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Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

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

See descriptions of 3 levels

Brief Description

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

CBASP has been developed solely for the treatment of the chronic depressive adults. Most patients present with maltreatment developmental histories that thwart normal cognitive-emotive maturational growth in the social-interpersonal domain. Hence, patients begin treatment functioning in a primitive (preoperational) manner meaning their cognitive-emotional patterns are diffuse, prelogical, ego-centric, global, and they talk to therapists in a monologic manner. Chronic depression is essentially a chronic mood disorder and does not fit the typical Beckian description of episodic major depression as a “thinking disorder.” The disorder is driven by an interpersonal fear (mood) and is characterized by generalized interpersonal avoidance behavior stemming from earlier developmental maltreatment. At the outset of psychotherapy, the patient is interpersonally detached and withdrawn and is perceptually disconnected from the actual consequences of their own behavior.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 discernible interpersonal 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.

Essential Components

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

Child Component

Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was not designed with a child component.

Parent / Caregiver Component

Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

  • Depression

Group Format

Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was not designed to be conducted in a group setting, and has not been tested for use in a group setting.

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:
Number of days/hours:

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

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(20), 1462-1471.

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

Population:

  • Age range — 43 years on average
  • Race/Ethnicity — 90.5% Caucasian
  • Gender — Not Specified
  • Status — Outpatients recruited from treatment centers.

Location / Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
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). Eligible participants were randomly assigned to receive 12 weeks of psychotherapy, nefazodone, or a combination of drug and psychotherapy. Outcomes were assessed using the HRSD. All three groups showed significant pre-test to post-test improvement. However, improvement in the combined drug and psychotherapy group was greatest, with 85% showing a response to treatment, compared with 55% in the nefazodone alone group and 52% in the psychotherapy only group. This study is limited by lack of long-term follow-up and lack of a placebo-only control.

Length of post-intervention 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 range — 43 years on average
  • Race/Ethnicity — 90.5% Caucasian
  • Gender — Not Specified
  • Status — 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 psychotherapy, nefazodone, or a combination of drug and psychotherapy. 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, combination therapy was significantly superior to either psychotherapy or drug therapy alone. In comparison, participants with a history of trauma showed a significantly better response to psychotherapy than to drug therapy, and the combination of drug and psychotherapy was not better than psychotherapy alone.

Length of post-intervention 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 range — 44 years on average
  • Race/Ethnicity — 90.5% Caucasian
  • Gender — Not Specified
  • Status — Outpatients recruited from treatment centers.

Location / Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study analyzes a sub-sample from Keller et al. 2000. Eligible participants were randomly assigned to receive 12 weeks of psychotherapy, nefazodone, or a combination of drug and psychotherapy. 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.

Length of post-intervention follow-up: None.

Klein, D. N., Santiago, N. J., Vivian, D., Arnow, B. A., Blalock, J. A., Dunner, D. J., … 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 range — 45.1 years on average
  • Race/Ethnicity — 91.5% Caucasian
  • Gender — Not Specified
  • Status — 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 CBASP or to assessment alone for a further year. Depression levels were assessed using the Hamilton Rating Scale for Depression (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 group patients also showed a small reduction in symptoms over time, while those in the assessment-only condition showed a small increase.

Length of post-intervention follow-up: None.

References

Show references...

Keller, M. B., McCullough, Jr., J. P., Klein, D. N., Arnow, B. A., Dunner, D. L., Gelenberg, A. J., … Zajecka, J. (2000). A comparison of nefazadone, the cognitive behavioral analysis system of psychotherapy, and their combination for treatment of chronic depression. New England Journal of Medicine, 342, 1462-1470.

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

McCullough, Jr., J. P. (2001). Skills training manual for diagnosing & treating chronic depression: CBASP. New York: Guilford.

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 Reviewed: March 2010