cbasp cognitive behavioural analysis system of psychotherapy personal background work through a small charity whose aims are : to help people with psychological difficulties – typically adults with depression and/or anxiety when effective help is not readily available elsewhere
work through a small charity whose aims are:
for more details & a downloadable copy of this talk go to the ‘good
knowledge’ section of www.goodmedicine.org.uk click on ‘lectures
and leaflets’ and look under ‘cbt, depression & ...’ in ‘past lectures’
Spijker J. et al. Duration of major depressive episodes in the general population. Br J Psychiatry 2002;181:208-213
time from start of depressive episode
lifetime prevalence in 7,667 young US adults (17-39) representative sample interviewed 1988-1994
Jonas, B. S., D. Brody, et al. (2003). Prevalence of mood disorders in a national
sample of young American adults.Soc Psychiatry Psychiatr Epidemiol38(11): 618-24.
current prevalence in 3,056 elderly Dutch adults (55-85); unfavourable prognosis commented on
Beekman, A. T., D. J. Deeg, et al. (2004). Dysthymia in later life: a study in the community.J Affect Disord81(3): 191-9.
12 month prevalence in 4,327 primary care Canadian adults; 90% had comorbid disorders
Steiner, M., B. Bell, et al. (1999). Prevalence of dysthymic disorder in primary care.J Affect Disord54(3): 303-8.
Keller, M. B., McCullough, J.P. et al. A comparison of nefazodone, the cog-nitive behavioral-analysis system of psychotherapy, & their combination for the treatment of chronic depression. N Engl J Med 2000; 342(20): 1462-70
response was defined as a reduction of at least 50% in the initial Hamilton Rating Scale for Depression (HRSD) score, and a final HRSD score of 15 or less.
‘all’ represents the 662 patients who attended at least one treatment session; ‘completers’ represents the 519 patients who completed the full 12 week protocol.
remission was defined as an HSRD score of 8 or less when they left the trial for those who didn’t complete the 12 week protocol or at both weeks 10 & 12 for those who did.
non-responders to single modality treatments (cbasp or nefazodone on their own) were later crossed over to the alternative single modality treatment, while responders were entered into maintenance treatment trials for both cbasp and for nefazodone.
Early alliance significantly predicted subsequent improvement in depressive symptoms after controlling for prior improvement and 8 prognostically relevant patient characteristics. Patients receiving combination treatment reported stronger alliances with their psychotherapists than patients receiving CBASP alone.
Klein, D. N., J. E. Schwartz, et al. (2003). "Therapeutic alliance in depression treatment: con-trolling for prior change and patient characteristics." J Consult Clin Psychol71(6): 997-1006.
Among chronically depressed individuals, CBASP appears to be efficacious for nonresponders to nefazodone, and nefazodone appears to be effective for CBASP nonresponders. A switch from an antidepressant medication to psychotherapy or vice versa appears to be useful for nonresponders to the initial treatment.
Schatzberg, A., A. Rush, et al. (2005). "Chronic depression: medication (nefazodone) or psychotherapy (CBASP) is effective when the other is not." Arch Gen Psychiatry62: 513-20.
Among those with a history of early childhood trauma (loss of parents at an early age, physical or sexual abuse, or neglect), psychotherapy alone was superior to antidepressant monotherapy. Moreover, the combination of psychotherapy and pharmacotherapy was only margin-ally superior to psychotherapy alone among the child abuse cohort.
Nemeroff, C. B., C. M. Heim, et al. (2003). "Differential responses to psycho-therapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma." Proc Natl Acad Sci U S A100(24): 14293-6.
Eighty-two patients who had responded to acute and continuation phase CBASP were randomized to monthly CBASP or assessment only for 1 year. Significantly fewer patients in the CBASP than assess-ment only condition experienced a recurrence. The 2 conditions also differed significantly on change in depressive symptoms over time.
Klein, D. N., N. J. Santiago, et al. (2004). "Cognitive-behavioral analysis system of psycho-therapy as a maintenance treatment for chronic depression." J Consult Clin Psychol72: 681-8.
the largest ever randomized psychotherapy-medication depression treatment trial – a 9 site, 4 (+ 2) year study – is due to report results in 2006
910 chronically depressed outpatients were
entered into a 12 week antidepressant trial
non & partial responders then had their antidepressant changed or augmented for 12 weeks & were randomized to one of three possible groups
1.) medication on its own
2.) medication plus Brief Supportive Psychotherapy
3.) medication plus CBASP
the four interpersonal domains targeted in the IDE:
for more details and a download-able copy of this talk go to the “good knowledge” section of www.goodmedicine.org.uk , click on “lectures and leaflets” & look under “cbt, depression & problem solving” in “past lectures”