Summary of “J. Mccullough, Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP) (New York: Guilford Press, 2000)”
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.
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).
Research into the effectiveness of CBASP can make an important contribution to the improvement of care for chronically depressed patients. According to the results of Keller et al., 73% of these patients can be effectively treated if CBASP is combined with antidepressant medication. 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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