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Peer-reviewedCC BY 4.0BMC Psychiatry

The Card Sort Task for Self-harm (CaTS): a review of the development, application, and adaptation of a novel tool for the assessment and contextual understanding of self-harm

  • Emma Nielsen1,2
  • Katherine Bird2,3
  • A. Jess. Williams4,5,6
  • Joanna Lockwood2,7
  • David Jobes8
  • Amy Brausch9
  • Ruth Wadman10
  • Delfina Bilello11
  • Camilla M. Babbage2,7
  • Sarah Cassidy3
  • Laura del Carpio12
  • Blandine French2,3
5 more authors
  • Carol MacDonald13,14
  • Victoria Newell2,3,15
  • Mirabel Pelton16
  • Susan Rasmussen17
  • Ellen Townsend2,3
17 affiliations
  1. 1National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), University of Manchester, Manchester, UK
  2. 2Self-Harm Research Group, University of Nottingham, Nottingham, UK
  3. 3School of Psychology, University of Nottingham, Nottingham, UK
  4. 4National Centre for Suicide Prevention and Self-Harm Research, Population Data Science, Swansea University Medical School, Swansea, UK
  5. 5Department of Informatics, Bush House, Strand Campus, King’s College London, London, UK
  6. 6Institute of Mental Health, Jubilee Park, University of Nottingham, Nottingham, UK
  7. 7NIHR MindTech MedTech Co-Operative, Institute of Mental Health, Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, NG7 2TU UK
  8. 8Department of Psychology, The Catholic University of America, Washington, DC USA
  9. 9Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY USA
  10. 10Department of Health Sciences, University of York, York, UK
  11. 11Department of Experimental Psychology, University of Oxford, Oxford, UK
  12. 12Health Technology Assessment in Primary Care and Mental Health (PRISMA Group), Fundació Sant Joan de Déu, Barcelona, Spain
  13. 13Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
  14. 14NIHR Nottingham Biomedical Research Centre-Hearing, Nottingham, Nottingham, UK
  15. 15School of Psychology, University of Sheffield, Sheffield, UK
  16. 16Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
  17. 17Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Abstract

Developing clear, adaptable, and engaging methodologies is critical for advancing the understanding and prevention of self-harm and suicide. This paper presents a review of the development, application and adaptation of the Card Sort Task for Self-Harm (CaTS), a structured, interactive tool designed to map individual pathways to self-harm. Grounded in psychological theory and co-developed with input from people with lived experience, CaTS uses 117 evidence-informed cards representing thoughts, feelings, events, behaviours, and support-related factors. Participants place these cards along a timeline spanning the period before and after a self-harm episode, enabling the identification of both risk and protective factors as well as the sequencing of relevant experiences. The inclusion of blank cards supports personalisation, ensuring the tool remains sensitive to diverse experiences. Unlike traditional psychometric measures, CaTS emphasises holistic understanding and temporal patterning. Since its initial application, CaTS has been adapted for use with varied populations, delivery formats, and research settings. This paper outlines the conception and evolution of CaTS, highlighting the tool’s potential for clinical, research and participatory applications, and utility in training and public engagement. By offering a flexible, person-centred approach, CaTS advances inclusive and nuanced exploration of self-harm processes, offering a novel way to explore often-overlooked, complex temporal dynamics.

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Cite

BibTeXRIS
BibTeX
@article{nielsen2026card,
  title = {{The Card Sort Task for Self-harm (CaTS): a review of the development, application, and adaptation of a novel tool for the assessment and contextual understanding of self-harm}},
  author = {Emma Nielsen and Katherine Bird and A. Jess. Williams and Joanna Lockwood and David Jobes and Amy Brausch and Ruth Wadman and Delfina Bilello and Camilla M. Babbage and Sarah Cassidy and Laura del Carpio and Blandine French and Carol MacDonald and Victoria Newell and Mirabel Pelton and Susan Rasmussen and Ellen Townsend},
  journal = {BMC Psychiatry},
  year = {2026},
  month = jul,
  doi = {10.1186/s12888-026-08377-3},
  url = {https://doi.org/10.1186/s12888-026-08377-3},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - The Card Sort Task for Self-harm (CaTS): a review of the development, application, and adaptation of a novel tool for the assessment and contextual understanding of self-harm
AU  - Emma Nielsen
AU  - Katherine Bird
AU  - A. Jess. Williams
AU  - Joanna Lockwood
AU  - David Jobes
AU  - Amy Brausch
AU  - Ruth Wadman
AU  - Delfina Bilello
AU  - Camilla M. Babbage
AU  - Sarah Cassidy
AU  - Laura del Carpio
AU  - Blandine French
AU  - Carol MacDonald
AU  - Victoria Newell
AU  - Mirabel Pelton
AU  - Susan Rasmussen
AU  - Ellen Townsend
PY  - 2026
DA  - 2026/07/17
JO  - BMC Psychiatry
DO  - 10.1186/s12888-026-08377-3
UR  - https://doi.org/10.1186/s12888-026-08377-3
AB  - Developing clear, adaptable, and engaging methodologies is critical for advancing the understanding and prevention of self-harm and suicide. This paper presents a review of the development, application and adaptation of the Card Sort Task for Self-Harm (CaTS), a structured, interactive tool designed to map individual pathways to self-harm. Grounded in psychological theory and co-developed with input from people with lived experience, CaTS uses 117 evidence-informed cards representing thoughts, feelings, events, behaviours, and support-related factors. Participants place these cards along a timeline spanning the period before and after a self-harm episode, enabling the identification of both risk and protective factors as well as the sequencing of relevant experiences. The inclusion of blank cards supports personalisation, ensuring the tool remains sensitive to diverse experiences. Unlike traditional psychometric measures, CaTS emphasises holistic understanding and temporal patterning. Since its initial application, CaTS has been adapted for use with varied populations, delivery formats, and research settings. This paper outlines the conception and evolution of CaTS, highlighting the tool’s potential for clinical, research and participatory applications, and utility in training and public engagement. By offering a flexible, person-centred approach, CaTS advances inclusive and nuanced exploration of self-harm processes, offering a novel way to explore often-overlooked, complex temporal dynamics.
SN  - 1471-244X
ER  -