Treatment for Chronic Depression Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

by McCullough, James P.

• ISBN13: 9781572305274
• ISBN10: 1572305274
• Edition: 1st
• Format: Hardcover
• Copyright: 1999-11-17
• Publisher: The Guilford Press

Summary

This volume describes the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), a research-based approach designed to motivate chronically depressed patients to change and to help them develop needed problem-solving and relationship skills. Integrating elements of cognitive-behavioral and interpersonal therapy, this approach has been shown to be as effective as medication treatment in a recent 12-site national study with 681 chronically depressed outpatients. Even more significant, a combination of CBASP and pharmacotherapy produced a response rate of 85%--unprecedented for any large-scale randomized clinical trial of its kind--and demonstrated for the first time the superiority of combination treatment to either psychotherapy or pharmacotherapy alone. Filled with detailed case examples, the volume presents clear, step-by-step guidelines for using CBASP. Also discussed are ways to measure treatment outcomes; issues in research, training, and supervision; and managing common crises and problems in treatment.

Author Biography

James P. McCullough, Jr., PhD, received his doctorate from the University of Georgia. He is a fellow of the American Psychological Association and was elected a Diplomate in Clinical Psychology by the American Board of Psychological Forensic Examiners. He is currently codirector of the Adult Psychotherapy Clinical Training Program at Virginia Commonwealth University, where he is also Professor of Psychology and Psychiatry and Executive Director of the Unipolar Mood Disorders Institute. An award-winning educator and researcher, Dr. McCullough has taught clinical psychology graduate students since 1970. His areas of special interest are dysthymia, double depression, and chronic major depression, particularly diagnostic criteria; unipolar diagnostic category psychosocial comparisons; and cognitive and single-case methodology evaluating both private practice and research. He is the author of many publications, including Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy.

Table of Contents

PART I. CBASP AND THE PSYCHOPATHOLOGY OF THE PATIENT
A Therapist's Problems with a Chronically Depressed Patient	3	(3)
Introduction to Chronically Depressed Patients and the CBASP Program	6	(19)
Crucial Beginnings	6	(2)
The Chronic Depressions: New DSM Categories	8	(1)
Treatment Prognosis	9	(2)
Medical Complaints, Comorbidity, and Spontaneous Remission	11	(1)
Unique Features of CBASP	12	(6)
Akiskal's Biopsychosocial View of Depression	18	(2)
The Cases of Phil and Stephanie	20	(2)
Depression and the Natural Wisdom of the Body	22	(3)
Understanding the Psychopathology of Chronically Depressed Patients	25	(26)
Importance of Correct Diagnosis and Understanding the Psychopathology of Chronic Patients	25	(2)
The Mutually Informing Relationship of Normal and Abnormal Behavior	27	(2)
The Teleogical Goal for Interpersonal-Social Development	29	(1)
Jean Piaget's Structural Model of Normal Development	30	(3)
Two Types of Derailment in Normal Development	33	(2)
Parallels between Chronically Depressed Adults and Normal Properational Children	35	(5)
Differences between Normal Preoperational Children and Chronically Depressed Adults	40	(1)
Normal Bifurcated Cognitive-Emotional Development	40	(2)
Maltreatment and Derailment of the Maturational Process among Early-Onset Chronic Depressives	42	(5)
Late-Onset Degeneration of Cognitive-Emotional Functioning	47	(3)
Similar Treatment Goals for Early- and Late-Onset Patients	50	(1)
Course Patterns, Comorbidity, and Psychological Characteristics	51	(18)
Five Course Patterns of Chronic Depression	51	(7)
Diagnosing Comorbidity	58	(2)
Psychological Characteristics of Untreated Chronically Depressed Adults	60	(3)
Need for an Integrative Therapeutic Program	63	(6)
PART II. CBASP METHOD AND PROCEDURES
Strategies to Enhance Motivation for Change	69	(36)
The Importance of Motivation	69	(1)
Perceiving Environmental Consequences	70	(2)
Patient Misery and the Negative Reinforcement Paradigm	72	(4)
Teaching Formal Operations Thinking to Modify the Preoperational Dilemma	76	(1)
Avoiding Takeover Pitfalls	77	(2)
Situational Analysis: Exacerbation and Resolution of Psychopathology	79	(6)
Proactively Addressing Interpersonal Transference Issues	85	(2)
Eliciting a Significant-Other List	87	(1)
Pitfalls in Eliciting the Significant-Other History	88	(2)
Constructing the Interpersonal Transference Hypotheses	90	(8)
Transference Hypotheses as Tacit Knowledge	98	(3)
A Rationale for Causal Theorizing	101	(1)
Freudian versus CBASP Transference Perspectives	102	(3)
Elicitation Phase of Situational Analysis	105	(37)
Situational Analysis	105	(1)
The Coping Survey Questionnaire	106	(36)
Situational Description	107	(6)
Situational Interpretations	113	(10)
Situational Behavior	123	(2)
Situational Actual Outcome	125	(4)
Situational Desired Outcome	129	(9)
Comparing the Actual Outcome to the Desired Outcome	138	(4)
Remediation Phase of Situational Analysis	142	(25)
Introduction to the Remediation Phase	142	(23)
Revising Irrelevant and Inaccurate Interpretations	143	(14)
Modifying Inappropriate Behavior	157	(4)
Wrap-Up and Summary of Situational Analysis Learning	161	(2)
Generalization and Transfer of Learning	163	(2)
Administering Situational Analysis for Anticipated Future Events	165	(2)
Using the Therapist-Patient Relationship to Modify Behavior	167	(29)
Introduction	167	(3)
Determining the Patient's Interpersonal ``Stimulus Value''	170	(6)
The Optimal Interpersonal Style for the Therapist	176	(1)
Dealing with Frustration and Anger	177	(6)
Actualizing the Clinician's Role	183	(5)
Disciplined Personal Involvement with Patients	188	(6)
Don't Downplay the Therapist's Role	194	(2)
Measuring Acquisition Learning and Generalized Treatment Effects	196	(21)
Measuring Two Types of Dependent Variables	197	(1)
History of the Current CBASP Method	198	(1)
An Important Distinction between Administering Situational Analysis and Rating the Patient's Performance Using the PPRF	199	(1)
The Patient Performance Rating Form	199	(8)
Measuring Acquisition of Perceived Functionality	207	(2)
Case Example of B. F.	209	(8)
PART III. HISTORY AND OTHER ASPECTS OF CBASP
CBASP Emergence on the National Scene	217	(6)
The Psychotherapy Arm of the Bristol-Myers Squibb Study	218	(2)
Acute-Phase Study Results	220	(3)
Training CBASP Psychotherapists	223	(10)
The CBASP Training Workshop	223	(3)
Certification of CBASP Psychotherapists	226	(1)
Optimal CBASP Therapist Qualities and Abilities	227	(6)
Comparison of CBASP to Beck's Cognitive Therapy and Klerman's Interpersonal Psychotherapy Models	233	(23)
Beginning Phase Distinctions	234	(6)
End/Goal Phase Distinctions	240	(3)
Middle Phase Distinctions	243	(12)
Conclusion	255	(1)
Resolving Common Patient Problems and Crises	256	(37)
Halting a Slide into a Major Depressive Episode	257	(1)
Standing between the Patient and Suicide	258	(2)
Inhibiting ``Acting Out'' Behavior	260	(2)
Strategy for Dealing with Lack of Improvement	262	(2)
Managing Hostile-Obsessive Patients	264	(2)
Managing Passive-Dependent Patients	266	(2)
Inhibiting Overintellectualized Therapy Administration	268	(2)
Modifying Refractory Cognitve-Emotive Responses	270	(4)
Final Thoughts	274	(3)
APPENDICES
Appendix A Therapist Prompts for Administering Situational Analysis (PASA)	277	(8)
Appendix B Rating Scales for Adherence Monitoring and for Evaluating the Quality of the Interpersonal Relationship	285	(6)
Appendix C Rating the Presence of Optimal CBASP Therapist Qualities and Abilities	291	(2)
References	293	(18)
Author Index	311	(4)
Subject Index	315