Relational approach to working with young people who self-harm (RELATE-YP): A Feasibility Trial

Background Self-harm often begins in adolescence, and there is a peak in prevalence during the teenage years. It is estimated 17% of adolescents aged 10 to 17 engage in self-harm. Self-harm is a key predictor for future psychological difficulties. It is also a robust predictor of suicide risk, which is a leading cause of death in young people in England and worldwide. There is scarce evidence regarding which treatments may be effective for young people who self-harm. Research into mechanisms underlying self-harm suggests that relational approaches may be particular helpful. Cognitive Analytic Therapy (CAT) is a structured, integrative, relational psychotherapy that was developed to meet the needs of the NHS. Preliminary work highlights that this approach may have promise for helping young people who self-harm, but larger scale evaluation is lacking. An 8-session version of CAT focused on self-harm has been developed and trialled in adults. This approach may also be beneficial for young people aged 13-17 who self-harm but this requires investigation. Aims and Objectives An important next step in evaluating CAT for young people who self-harm is to ascertain the feasibility of undertaking a larger-scale efficacy-focused clinical trial of this approach. The aim of the proposed study is therefore to undertaken a feasibility Randomised Controlled Trial (RCT) that will answer key feasibility uncertainties relating to recruitment, attrition, engagement with therapy, trial design and assessment. We will also assess the feasibility of undertaking a full economic evaluation of CAT for self-harm in young people. The research will be guided by pre-specified progression criteria. Methods Young people aged 13 to 17 years with a history of self-harm in the past year will be recruited via community child and adolescent mental health services across three NHS trusts. Following baseline assessments, participants will randomly allocated (1:1 ratio) to receive either CAT or Treatment-as-Usual (TAU). Follow-up assessments will take place at 8, 16 and 20 weeks post randomisation by researched masked to participant allocation. A qualitative process analysis will be embedded into the trial, involving interviews with participants and wider stakeholders (e.g. parents, caregivers, teachers, clinicians). An advisory group of young people with lived experience of self-harm and parents/caregivers of children who have self-harmed, will be involved in guiding the research. Anticipated Impact and Dissemination The results of the trial will help determine whether a larger-scale definitive trial of CAT for self-harm in young people would be feasible, based on whether progression criteria are met. The proposed study will also resolve key questions that would inform the design of a subsequent trial (e.g. best choice of primary outcome). More broadly it will provide initial data on the potential promise of CAT for young people struggling with self-harm and help further our understanding of these experiences. Dissemination along traditional lines including peer-reviewed papers and conference presentations will be supplemented with press releases, dissemination events, and infographics aimed at broader audience, including young people who self-harm, their caregivers, and other key stakeholders (parents/caregivers, clinicians, teachers).