Cognitive Behavioral Analysis System of Psychotherapy as group psychotherapy for chronically depressed inpatients: a naturalistic multicenter feasibility trial.

The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is a relatively new approach in the treatment of chronic depression (CD). Adapted as group psychotherapy for inpatients, CBASP is attracting increasing attention. In this naturalistic multicenter trial, we investigated its feasibility after 10 sessions of CBASP group therapy over a treatment time of at least 5 to a maximum of 10 weeks. Treatment outcome was additionally assessed. Across four centers, 116 inpatients with CD (DSM-IV-TR) attended CBASP group psychotherapy. Feasibility was focused on acceptance, and evaluated for patients and therapists after five (t1) and ten sessions (t2) of group psychotherapy. Observer- and self-rating scales (Hamilton Depression Rating Scale-24 items, HDRS24; Beck Depression Inventory-II, BDI-II; World Health Organization Quality of Life assessment, WHOQOL-BREF) were applied before group psychotherapy (t0) and at t2. Dropouts were low (10.3%). Patients' evaluation improved significantly from t1 to t2 with a medium effect size (d = 0.60). Most of the patients stated that the group had enriched their treatment (75.3%), that the size (74.3%) and duration (72.5%) were 'optimal' and 37.3% wished for a higher frequency. Patients gave CBASP group psychotherapy an overall grade of 2 ('good'). Therapists' evaluation was positive throughout, except for size of the group. Outcome scores of HDRS24, BDI-II, and WHOQOL-BREF were significantly reduced from t0 to t2 with medium to large effect sizes (d = 1.48; d = 1.11; d = 0.67). In this naturalistic open-label trial, CBASP, when applied as inpatient group psychotherapy, was well accepted by patients and therapists. The results point towards a clinically meaningful effect of inpatient treatment with CBASP group psychotherapy on depression and quality of life. Other potential factors that could have promoted symptom change were discussed. A future controlled study could investigate the safety and efficacy of CBASP group psychotherapy for inpatients.

Phenomenological differences between acute and chronic forms of major depression in inpatients.

BACKGROUND: Chronic forms of depression are highly prevalent especially in inpatient settings. Defined only by episode duration greater than 2 years, heterogeneous diagnoses like dysthymic disorder, double depression, major depression and recurrent major depression are included. Chronic depression is considered difficult to treat, although its distinguishing characteristics remain unclear. AIMS: The purpose of the present study was empirically to approach proposed differences between acute and chronic forms of depression. METHODS: 80 psychiatric inpatients positively screened for depression and diagnosed with the Composite International Diagnostic Interview (CIDI), completed a set of questionnaires regarding symptom severity (a simplified version of the Beck Depression Inventory), dysfunctional attitudes (Dysfunctional Attitudes Scale), ruminative response style (Response Styles Questionnaire, Why Ruminate Scale) and interpersonal problems (Inventory of Interpersonal Problems; IIP). RESULTS: 30 patients were diagnosed with chronic forms of depression; 34 patients with acute depression. Patients did not differ regarding symptom severity, ruminative response styles, all but one subscales of the IIP or presence of comorbid post-traumatic stress disorder. However, chronic depression did show higher dysfunctional attitudes than acute depression, and reported higher rates of socially avoidant behavior. CONCLUSIONS: In line with previous findings, acute and chronic forms of depression differed in dysfunctional attitudes, which might actually reflect a distinguishing pattern of chronicity. Chronic depression patients also reported higher socially avoidant behavior, which might be crucial to focus in treatment. Surprisingly, other variables that are assumed to characterize chronic depression could not be confirmed as distinguishing features. Future research should take etiological aspects into account.