Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been rated by the CEBC in the area of: Depression Treatment (Adult).

Target Population: Chronically depressed adults

Brief Description

CBASP has been developed solely for the treatment of the chronic depressive adults. Most patients present with maltreatment developmental histories that impede normal cognitive-emotive growth in the ability to related socially with others. Hence, patients begin treatment functioning in a primitive manner meaning their thought and feeling patterns are not very organized, self-centered, and prelogical, and they talk to therapists in a monologic manner. Chronic depression is essentially a chronic mood disorder and does not fit the typical description of major depression that comes and goes as a “thinking disorder."

At the outset of psychotherapy, the patient is interpersonally detached and withdrawn and is perceptually disconnected from the actual consequences of their own behavior. The general fiction they live out is “it doesn’t matter what I do, nothing will change.” Three techniques are administered to demonstrate to patients that the way they behave with others has consequences (Situational Analysis); to help patients discriminate the psychotherapist from toxic Significant Others who have hurt them (Interpersonal Discrimination Exercise); and to modify in-session maladaptive behavior that precludes the therapist from administering treatment (Contingent Personal Responsivity). The CBASP therapist role is interpersonally active and administered in a disciplined personal involved manner.

Program Goals:

The program representative did not provide information about the program’s goals.

Essential Components

The essential components of Cognitive Behavioral Analysis System of Psychotherapy (CBASP) include:

  • A learning model where patients learn skills to operationalized criterion
  • Grounded upon a Person x Environment Causal Determinant Model of Behavior: Behavior = f (P X E)
  • Patients:
    • Learn they produce the interpersonal problems they complain about during the therapy hour
    • Learn to enact a situational problem-solving algorithm
    • Learn to discriminate emotionally the psychotherapist from toxic Significant Others
  • Therapist Role:
    • Disciplined personal involvement role to counter toxic interpersonal experiences leading to interpersonal avoidance/withdrawal

Adult Services

Cognitive Behavioral Analysis System of Psychotherapy (CBASP) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Depression

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Hospital
  • Outpatient Clinic

Homework

Cognitive Behavioral Analysis System of Psychotherapy (CBASP) includes a homework component:

Patients complete the "Coping Survey Questionnaire (CSQ)" each session where they report on one stress situation that is then addressed in the Situational Analysis (SA).

Languages

Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has materials available in languages other than English:

Chinese, German, Japanese, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Offices for therapy sessions with clients

Minimum Provider Qualifications

Post Degree PhD Psychologists, MSW Social Workers, and Post Residency Psychiatrists in addition to experience treating the chronically depressed patient

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contacts:
Training is obtained:

Varies by client

Number of days/hours:

One-Week Intensive Training Workshop (Monday through Friday, 9:00 AM - 5:00 PM)

Implementation Information

Since Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

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Pre-Implementation Materials

The program representative did not provide information about pre-implementation materials.

Formal Support for Implementation

The program representative did not provide information about formal support for implementation of Cognitive Behavioral Analysis System of Psychotherapy (CBASP).

Fidelity Measures

The program representative did not provide information about fidelity measures of Cognitive Behavioral Analysis System of Psychotherapy (CBASP).

Implementation Guides or Manuals

The program representative did not provide information about implementation guides or manuals for Cognitive Behavioral Analysis System of Psychotherapy (CBASP).

Research on How to Implement the Program

The program representative did not provide information about research conducted on how to implement Cognitive Behavioral Analysis System of Psychotherapy (CBASP).

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Keller, M. B., McCullough, J. P., 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. The New England Journal of Medicine, 342, 1462-1471. doi:10.1056/NEJM200005183422001

Type of Study: Randomized controlled trial
Number of Participants: 681

Population:

  • Age — Mean=43 years
  • Race/Ethnicity — 90.5% White
  • Gender — 65.3% Female
  • Status — Participants were outpatients recruited from treatment centers.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Eligible participants were randomly assigned to receive 12 weeks of Cognitive Behavioral Analysis System of Psychotherapy (CBASP), nefazodone, or a combination of nefazodone and CBASP. Recruited patients were required to meet study criteria on the Hamilton Rating Scale for Depression (HRSD) and to fulfill criteria for major depressive disorder from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Outcomes were assessed using the HRSD. All three groups showed significant pretest to posttest improvement. However, improvement in the combined drug and CBASP group was greatest compared with the nefazodone alone group and the CBASP-only group. Limitations include lack of long-term follow-up, lack of a placebo-only control, and reduced generalizability due to restrictive participant exclusion criteria.

Length of postintervention follow-up: None.

Nemeroff, C. B., Heim, C. M., Thase, M. E., Klein, D. N., Rush, A. J., … Keller, M. B. (2003). Differential responses to psychotherapy versus pharmacotherapy with chronic forms of major depression and childhood trauma. National Academy of Sciences, 100, 14293-14296.

Type of Study: Randomized controlled trial
Number of Participants: 681

Population:

  • Age — Mean=43 years
  • Race/Ethnicity — 90.5% Caucasian
  • Gender — Not Spectified
  • Status — Participants were outpatients recruited from treatment centers.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study uses the same sample as Keller et al. (2000). Eligible participants were randomly assigned to receive 12 weeks of Cognitive Behavioral Analysis System of Psychotherapy (CBASP), nefazodone, or a combination of nefazodone and CBASP. Depression outcomes were assessed using the Hamilton Rating Scale for Depression (HRSD). Participants also completed the Childhood Trauma Scale (CTS) at baseline to assess the presence of childhood trauma (parental loss, physical abuse, sexual abuse, neglect or other trauma). Results showed a significantly different pattern of treatment response in participants who reported childhood trauma from those who did not. For those who reported no trauma, Nefazodone combined with CBASP was significantly superior to either CBASP or drug therapy alone. In comparison, participants with a history of trauma showed a significantly better response to CBASP than to drug therapy, and the combination of drug and CBASP was not better than CBASP alone. Limitations include limited generalizability to other populations than individuals with major depressive disorder.

Length of postintervention follow-up: None.

Manber, R., Arnow, B. A., Blasey, C., Vivian, D., McCullough, J. P., Blalock, J. A., … Keller M. B. (2003). Patient's therapeutic skill acquisition and response to psychotherapy, alone and in combination with medication. Journal of Psychological Medicine, 33, 693-702.

Type of Study: Randomized controlled trial
Number of Participants: 431

Population:

  • Age — 18-75 years
  • Race/Ethnicity — 91.9% White
  • Gender — 66.4% Female
  • Status — Participants were outpatients recruited from treatment centers.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study analyzes a subsample from Keller et al. (2000). Eligible participants were randomly assigned to receive 12 weeks of Cognitive Behavioral Analysis System of Psychotherapy (CBASP), nefazodone, or a combination of drug and CBASP. Depression outcomes were assessed using the Hamilton Rating Scale for Depression (HRSD). The current analysis also looked at therapists’ assessments of patients’ skill acquisition during the course of therapy using the Patient Performance Rating Form. Results showed differences in skill acquisition across treatment groups. Limitations include results may be specific to the treatments provided, CBASP and nefazodone, and may not generalize to other forms of psychotherapy or to other antidepressant medications, generalizability due to sample, population and ethnicity, and may be specific to major depressive disorder only.

Length of postintervention follow-up: None.

Klein, D. N., Santiago, N. J., Vivian, D., Arnow, B. A., Blalock, J. A., Dunner, D. L., … 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), 681-688.

Type of Study: Randomized controlled trial
Number of Participants: 82

Population:

  • Age — Mean=45.1 years
  • Race/Ethnicity — 91.5% White
  • Gender — 67.1% Female and 32.9% Male
  • Status — Participants were outpatients recruited from treatment centers.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study is a continuation of Keller et al. (2000), and uses a subsample of the original sample. Patients who had responded to their initial 12 weeks treatment in Keller et al. (2000) study were randomly assigned to receive monthly maintenance Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or to assessment alone for a further year. Recruited patients were required to meet study criteria on for severe chronic depressive from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Measures utilized were the Hamilton Depression Rating Scale (HRSD) and the Inventory of Depressive Symptoms, Self-Report version (IDS-SR-30). Participants in the CBASP maintenance condition were less likely to experience recurrence of depression than those in the assessment-only condition. CBASP patients also showed a small reduction in symptoms over time, while those in the assessment-only condition showed a small increase. Significantly fewer patients in CBASP experienced a recurrence compared to those in the assessment-only condition. The two conditions also differed significantly on change in depressive symptoms over time. Limitations include sample size, generalizability due to gender and disorder, and reliability of both instruments utilized in study.

Length of postintervention follow-up: None.

Schramm, E., Zobel, I., Dykierek, P., Kech, S., Brakemeier, E. L., Kulz, A., & Berger, M. (2011). Cognitive Behavioral Analysis System of Psychotherapy versus Interpersonal Psychotherapy for early-onset chronic depression: A randomized pilot study. Journal of Affective Disorders, 129(1-3), 109-116.

Type of Study: Randomized controlled trial
Number of Participants: 30

Population:

  • Age — 18- 65 years
  • Race/Ethnicity — Not Specified
  • Gender — Not Specified
  • Status — Participants were patients who met Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for a current episode of chronic Major Depressive Disorder (MDD), MDD superimposed on a preexisting dysthymic disorder, recurrent MDD with incomplete remission between episodes in a patient with a current MDD and a total duration of at least 2 years, or dysthymia.

Location/Institution: Department of Psychiatry and Psychotherapy of the University Medical Center Freiburg, Germany

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined patients with early-onset chronic depression randomly assigned to Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or Interpersonal Psychotherapy (IPT). Measures utilized were Hamilton Rating Scale for Depression (HRSD), the Child Trauma Questionnaire, Structured Clinical Interview for DSM-IV and the Beck Depression Inventory (BDI). There was no significant difference in post-treatment HRSD scores between the CBASP and the IPT condition, but a significant difference was seen on the self-rated BDI scores, with subjects in the CBASP condition reporting a significantly higher reduction in self-rated depressive symptoms. Significantly higher remission rates were found in CBASP (57%) as compared to the IPT (20%) group. One year post-treatment, no significant differences were found between the two groups in the self-reported symptom level (BDI). Limitations include small sample size which may limit the statistical power of the study.

Length of postintervention follow-up: 12 months.

Klein, D. N., Leon, A. C., Li, C., D'Zurilla, T. J., Black, S. R., Vivian, D., … Kocsis, J. H. (2011). Social problem solving and depressive symptoms over time: A randomized clinical trial of Cognitive-Behavioral Analysis System of Psychotherapy, brief supportive psychotherapy, and pharmacotherapy. Journal of Consulting and Clinical Psychology, 79(3), 342-352.

Type of Study: Randomized controlled trial
Number of Participants: 491

Population:

  • Age — 18-75 years
  • Race/Ethnicity — 85.1% White, 4.3% Black, and 6.1% Other
  • Gender — 42.8% Male
  • Status — Participants were recruited at eight sites through outreach to clinicians and advertising. All patients met criteria for major depressive disorder and had achieved less than full remission following treatment with antidepressant medication.

Location/Institution: Eight sites in the US

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the associations between treatment, social problem solving, and depression in a randomized clinical trial testing the efficacy of psychotherapy augmentation for chronically depressed patients who failed to fully respond to an initial trial of pharmacotherapy. Subjects with chronic depression were randomly assigned to Cognitive-Behavioral Analysis System of Psychotherapy (CBASP) plus medication, Brief Supportive Psychotherapy (BSP) plus medication, or medication alone for 12 weeks. Measures included the Social Problem Solving Inventory–Revised and the Hamilton Depression scale. CBASP plus pharmacotherapy was associated with significantly greater improvement in social problem solving than BSP plus pharmacotherapy, and a trend for greater improvement in problem solving than pharmacotherapy alone. In addition, change in social problem solving predicted subsequent change in depressive symptoms over time. However, the magnitude of the associations between changes in social problem solving and subsequent depressive symptoms did not differ across treatment conditions. Limitations include a lack of post-intervention follow-up and concerns regarding generalizability; as the study was conducted at academic centers.

Length of postintervention follow-up: None.

Swan, J. S., MacVicar, R., Christmas, D., Durham, R., Rauchhaus, P., McCullough Jr, J. P., & Matthews, K. (2014). Cognitive Behavioural Analysis System of Psychotherapy (CBASP) for chronic depression: Clinical characteristics and six month clinical outcomes in an open case series. Journal of Affective Disorders, 152, 268-276.

Type of Study: Pretest/Posttest
Number of Participants: 74

Population:

  • Age — 18-72 years
  • Race/Ethnicity — 68% Women and 32% Men
  • Gender — 100% White
  • Status — Participants were outpatient clients recruited from treatment centers.

Location/Institution: Tayside and Lothian, Scotland, UK

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the effectiveness of a trial of 20 sessions of Cognitive Behavioral Analysis System of Psychotherapy (CBASP) over a 6-month period. A comparison group was not utilized. Measures utilized include the Mini International Neuropsychiatry Interview V.5 (MINI), the Hamilton Rating Scale for Depression 24-item version (HRSD-24), the Beck Depression Inventory-II (BDI-II), the Brief Symptom Inventory (BSI), and the Childhood Trauma Questionnaire (CTQ). Results indicate that over half of the patients made significant clinical gains. Almost a third of the parents achieved remission and almost a third of them met criteria for clinically significant improvement. Group measures of quality of life, social functioning, and interpersonal functioning also improved. Limitations include no randomization of participants, lack of a control group, a high dropout rate, lack of generalizability of findings due the sample containing no racial/ethnic diversity, and lack of follow-up.

Length of postintervention follow-up: None.

Schramm, E., Zobel, I., Schoepf, D., Fangmeier, T., Schnell, K., Walter, H., ... Normann, C. (2015). Cognitive Behavioral Analysis System of Psychotherapy versus escitalopram in chronic major depression. Psychotherapy and Psychosomatics, 84(4), 227-240. doi:10.1159/000381957

Type of Study: Randomized controlled trial
Number of Participants: 60

Population:

  • Age — 18-65 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were outpatient clients recruited from treatment centers.

Location/Institution: University Medical Centers of Freiburg and Bonn, Germany

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study compared Cognitive Behavioral Analysis System of Psychotherapy (CBASP) to escitalopram (ESC) for patients with chronic major depression. Participants were randomized to either 22 sessions of CBASP or to escitalopram (ESC) plus 18 sessions of clinical management (ESC/CM) over 28 weeks. Measures utilized include the Montgomery-Asberg Depression Scale (MADRS), the Inventory of Depressive Symptomatology, Self-Report (IDS-SR), the Global Assessment of Functioning scale (GAF), the Social Adaptation Self-Evaluation Scale (SASS), and the Childhood Trauma Questionnaire (CTQ). Results indicate that depression scores decreased significantly after 8 and 28 weeks with no significant differences between the groups. The response rates after 28 weeks of treatment were high, and the remission rates were moderate with neither group being superior. Limitations include small sample size, intervention not superior to comparison group, lack of follow-up.

Length of postintervention follow-up: None.

References

McCullough, Jr., J. P. (2003). Patient’s manual for CBASP. New York: Guilford Press.

McCullough, Jr., J. P. (2006). Treating chronic depression with disciplined personal involvement: CBASP. New York: Springer.

McCullough, Jr., J. P. (2003). Treatment for chronic depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP). New York: Guilford Press. (paperback edition)

Contact Information

Name: James P. McCullough, Jr., PhD
Title: Distinguished Professor of Psychology & Psychiatry
Agency/Affiliation: Virginia Commonwealth University
Department: Department of Psychology
Website: www.cbasp.org
Email:
Phone: (804) 740-7646
Fax: (804) 740-0305

Date Research Evidence Last Reviewed by CEBC: June 2016

Date Program Content Last Reviewed by Program Staff: June 2015

Date Program Originally Loaded onto CEBC: March 2010