Self-harm (SH) is one of the strongest predictors of eventual death by suicide. This study examines the potential protective role of reasons for living (RFL) and hope in youth with a history of self-harm using data from a randomized control trial (RCT) of brief cognitive behavioural therapy (BCBT). A single-blind, pilot RCT examined the efficacy of BCBT for suicide prevention versus an attentional control in youth aged 15-25 admitted to hospital following self-harm. Subjects’ reasons for living and hope were measured weekly by the Reasons for Living Scale (RFL) and Adult Hope Scale (AHS), respectively, for 10 weeks of acute treatment. Logistic regression was performed to evaluate whether baseline RFL and AHS scores predicted repeat self-harm. Mann-Whitney U tests were used to compare median RFL and AHS scores. Our study did not find associations between reasons for living or hope and repeat self-harm in youth. Treatment with BCBT was also not associated with improved scores on either measure. •There was no association between baseline RFL or AHS scores and repeat self-harm.•Reasons for living and hope did not protect against repeat self-harm.•There were no differences in RFL or AHS scores across treatment conditions at Week 10.•BCBT did not improve reasons for living or hope compared to an attentional control.