9781572305274

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

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  • ISBN13:

    9781572305274

  • ISBN10:

    1572305274

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

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