Abstract
Die chronische Depression ist eine schwer beeinträchtigende psychische Störung, welche meist schon während der Kindheit beginnt. Viele der betroffenen Patienten berichten über frühe traumatisierende Beziehungserfahrungen mit wichtigen Bezugspersonen. Aufgrund der hohen Therapieresistenz stellt sie eine therapeutische Herausforderung dar. Das Cognitive Behavioral Analysis System of Psychotherapy (CBASP) ist die erste Psychotherapie, welche speziell für diese Patientengruppe entwickelt wurde. CBASP kombiniert schulenübergreifend behaviorale, kognitiv-emotionale, interpersonelle und psychodynamisch-analytische Theorien, indem Kindheits- und Lebenserfahrungen in einen Zusammenhang zu aktuellen interpersonellen Problemen gestellt werden. Zentrale Therapie-Elemente sind die Liste prägender Bezugspersonen mit Übertragungshypothesen, Situationsanalysen mit Verhaltenstrainings durch Rollenspiele, interpersonelle Strategien und Transferübungen. Die therapeutische Rolle ist gekennzeichnet durch das disziplinierte Preisgeben eigener Gefühle und Reaktionen auf die Verhaltensweisen chronisch Depressiver, um dem Patienten korrigierende und heilsame Beziehungserfahrungen zu ermöglichen. Randomisiert kontrollierte Studien und Einzelfallstudien konnten die Wirksamkeit von CBASP in der Behandlung der chronischen Depression nachweisen. Nach den Kriterien der American Psychiatric Association kann CBASP mittlerweile als empirisch validiert angesehen werden. Weitere Studien, insbesondere zum Vergleich mit anderen Psychotherapien sowie Prozess- und Prädiktorstudien, sind jedoch wichtig und laufen derzeit. Zudem wird CBASP für verschiedene Settings (stationär, in Gruppen) und andere Störungsbilder modifiziert.Im Beitrag erfolgt abschließend eine kritische Diskussion und Würdigung des Ansatzes.
Chronic depression (CD) is a severe and disabling disorder that often begins in early childhood. Most of the patients underwent traumatic experiences in interpersonal relationships. Because of high treatment resistance, treating CD often poses a therapeutic challenge. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is the first treatment tailored to the particular needs of CD patients. It integrates cognitive-emotional, behavioral, interpersonal, and psychodynamic/psychoanalytical theories from different schools by putting childhood and life experiences in relation with current interpersonal problems. Main treatment elements are the significant other history with transference hypotheses, situational analyses with role play, interpersonal strategies, and transfer exercises. The therapists role is characterized by the disciplined disclosure of own feelings and reactions according to the needs of chronic depressive patients making corrective and healing interpersonal experiences possible. Randomized-controlled studies and case studies have proven the efficacy of CBASP in the treatment of chronic depression. According to the criteria of the American Psychiatric Association, CBASP could be labeled as an empirically supported treatment. Further studies, especially studies comparing CBASP to other psychotherapies as well as process and predictor studies, are crucial and ongoing. In addition, CBASP was modified for other settings (inpatients, groups) and other disorders. The article ends with a critical discussion and appreciation of the CBASP approach.
Literatur
1995). Mood disorders: Clinical features. In H. I. KaplanB. J. SadockEds., Comprehensive textbook of psychiatry (Vol. 1, pp. 1123 – 1152). Baltimore: Williams and Wilkins.
(2003). Effectiveness of Psychotherapy and Combination Treatment for Chronic Depression. Journal of Clinical Psychologie, 59, 893 – 905
(1995). Training in and dissemination of empirically-validated psychological treatments: Report and recommendations. The Clinical Psychologist, 48, 3 – 27.
(2013). Diagnostic & statistical manual of mental disorders (5th ed, revised). Washington DC: APA.
(1986). Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, N. J.: Prentice-Hall.
(2013). Therapieren mit CBASP. München: Elsevier.
(2007). Learning and Behavior: A Contemporary Synthesis. Sunderland, MA, US: Sinauer Associates.
(2011). Feasibility and outcome of cognitive behavioral analysis system of psychotherapy (CBASP) for chronically depressed inpatients: a pilot study. Psychotherapy and Psychosomatics, 80, 191 – 194.
(2014). Effectiveness of inpatient cognitive behavioral analysis system of psychotherapy for chronically depressed patients: A pilot study. Psychotherapy and Psychosomatics. In Press.
(2014). Continuation treatment after electroconvulsive therapy in patients with unipolar depression. Biological Psychiatry, 76, 194 – 202.
(2012). Praxisbuch CBASP. Behandlung chronischer Depression. Weinheim: Beltz.
(2012). Chronische Depression. Göttingen: Hogrefe.
(2013). CBASP@home: Ein internetbasiertes Situationsanalysen-Training zur Stabilisierung des Therapieerfolges nach stationärer Therapie für chronisch depressive Patienten. Verhaltenstherapie, 23, 190 – 203.
(2013). Die Mauer überwinden: Wege aus der chronischen Depression. Weinheim: Beltz.
(2014). Chronic and treatment resistant depression–diagnosis and stepwise therapy. Deutsches Ärzteblatt International, 111, 766 – 776.
(2002). Das Impact Message Inventory von Kiesler. In E. BrählerJ. SchumacherB. StraussHrsg., Diagnostische Verfahren in der Psychotherapie (S. 214 – 216). Göttingen: Hogrefe.
(1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychologie, 66 (1), 7 – 18.
(2008). Interpersonal styles of chronically depressed outpatients: Profiles and therapeutic change. Psychotherapy: Theory, Research, Practice, Training, 45, 491 – 506.
(2010). Psychotherapy for chronic major depression and dysthymia: a meta-analysis. Clinical Psycholical Review, 30 (1), 51 – 62.
(2009). S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression-Kurzfassung (1. Aufl., DGPPN, ÄZO, AWMF–Berlin, Düsseldorf 2009). Zugriff am 14. 12. 2014. Verfügbar unter www.leitlinien.de/nvl/depression
(1960). A General Introduction to Psychoanalysis (Original work published 1916 – 1917). New York: Washington Square Press.
(2011). Risk factors for chronic depression–A systematic review. Journal of Affective Disorders, 129, 1 – 13.
(2013). Was sind schwierige Psychotherapiesituationen? Ergebnisse einer Befragung an 60 Psychotherapeuten. Vortrag auf dem DGPPN Kongress im Rahmen des Symposiums: Wenn der Psychotherapeut nicht mehr weiter weiß: Schulenübergreifende Strategien zur Beziehungsgestaltung in therapeutischen Grenzsituationen (Vorsitzende: E. L. Brakemeier & M. Bohus). Berlin: DGPPN.
(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 – 1470.
(1983). The Interpersonal Circle: A taxonomy for complementarity in human transactions. Psychological Review, 90, 185 – 214.
(1996). From communications to interpersonal theory: a personal odyssey. Journal of Personality Assessment, 66, 267 – 282.
(2014). Psychotherapie chronischer Depression. Göttingen: Hogrefe.
(2011). Psychotherapie chronischer Depression nach dem Cognitive Behavioral Analysis System of Psychotherapy (CBASP)-Konzept. Psychotherapie Psychosomatik Medizinische Psychologie, 61, 526 – 535.
(2009). 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, 1178 – 1188.
(2014). Efficacy and acceptability of acute treatments for persistent depressive disorder: A network meta-analysis. Depression and Anxiety, 31, 621 – 630.
(2011). Chronic Depression: Development and Evaluation of the Luebeck Questionnaire for Recording Preoperational Thinking (LQPT). BMC Psychiatry, 11, 199.
(2006). Treating chronic depression with disciplined personal involvement. Cognitive behavioral analysis system of psychotherapy. New York: Springer.
(2000). Treatment of chronic depression: Cognitive Behavioral Analysis System of Psychotherapy. New York: Guilford Press.
(2010). CBASP, the Third Wave and the Tratment of Chronic Depression. European Psychotherapy, 9, 169 – 190.
(1947). On the dual nature of learning–a reinterpretation of „conditioning” and „problem solving”. Harvard Educational Review, 17, 102 – 148.
(2012). Prevalence and correlates of the proposed DSM-5 diagnosis of chronic depressive disorder. Journal of Affective Disorder, 139, 172 – 180.
(2003). Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proceedings of the National Academy of Sciences, 100, 14293 – 14296.
(2008). Efficacy of the third wave of behavioural therapies: a systematic review and meta-analysis. Behaviour Research and Therapy, 46, 296 – 321.
(1941). ‘The Conditioned Reflex’. In W. HorsleyEd., Lectures on Conditioned Reflexes (Conditioned Reflexes and Psychiatry, Vol. 2, pp. 166 – 185). New York: International Publishers.
(1984). Causal explanations as a risk factor for depression: Theory and evidence. Psychological Review, 91, 347 – 374.
(1995). Intelligenz und Affektivität in der kindlichen Entwicklung. Frankfurt a.M.: Suhrkamp.
(2002). The search for determinants of chronic depression: a review of six factors. Journal of Affective Disorders, 70, 103 – 115.
(2005). Chronic depression: medication (nefazodone) or psychotherapy (CBASP) is effective when the other is not. Archives of General Psychiatry, 62, 513 – 520.
(2007). Specific Psychotherapy of Chronic Depression with the Cognitive Behavioral Analysis System of Psychotherapy. Nervenheilkunde, 26, 790 – 802.
(2012). CBASP in der Gruppe. Das Kurzmanual. Stuttgart: Schattauer.
(2006). Psychotherapie für chronische Depression. Cognitive Behavioral Analysis System of Psychotherapy (CBASP) von James P. McCullough. München: Elsevier.
(2011a). Cognitive behavioral analysis system of psychotherapy versus interpersonal psychotherapy for early-onset chronic depression: A randomized pilot study. Journal of Affective Disorders, 129, 109 – 116.
(2011b). Comparative efficacy of the cognitive behavioral analysis system of psychotherapy versus supportive psychotherapy for early onset chronic depression: Design and rationale of a multisite randomized controlled trial. BMC Psychiatry, 11, 134.
(1978). Comment and integration. Journal of Abnormal Psychology, 87 (1), 165 – 179.
(1953). Science and Human Behavior. New York: Macmillan.
(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 – 154, 268 – 276
(2009). Childhood trauma as a risk factor for chronicity of depression. Journal of Clinical Psychiatry, 7, 983 – 989.
(2014). The Effectiveness of the Cognitive Behavioral Analysis System of Psychotherapy for Chronic Depression: A Randomized Controlled Trial. Psychotherapy and Psychosomatics, 83, 263 – 269.
(2010). Exploring preoperational features in chronic depression. Journal of Affective Disorders, 124, 262 – 269.
(1949). Hate in the counter-transference. International Journal of Psychoanalysis, 30, 69 – 74.
(