Deliberate non-fatal acts of self-harm, including self-poisoning and self-injury are a significant public health challenge: the incidence of self-harm in young people is in the region of 7–14%. This paper considers the application of cognitive behaviour therapy to people who harm themselves through attempted suicide or self-injury. Models and interventions for self-harm based on problem-solving, Beck's cognitive therapy and other cognitive behaviour therapies are considered, as well as interventions for this behaviour used within the context of treatments for borderline personality disorder. A model of coping with adversity, based on a combination of Lazarus & Folkman's theory of stress and coping and Beck's cognitive therapy is presented. The model is then used to consider how people who self-harm may be helped to better manage the consequences of affective arousal in stressful situations.