Understanding factors that could influence feasibility and acceptability of brief CAT for adults who self‐harm: a qualitative exploration using the theoretical framework of acceptability

Introduction

Self-harm in adults is a complex and highly prevalent problem. The Relational Approach to Treating Self-Harm (RELATE, ISRCTN code: ISRCTN75661422) trial investigated the feasibility, acceptability and safety of 8-session cognitive analytic therapy (CAT) for self-harm, compared with treatment as usual. This qualitative evaluation explored participants' experiences of study processes and of brief CAT.

Method

Semi-structured one-to-one interviews were carried out with N = 24 participants and reflexive thematic analysis explored participants' experiences.

Results

Five themes were identified supporting the perceived acceptability of the trial and the therapy. Being responsible to accept uncertainty was the concern prior to and at the start of the CAT and centred on a sense of vulnerability during the therapy itself. Self-acceptance through more understanding and taking ownership illustrated understandings of how CAT worked. Living with urges was seen as the impact of the CAT on impulsivity, and being prepared for the end of treatment was a key factor in the overall view of brief CAT.

Conclusions

Brief CAT for self-harm appears acceptable in terms of intervention coherence, self-efficacy and perceived effectiveness. Anticipation of increased vulnerability (i.e., affective attitudes) and the energy required (i.e., burden) in talking through difficulties and trauma suggest a need to manage patient expectations before brief CAT is started.