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Cognitive Behavioural Analysis System of Psychotherapy for Treatment-Resistant Depression: Adaptation to a Group Modality

Published online by Cambridge University Press:  06 July 2012

Liliane Sayegh*
Affiliation:
Douglas Mental Health University Institute, Canada
Kenneth D. Locke
Affiliation:
Department of Psychology and Communication Studies, University of Idaho, USA
Daniele Pistilli
Affiliation:
Douglas Mental Health University Institute, Canada
J. Kim Penberthy
Affiliation:
Department of Psychiatry & Neurobehavioral Sciences, University of Virginia, USA
Eduardo Chachamovich
Affiliation:
Douglas Mental Health University Institute, Canada
James P. McCullough
Affiliation:
Department of Psychology, Virginia Commonwealth University, USA
Gustavo Turecki
Affiliation:
Department of Psychiatry, McGill University, Canada
*
Address for correspondence: Liliane Sayegh, Psychologist, Depressive Disorders Program, Douglas Mental Health University Institute, 6875 Boul. LaSalle Montréal, Qc, Canada, H4H 13R. Email: lilian.sayegh@douglas.mcgill.ca
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Abstract

Studies researching psychotherapeutic interventions for treatment-resistant depression (TRD) are quite new to the field. The Cognitive Behavioural Analysis System of Psychotherapy (CBASP) is the only model developed specifically to treat the chronically depressed patient. While empirical evidence indicates that CBASP is an effective treatment for chronic depression, little is known about its adaptation to a group modality. Treating these patients in a group approach would have the added benefits of being cost-effective and providing in vivo previously avoided interpersonal situations for practising social skills and role-plays. This single arm study asks whether CBASP adapted to a group modality can be effective. All patients received 12 CBASP group therapy sessions with two to four individual preparatory sessions before the group. Our results suggest that CBASP group treatment demonstrated positive effects on patient outcomes. Specifically, patients showed significant decreases in symptoms of depression and the use of emotion-oriented coping, as well as increases in overall social adjustment and interpersonal self-efficacy when compared to pretreatment levels. However, patients did not achieve normative levels in these areas by the end of treatment. These pilot results are encouraging and support further study of the effectiveness of CBASP group treatment with a control group.

Type
Standard Papers
Copyright
Copyright © The Authors 2012

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References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Arlington, VA: Author.Google Scholar
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman.Google Scholar
Beck, A.T., Ward, C.H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561571.CrossRefGoogle ScholarPubMed
Bristow, M., & Bright, J. (1995). Group cognitive therapy in chronic depression: Results from two intervention studies. Behavioural and Cognitive Psychotherapy, 23, 373380.CrossRefGoogle Scholar
Cinciripini, P.M., Blalock, J.A., Minnix, J.A., Robinson, J.D., Brown, V.L., Lam, C., . . . Karam-Hage, M. (2010). Effects of an intensive depression-focused intervention for smoking cessation in pregnancy. Journal of Consulting and Clinical Psychology, 78 (1), 4454.CrossRefGoogle ScholarPubMed
Cuijpers, P., Van Straten, A., & Warmerdam, L. (2008). Are individual and group treatments equally effective in the treatment of depression in adults? A meta-analysis. European Journal of Psychiatry, 22 (1), 3851.Google Scholar
DeRubeis, R., Gelfand, L., Tang, T., & Simons, A. (1999). Medications versus cognitive behavior therapy for severely depressed outpatients: Mega-analysis of four randomized comparisons. American Journal of Psychiatry, 156 (7), 10071013.Google Scholar
DeRubeis, R., Hollon, S., Amsterdam, J., Shelton, R., Young, P., Salomon, R., . . . Gallop, R. (2005). Cognitive therapy vs medication in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409416.CrossRefGoogle ScholarPubMed
Endler, N.S., & Parker, J.D.A. (1999). Coping Inventory for Stressful Situations (CISS). Toronto: Multi-Health Systems Inc.Google Scholar
Fava, G.A., Ruini, C., & Belaise, C. (2007). The concept of recovery in major depression. Psychological Medicine, 37 (3), 307317.CrossRefGoogle ScholarPubMed
First, M.B., Gibbon, M., Spitzer, R.L., & Williams, J.B.W. (1996a). User's guide for the Structured Clinical Interview for DSM-IV Axis I Disorders — Research version (SCID-I, version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
First, M.B., Spitzer, R.L., Gibbon, M., & Williams, J.B.W. (1996b). Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II, version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
Greden, J.F. (2001). The burden of disease for treatment-resistant depression. Journal of Clinical Psychiatry, 62 (Suppl 16), 2631.Google ScholarPubMed
Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social & Clinical Psychology, 6 (4), 278296.CrossRefGoogle ScholarPubMed
Harley, R., Sprich, S., Safren, S., Jacobo, M., & Fava, M. (2008). Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. Journal of Nervous & Mental Disease, 196 (2), 136143.Google Scholar
Hirschfeld, R.M., Dunner, D.L., Keitner, G., Klein, D.N., Koran, L.M., Kornstein, S.G., . . . Keller, M.B. (2002). Does psychosocial functioning improve independent of depressive symptoms? A comparison of nefazodone, psychotherapy, and their combination. Biological Psychiatry, 51 (2), 123133.CrossRefGoogle ScholarPubMed
Hollon, S., DeRubeis, R., Shelton, R., Amsterdam, J., Salomon, R., O'Reardon, J., . . . Gallop, R. (2005). Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Archives of General Psychiatry, 62, 417422.CrossRefGoogle ScholarPubMed
Horowitz, L.M., Alden, L.E., Wiggins, J.S., & Pincus, A.L. (2000). Inventory of Interpersonal Problems (IIP) — Manual. Oxford, UK: The Psychological Corporation a Harcourt Assessment Company.Google Scholar
Keller, M.B. (2001). Long-term treatment of recurrent and chronic depression. Journal of Clinical Psychiatry, 62 (Suppl. 24), 35.Google Scholar
Keller, M.B., Klerman, G.L., Lavori, P.W., Coryell, W., Endicott, J., & Taylor, J. (1984). Long-term outcome of episodes of major depression. Journal of the American Medical Association, 252 (6), 788792.CrossRefGoogle ScholarPubMed
Keller, M.B., McCullough, J.P. Jr., Klein, D.N., Arnow, B., Dunner, D.L., Gelenberg, A.J., . . . Zajecka, J. (2000). A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine, 342 (20), 14621470.CrossRefGoogle ScholarPubMed
Klein, D.N., Santiago, N.J., Vivian, D., Blalock, J.A., Kocsis, J.H., Markowitz, J.C., . . . Keller, M.B. (2004). Cognitive-behavioral analysis system of psychotherapy as a maintenance treatment for chronic depression. Journal of Consulting and Clinical Psychology, 72 (4), 681688.CrossRefGoogle ScholarPubMed
Kocsis, J.H., Gelenberg, A.J., Rothbaum, B.O., Klein, D.N., Trivedi, M.H., Manber, R., . . . Thase, M.E. (2009b). Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial. Archives of General Psychiatry, 66 (11), 11781188.Google Scholar
Kocsis, J.H., Leon, A.C., Markowitz, J.C., Manber, R., Arnow, B., Klein, D. N., & Thase, M.E. (2009a). Patient preference as a moderator of outcome for chronic forms of major depressive disorder treated with nefazodone, cognitive behavioral analysis system of psychotherapy, or their combination. Journal of Clinical Psychiatry, 70 (3), 354361.Google Scholar
Kocsis, J.H., Rush, A.J., Markowitz, J.C., Borian, F.E., Dunner, D.L., Koran, L.M., . . . Keller, M.B. (2003). Continuation treatment of chronic depression: A comparison of nefazodone, cognitive behavioral analysis system of psychotherapy, and their combination. Psychopharmacology Bulletin, 37 (4), 7387.Google Scholar
Locke, K.D. (2000). Circumplex scales of interpersonal values: Reliability, and applicability to interpersonal problems and personality disorders. Journal of Personality Assessment, 75 (2), 249267.Google Scholar
Locke, K.D., & Sadler, P. (2007). Self-efficacy, values, and complementarity in dyadic interactions: Integrating interpersonal and social-cognitive theory. Personality and Social Psychology Bulletin, 33 (1), 94109.CrossRefGoogle ScholarPubMed
Matsunaga, M., Okamoto, Y., Suzuki, S., Kinoshita, A., Yoshimura, S., Yoshino, A., . . . Yamawaki, S. (2010). Psychosocial functioning in patients with treatment-resistant depression after group cognitive behavioral therapy. BMC Psychiatry, 10, 22.Google Scholar
McCullough, J.P. Jr. (2000). Treatment for chronic depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP). New York: Guilford Press.Google Scholar
McCullough, J.P. Jr. (2006). Treating chronic depression with disciplined personal involvement: CBASP. New York: Springer.CrossRefGoogle Scholar
McCullough, J.P. Jr. (2008). The Cognitive Behavioral Analysis System of Psychotherapy: A value-added strategy for chronic depression. Psychiatric Times, 25 (10).Google Scholar
McDermut, W., Miller, I.W., & Brown, R.A. (2001). The efficacy of group psychotherapy for depression: A meta-analysis and review of the empirical research. Clinical Psychology: Science and Practice, 8 (1), 98116.Google Scholar
Michalak, E.E., & Lam, R.W. (2002). Breaking the myths: New treatment approaches for chronic depression. Canadian Journal of Psychiatry, 47 (7), 635643.CrossRefGoogle ScholarPubMed
Oei, T.P., & Dingle, G. (2008). The effectiveness of group cognitive behaviour therapy for unipolar depressive disorders. Journal of Affective Disorders, 107 (1–3), 521.CrossRefGoogle ScholarPubMed
Paykel, E.S., Scott, J., Teasdale, J.D., Johnson, A.L., Garland, A., Moore, R., . . . Pope, M. (1999). Prevention of relapse in residual depression by cognitive therapy: A controlled trial. Archives of General Psychiatry, 56 (9), 829835.Google Scholar
Petersen, T., Papakostas, G.I., Mahal, Y., Guyker, W.M., Beaumont, E.C., Alpert, J.E., . . . Nierenberg, A.A. (2004). Psychosocial functioning in patients with treatment resistant depression. European Psychiatry, 19 (4), 196201.Google Scholar
Rush, A.J., Bernstein, I.H., Trivedi, M.H., Carmody, T.J., Wisniewski, S., Mundt, J.C., . . . Fava, M. (2006). An evaluation of the quick inventory of depressive symptomatology and the hamilton rating scale for depression: A sequenced treatment alternatives to relieve depression trial report. Biological Psychiatry, 59 (6), 493501.CrossRefGoogle ScholarPubMed
Rush, A.J., Fava, M., Wisniewski, S.R., Lavori, P.W., Trivedi, M.H., Sackeim, H.A., . . . Niederehe, N. (2004). Sequenced treatment alternatives to relieve depression (STAR*D): rationale and design. Controlled Clinical Trials, 25 (1), 119142.CrossRefGoogle ScholarPubMed
Rush, A.J., Thase, M.E., & Dube, S. (2003). Research issues in the study of difficult-to-treat depression. Biological Psychiatry, 53 (8), 743753.Google Scholar
Sackeim, H.A. (2001). The definition and meaning of treatment-resistant depression. Journal of Clinical Psychiatry, 62 (Suppl. 16), 1017.Google ScholarPubMed
Saulsman, L.M., Coall, D.A., & Nathan, P.R. (2006). The association between depressive personality and treatment outcome for depression following a group cognitive-behavioral intervention. Journal of Clinical Psychiatry, 62 (9), 11811196.Google Scholar
Schramm, E., Schneider, D., Zobel, I., van Calker, D., Dykierek, P., Kech, S., . . . Berger, M. (2008). Efficacy of Interpersonal Psychotherapy plus pharmacotherapy in chronically depressed inpatients. Journal of Affective Disorders, 109 (1–2), 6573.CrossRefGoogle ScholarPubMed
Scott, J., Palmer, S., Paykel, E., Teasdale, J., & Hayhurst, H. (2003). Use of cognitive therapy for relapse prevention in chronic depression: Cost-effectiveness study. British Journal of Psychiatry, 182, 221227.Google Scholar
Solomon, D.A., Leon, A.C., Endicott, J., Mueller, T.I., Coryell, W., Shea, M.T., & Keller, M.B. (2004). Psychosocial impairment and recurrence of major depression. Comprehensive Psychiatry, 45 (6), 423430.Google Scholar
Stewart, W.F., Ricci, J.A., Chee, E., Hahn, S.R., & Morganstein, D. (2003). Cost of lost productive work time among US workers with depression. JAMA, 289 (23), 31353144.CrossRefGoogle ScholarPubMed
Thase, M.E., Friedman, E.S., Biggs, M.M., Wisniewski, S.R., Trivedi, M.H., Luther, J.F., . . . Rush, A.J. (2007). Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments: A STAR*D report. American Journal of Psychiatry, 164 (5), 739752.CrossRefGoogle ScholarPubMed
Thase, M.E., Friedman, E.S., & Howland, R.H. (2001). Management of treatment-resistant depression: Psychotherapeutic perspectives. Journal of Clinical Psychiatry, 62 (Suppl. 18), 1824.Google ScholarPubMed
Vittengl, J.R., Clark, L.A., & Jarrett, R.B. (2009). Deterioration in psychosocial functioning predicts relapse/recurrence after cognitive therapy for depression. Journal of Affective Disorders, 112 (1–3), 135143.CrossRefGoogle ScholarPubMed
Vos, T., Corry, J., Haby, M.M., Carter, R., & Andrews, G. (2005). Cost-effectiveness of cognitive-behavioural therapy and drug interventions for major depression. Australian and New Zealand Journal of Psychiatry, 39 (8), 683692.Google Scholar
Weissman, M.M. (1999). Social Adjustment Scale Self-Report (SAS-SR): Technical manual. Toronto: Multi-Health Systems Inc.Google Scholar
Whisman, M.A., Miller, I.W., Norman, W.H., & Keitner, G.I. (1991). Cognitive therapy with depressed inpatients: specific effects on dysfunctional cognitions. Journal of Consulting and Clinical Psychology, 59 (2), 282288.Google Scholar