Cognitive Behavioral Analysis System of Psychotherapy

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The Cognitive Behavioral Analysis System of Psychotherapy ( English , roughly translated cognitive-behavioral-therapeutic-analytical psychotherapy system , abbreviated CBASP ) is a treatment method of psychotherapy . It was developed by the US psychologist James P. McCullough specifically for the treatment of patients with chronic depression and has been empirically verified in scientific studies since 1980.

CBASP cannot be assigned to any of the established schools of psychotherapy, since both behavioral approaches and interpersonal and psychodynamic approaches are part of the procedure. CBASP is a highly structured and directive therapy method . A main difference to many cognitive therapy approaches is the lower level of cognitive performance that is assumed in the patient.

target group

The CBASP was developed to treat patients suffering from chronic depression. Research shows that approximately 30% of those affected by depression fall into this category. These patients often show an early onset of their illness (before the age of 21), no complete regression of symptoms between individual depressive phases, particularly severe phases and more frequent occurrences of depressive episodes. Their treatment is considered difficult, the points mentioned are considered an indication of an unfavorable course of the disease.

McCullough describes the patients for whom the treatment method was developed as patients who have had negative experiences in contact with other people since early adulthood and who have therefore developed long-lasting, mild depression ( dysthymia ) ranging from moderate to severe phases Depression interrupted. This leads to hopelessness and the attitude of patients that there is nothing they can do to control their depressed mood. At the same time, those affected show very rigid behaviors that are influenced neither by positive nor by negative events.

Underlying Theories

CBASP integrates various approaches that are significant in psychology, including a. by Piaget , Seligman , Skinner , Kiesler, and Bandura .

McCullogh names the development theory of Jean Piaget as the most important influence and theoretical foundation . According to this theory, "preoperational thinking" is usually overcome at the age of about seven. At this age, children learn the principle of perspective taking , i.e. That is, they overcome their purely egocentric view of things and learn - as a basis for empathic understanding - to put themselves in other people's shoes. This also includes the knowledge that in a certain situation a certain emotional reaction is only one of several possible reactions, that different people can react differently in the same situation and that many interpersonal situations are based on one another, i.e. that past situations also influence the current situation. CBASP conceptually assumes that patients suffering from chronic depression had difficulties with this step in their development (e.g. due to early trauma ). They do not recognize the effect of their behavior on others and thus do not recognize the connection between their behavior and its consequences. As a result, those affected developed an avoidant, anxious lifestyle and were unable to correct their negative-depressive assumptions about life and the environment, even with repeated other experiences.

The Kiesler Circumplex model (also: Kiesler Circle ) is used to describe the type of interaction between the patient and his or her environment . Here, the interpersonal behavior on the two dimensions " dominant vs. submissive "and" hostile vs. friendly ”.

therapy

Together with the patient, the CBASP therapist particularly looks at how they interact with other people (including the therapist). McCullough assumes in his program that it is precisely in these situations that a major influence from chronic depression becomes visible. Therefore, a large part of the CBASP-specific interventions relate to these social situations. Three intervention techniques in particular distinguish the CBASP in this area:

  • First, a list of key figures in the patient's previous life is drawn up (the so-called significant other history ). Above all, it is considered which basic assumptions have been anchored in the patient's learning history by these people.
  • In the context of detailed situation analyzes , u. a. analyzes how these basic assumptions influence the interaction with other people in the patient's current life situation, and whether or not his behavior contributed to the successful course (i.e. the result desired by the patient) of the situation. Problematic interpretations by the patient are jointly analyzed and replaced with more helpful (i.e., one that contributes to the desired outcome) interpretations. This part takes up about 75% of the therapy.
  • By interpersonal discrimination activities ( Interpersonal Discrimination Exercise IDE) the patient learns his problematic interpretations of behavior to recognize the other, and he learns to avoid such misinterpretations (z. B. the expectation that his wife will react just like his mother). Since McCullough assumes that these basic assumptions will sooner or later also be reflected in conflicts in the therapist-patient relationship, the CBASP uses the so-called disciplined personal involvement as a technique ( engaging personally in a controlled manner with the patient). Here, a transference situation is consciously taken up and discussed. In other words, the therapist empathically reports back to the patient about how he is doing with his behavior.
    • First, the Kiesler circle is used to describe which interpersonal behavior is predominant in the patient (often submissive behavior with friendly or hostile aspects to which the patient usually reacts dominantly).
    • The therapist should react in an acomplementary (i.e. not dominant) manner in a controlled manner (controlled relational establishment).
    • There are causally theoretical derived conclusions with respect to each formative caregiver.
    • Transfer hypotheses are formulated as implications (e.g. "If I make a mistake with my therapist, then ...").
    • Corrective emotional experience through the perception of the difference between the therapist's behavior and the previous behavior of the formative caregiver ( discrimination training : e.g. "What differences can you see between the behavior of your father and mine?")
  • Development of behavioral skills (e.g. self-confidence training )

effectiveness

The most extensive study to date to prove the effectiveness of this therapeutic method was published in 2000. This randomized controlled study showed that CBASP is just as effective for chronic depression as the administration of the antidepressant nefazodone (which is no longer on the market due to serious side effects). In both groups about 50% of the participants benefited from the respective treatment. The most effective, however, was the combination of antidepressant and CBASP; after twelve weeks, 85% of the participants showed a significant improvement in their depressive symptoms.

literature

  • JP McCullough Jr .: Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP) . Guilford Press , New York 2000, ISBN 1-57230-965-2 .
  • JP McCullough Jr .: Treating Chronic Depression With Disciplined Personal Involvement: CBASP . Springer, New York 2006, ISBN 0-387-31065-7 .
  • E. Schramm, U. Schweiger, F. Hohagen, M. Berger: Psychotherapy of chronic depression: Cognitive Behavioral Analysis System of Psychotherapy - CBASP . Ed .: JP McCullough Jr. Elsevier , Munich 2006, ISBN 3-437-23970-8 .

Web links

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  1. ↑ JP McCullough: Helping depressed patients regain control over Their Lives . In: Behavioral Medicine . tape 7 , 1980.
  2. ↑ a b c J. P. McCullough Jr .: Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP) . Guilford Press , New York 2000, ISBN 1-57230-965-2 .
  3. ↑ a b c E. Schramm, F. Caspar, M. Berger: Specific therapy for chronic depression . In: The neurologist . No. 77 , 2006, p. 355-371 , doi : 10.1007 / s00115-006-2059-1 .
  4. ^ ES Paykel, T. Brugha, T. Fryers: Size and burden of depressive disorders in Europe . In: European Neuropsychopharmacology . tape 15 , 2005.
  5. ↑ K. Beesdo, H.-U. Wittchen: Depressive disorders: major depression and dysthymia . In: H.-U. Wittchen, J. Hoyer (Ed.): Clinical Psychology & Psychotherapy . Springer Medizin Verlag , Heidelberg 2006, ISBN 3-540-28468-0 , chap. 37 .
  6. ↑ James P. McCullough, Jr .: Treatment of Depression with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Therapy manual. Munich: CIP-Medien, 2007, ISBN 978-3-932096-54-9 .
  7. ↑ MB Keller, JP McCullough, DN Klein, B. Arnow, DL Dunner, AJ Gelenberg, JC Markowitz, CB Nemeroff, JM Russell, ME Thase, MH Trivedi, J. Zajecka, JA Blalock, FE Borian, C. DeBattista, J . Fawcett, RMA Hirschfeld, DN Jody, G. Keitner, JH Kocsis, LM Koran, SG Kornstein, R. Manber, I. Miller, PT Ninan, B. Rothbaum, AJ Rush, AF Schatzberg, D. Vivian, D .: A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression . In: The New England Journal of Medicine . tape 342 , no. 20 , 2000.