Chronic depression accounts for roughly a third of all mood disorders. It is a particularly disabling disorder, which is associated with greater comorbidity and suicidality, more significant impairments in functioning, and increased health care utilization than acute major depressive episodes. In the past, chronic depression was often considered as treatment-resistant since traditional pharmacological and psychological treatment approaches show at most modest success. In addition, relatively few psychotherapy studies have focused on chronic (mostly dysthymia) forms of depression. However, in chronic Major Depression a specific form of psychotherapy, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), proved to be equally effective than medication; the combination of CBASP and medication revealed significant superiority over both monotherapies.CBASP-developed by James McCullough-is the only psychotherapeutic intervention specifically designed for chronic depression. The approach integrates behavioral, cognitive, psychodynamic, and interpersonal strategies. It focuses on problems resulting from an inhibition of maturation in early childhood often caused by early traumatization by using the therapeutic relationship in a disciplined personal way. In addition, other interpersonal strategies are applied to overcome preoperational thinking. By means of a specific behavioral technique, the Situation Analysis, patients learn to focus on the consequences of their behavior and to use efficient social problem-solving. The techniques of CBASP will be demonstrated.Results of two pilot studies will be presentedFirst, a randomized pilot outpatient study comparing CBASP with the interpersonal psychotherapy (IPT) in early onset chronically depressives was conducted showing significant superiority of CBASP against IPT. Second, a first open pilot study in the inpatient setting investigated a new modified multidisciplinary CBASP inpatient program. The data of the first patients suggest that the three-month CBASP inpatient program is a feasible and effective treatment for severely chronically depressed patients with severly to extreme traumatization.
Cognitive Behavioral Analysis System of Psychotherapy (CBASP): A Disorder-Oriented, Theory-Driven Psychotherapy Method from the “Third Generation” of Behavior Therapy Models, Designed for the Treatment of Chronic Depression
