Summary of “J. Mccullough, Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP) (New York: Guilford Press, 2000)”
Much of this is shared with other systems of brief psychotherapy. Reports of effectiveness in clinical trials cannot be equated with establishing the theoretical concepts of the therapy or substantiating the origins of the disorder and its psychopathology. Chronic depression in its various forms is a common and disabling disorder, with a high rate of relapse and relatively poor response to treatment. A number of studies suggest that a combination of antidepressant medication with brief (10–20 sessions) psychotherapy, is superior to either psychotherapy or medication alone, yet the availability of therapists adequately trained in the techniques of brief psychotherapy is quite limited. If this book increases that number, patients will have been well served.
There is a growing literature on the first two strategies, including work specific to chronic depression. Few data address the third option, even though it may be among the most common. Although most studies have failed to demonstrate decisive advantages for combined medication and psychotherapy over monotherapy in acute major depressive disorder (MDD) or dysthymic disorder, one large study found combination treatment significantly more efficacious than either medication or psychotherapy alone in chronic depression. Combination treatment is more expensive, at least acutely, than medication alone. Therefore, the most fiscally conservative strategy may be a stepwise approach: initially treat chronic depression with antidepressant medication, and add adjunctive psychotherapy for patients who have a poor or partial response. Recent data suggest that this may be a useful alternative to further courses of pharmacotherapy for MDD. The value of combining both strategies (ie, changing pharmacotherapy and adding psychotherapy) has not been studied. We therefore formulated the present study believing that augmentation with psychotherapy might play an important role in treating chronically depressed patients because chronic depression is less likely to respond to medication than is acute MDD, suggesting a greater need for adjunctive treatment strategies, and because patients with chronic depression exhibit greater psychosocial and interpersonal deficits than do patients with acute MDD, problems that psychotherapy may address (Thase ME, Rush AJ., 1995). Because a previous study by our group found that the cognitive behavioral analysis system of psychotherapy (CBASP)had a significant additive effect on chronic depression when combined with the antidepressant nefazodone hydrochloride and appeared to be an effective switch option when nefazodone alone was ineffective,we chose this psychotherapy for the present trial (Miller IW, Keitner GI, 1998).
CBASP can also be an alternative for patients who are not motivated for or refractory to pharmacological treatment. Furthermore, CBASP could also be effective as a maintenance treatment.
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