Culturally Adapted Cognitive Behavioral Therapy for Prevention of Self Harm

• Beck scale for suicidal ideation [ Time Frame: six months ] [ Designated as safety issue: No ]
  This is a 19 item instrument which measures the intensity, duration, and specificity of a patient's thoughts about committing suicide.
  
  

• Quality of life (EQ 5 D) [ Time Frame: six months ] [ Designated as safety issue: No ]
  It is a measure of health and quality of life. This is a standardised instrument for use as a measure of health outcome; it provides a simple descriptive profile and a single index value for health status.
  
  
• Coping Resource Inventory (CRI) [ Time Frame: six months ] [ Designated as safety issue: No ]
  Assesses coping resources available for managing stress
  
  
• CSRI Health care use Questionnaire [ Time Frame: six months ] [ Designated as safety issue: No ]
  An estimate of the health and social services received.
  
  
• Para suicide history: interview [ Time Frame: six months ] [ Designated as safety issue: No ]
  This records all self harm events in a chronological order and can be used to assess both the time of first repeat self harm episode and the number of episodes over time together with the severity of episodes if required
  
  
• Hopelessness ( Beck hopelessness scale) [ Time Frame: six months ] [ Designated as safety issue: No ]
  This is a self-report instrument that consists of 20 true-false statements designed to assess the extent of positive and negative beliefs about the future during the past week.
  
  
• Beck Depression Inventory [ Time Frame: six months ] [ Designated as safety issue: No ]
  21 item scale measuring symptoms of depression. Higher scores indicating greater severity of depression
  
  
• PSI/SF [ Time Frame: six months ] [ Designated as safety issue: No ]
  This is a brief version of parenting stress index. It has 36 items which measure four domains including family stress, general symptomotology (child), parent-child relationship and validity (caregiver).
  
  

Culturally Adapted manualised Cognitive Behavioral Therapy (CBT) will be a brief problem focused therapy comprising of 6 sessions within three months after a self-harm episode. The adapted therapy/training will be delivered by therapists/trained counselors at the hospital. Sessions will be offered weekly in the first two weeks and than fortnightly and will last 50 minutes. During each session the therapists will assess the risk of suicide and will liaise with the research supervisor and patient's treating clinician.

The areas covered by the manual which has been adapted include an evaluation of the self-harm attempt, crisis skills, problem solving, and basic cognitive techniques to manage emotions and negative thinking and relapse prevention strategies. The treatment will be structured around patient's current problems with the relevant sections of the manual helping the patient to deal with specific problems leading to the self-harm act. Between the sessions the manual can be used for homework tasks by the patient.