated with somewhat greater clinical improvement. Although findings associate MACT with symptom reduction among persisting patients, attrition rate was problematically high in the overall sample.
    Full-text · Article · Aug 2010 · Psychiatry Research
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