Program

Mar 20, 2013

OVERVIEW

Developmental Group Therapy is a clinic-based group therapy to reduce self-harm behaviors (such as deliberate poisoning, cutting, or scratching) among adolescents.  It is targeted at young women and men who have a mild to severe history of deliberate self-harm, many of whom have other serious mental health difficulties.  While an initial evaluation of this intervention showed promise in reducing instances of self-harm, school absences, and diagnoses of behavioral disorders among participants, a subsequent and larger study showed no benefit over traditional care.

DESCRIPTION OF PROGRAM

Target population: Adolescents ages 12 to 16 with a history of deliberate self-harm.

Developmental Group Therapy is a manualized, clinic-based form of group therapy that is designed for adolescents.  The intervention draws on other approaches, including cognitive behavioral therapy, dialectical behavioral therapy, and group problem-solving approaches. This particular developmental group therapy was developed specifically for adolescents with a history of self-harm. The intervention is intended to be administered by an experienced group therapist in two stages.  The first stage includes six “acute” group sessions, which focus on the following themes: relationships, school problems and peer relationships, family problems, anger management, depression and self-harm, and hopelessness and feelings about the future. The second stage, which follows the six “acute” group sessions, involves weekly group sessions, which focus on group dynamics; these sessions continue until the adolescent feels ready to leave the group. The therapy aims to minimize deliberate self-harm and depression among participants. A cost-evaluation of the program found that it cost an additional ₤6,409 per patient over routine care (though this included hospitalization and other indirect costs). A manual is available by request, free of charge.

EVALUATIONS OF PROGRAM

Wood, A., Trainor, G., Rothwell, J., Moore, A., & Harrington, R. (2001). Randomized trial of group therapy for repeated deliberate self-harm in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11), 1246-1253.

Evaluated population: The sample for this efficacy evaluation included 63 adolescents, aged 12 to 16 years, from a health district in South Manchester, England.  The participants had been referred to mental health services after committing deliberate self-harm, and they also had a history of self-harm within the past year. Adolescents who were suicidal or who had a psychotic disorder were excluded, as were those who could not attend groups or who could not participate in group sessions. The participants in the evaluated sample had harmed themselves an average of four times before the study and tended to come from disadvantaged backgrounds.  Approximately one-half of the participants displayed evidence of abuse at some point during their lives.

Approach: Each adolescent was randomly assigned to the Developmental Group Therapy group or to a control group that received routine care using a single-blind method. Those in the routine care group received care-as-usual, which included some combination of counseling, family counseling, and psychotropic medication. Outcomes were measured before treatment, six weeks into treatment, and seven months after the treatment began. The outcome measures, obtained through interviews and questionnaires, included self-reported depressive symptoms, self-harming behavior, behavioral disorders, and a global outcome measure with 13 subscales encompassing emotional symptoms, behavioral problems, substance abuse, school attendance, and peer relationships.

Results: At the 7-month follow-up, members of the treatment group were 20 percent less likely to repeat deliberate self-harm behavior than participants not receiving the intervention. They were also less likely than those in the routine care group to have multiple instances of self-harm, and there was a longer period of time, on average, before self-harm behaviors restarted.  Further, there appeared to be a dose response; those who attended more group sessions reported fewer instances of self-harm.  Participants in the intervention group also had higher levels of school attendance, lower levels of behavioral disorders, and were less likely to use the offered routine care services. The intervention, however, did not impact depressive symptoms, suicidal thinking, or the global outcome measure.

Green, J. M., Wood, A. J., Kerfoot, M. J., Trainor, G., Roberts, C., Rothwell, J., Woodham, A., Ayodeji, E., Barrett, B., Byford, S., Harrington, R. (2011). Group therapy for adolescents with repeated self harm: Randomised controlled trial with economic evaluation. British Medical Journal, 342, d682.

Evaluated population: The sample consisted of 366 adolescents between the ages of 12 and 17 who had been referred to one of eight mental health facilities in Northwest England for treatment. To be eligible for the evaluation, adolescents had to have either deliberately overdosed on drugs or other toxic substances or deliberately injured themselves (including by scratching, cutting, burning, or strangulation) on two or more occasions in the past 12 months.  Possible participants were excluded from the study if they did not speak English, had severe low weight anorexia nervosa, a current psychotic illness, attended a special disability school, or were currently staying in a secure care facility.  Eighty-nine percent of participants were female, and nearly all (94 percent) were white.  Twelve percent had practiced self-harm at least once a week, while 37 percent had practiced self-harm less than once a month in the past year; one percent had self-poisoned, 37 percent had self-injured, and 62 percent had done both.  Two-thirds had a depressive disorder and one-third had a behavioral disorder at baseline.

Approach: Controlling for high/low incidence of self-harm, presence/absence of a behavioral or depressive disorder, and the presence/absence of high psychosocial risk, each adolescent was randomly assigned to a control group that received routine care or to the Developmental Group Therapy group, which received the intervention in addition to routine care.  . Outcomes were measured through interviews and surveys of the participants before treatment, six months after treatment, and 12 months after the treatment started. The outcomes measured included frequency of self-harm, the severity of the self-harm, symptoms of depression or a mood disorder, frequency of suicidal thoughts, and a global outcome measure with 13 subscales encompassing emotional symptoms, behavioral problems, substance abuse, school attendance, and peer relationships.

Results: While patients in routine care, both with and without group therapy, had improved significantly in all measures at the 6- and 12-month follow-ups, there were no significant differences between the two groups.

SOURCES FOR MORE INFORMATION

References

Green, J. M., Wood, A. J., Kerfoot, M. J., Trainor, G., Roberts, C., Rothwell, J., Woodham, A., Ayodeji, E., Barrett, B., Byford, S., Harrington, R. (2011). Group therapy for adolescents with repeated self harm: Randomised controlled trial with economic evaluation. British Medical Journal, 342, d682.

Wood, A., Trainor, G., Rothwell, J., Moore, A., & Harrington, R. (2001). Randomized trial of group therapy for repeated deliberate self-harm in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11), 1246-1253.

Contact Information

Richard Harrington

University Department of Child Psychology

Royal Manchester Children’s Hospital,

Pendlebury, Manchester M27 4HA, England

KEYWORDS: Adolescents, males and females (co-ed), high-risk, clinic/provider-based, manual is available, cost information is available, counseling/therapy, depression/mood disorders, attendance, other mental health, other behavior problems, other social/emotional health, other substance use

Program information last updated on 3/20/13.