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Cognitive behavioral analysis system of psychotherapy

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The cognitive behavioural analysis system of psychotherapy (CBASP) is a form of cognitive behaviour therapy developed (and patented) by James P. McCullough Jr[1], and partly based on Piaget's theory of cognitive development. It uses a structured exercise called "situational analysis" to help the patient redevelop the ability to see the cause and effect relationships in interpersonal interactions, and then remedy thinking patterns[2]; it may involve "disciplined personal involvement" of the therapist with the patient[3]. When combined with appropriate antidepressants, it can be extremely effective.

Effectiveness in combination with drug therapyEdit

A large-scale study, published in 2000 by Martin Keller MD of Brown University and others[4], compared the (then available) antidepressant Serzone with CBASP.

Six hundred and eighty-one patients with severe chronic depression (some with other psychiatric illnesses) were enrolled in the trial, and were assigned to either Serzone, CBASP, or combination Serzone-CBASP for 12 weeks. The response rates to either Serzone or CBASP alone were 55 percent and 52 percent, respectively, for the 76 percent who completed the study. In other words, a little more than half of the completers in those two arms of the trial reduced their depression by 50 percent or better.

The Serzone findings roughly correspond with many other trial results for antidepressants, and underscore a major weakness in these drugs — that while they are effective, the benefit is often marginal and the treatment outcome problematic. Similarly, the CBASP findings validate other studies finding talking therapy about equal in efficacy to taking antidepressants.

The results for the combination drug-therapy group, however, were surprising, with 85 percent of the completing patients achieving a 50 percent reduction in symptoms or better. 42 percent in the combination group achieved remission (a virtual elimination of all depressive symptoms) compared to 22 percent in the Serzone group and 24 percent in the CBASP group.

The authors of the frequently cited study noted that "the rates of response and remission in the combined-treatment group were substantially higher than those that might have been anticipated on the basis of the outcomes of previous trials in similar patients." Their figures are important, because they suggest that treating depression with a combination of both an anti-depressant drug and a form of cognitive behaviour therapy can be highly effective, giving substantially better results than other methods of dealing with depression.

The study requires replication now to see if these results are reliably confirmed and not an example of initial study syndrome.


NotesEdit

  1. CBASP: Development and Patient Demographics. CBASP.org. URL accessed on 2006-06-25.
  2. Psychotherapy of Chronic Depression. Gateway Psychiatric Services. URL accessed on 2006-07-01.
  3. McCullough Jr, James P. (2006-08-11). Treating Chronic Depression with Disciplined Personal Involvement: CBASP, Springer. ISBN 0-387-31065-7. (See Books. URL accessed on 2006-07-01.)
  4. Keller, M. et al. A Comparison of Nefazodone, the Cognitive Behavioural-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression. New England Journal of Medicine Volume 342:1462-1470 May 18, 2000.

Further readingEdit

  • McCullough Jr., James P. Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Guilford Press, 2003. ISBN 1-57230-965-2
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