Group Cognitive Behavioral Analysis System of Psychotherapy (CBASP): A Pilot Study for Bipolar Depression.

OBJECTIVES: Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is an individually administered treatment model designed specifically for Persistent Depression however bipolar patients have traditionally been excluded from CBASP studies. There is a perception that bipolar depression will be harder to treat and requires a unique psychological approach. This pilot study reports on the feasibility of administering the same 20-week manualized group CBASP therapy with bipolar patients currently in a depressive episode. METHODS: This non-randomized, single-arm prospective pilot study, reports on an a posteriori exploration of benefits to bipolar depressed patients (n=26) of the same 20-week group CBASP intervention administered to unipolar depressed patients (n=81). The clinical trial for the initial phase examining benefits of the manualized 20-week group CBASP intervention with unipolar patients was registered with the ISRCTN registry, study ID: ISRCTN95149444. Results reported here include mixed ANOVA analyses, across group treatment models and diagnostic categories. Changes over time in self-reported depressive symptoms (Inventory of Depressive Symptoms -IDS-SR), self-reported social functioning, interpersonal problems and interpersonal dispositions are documented for all patients. An exploratory longitudinal latent class analysis was used to examine patients' trajectories of improvement in depressive symptoms. Finally, the best predictors of change in reported depressive symptoms were explored with a logistic regression for all patients. RESULTS: Improvements in depressive symptoms and in social functioning over time were significant for all patients with bipolar patients trending towards a greater improvement in depressive symptoms after controlling for baseline differences. An exploratory Latent Class Analysis identified two different treatment trajectories for the entire sample: 1) moderate to severely depressed patients who improved significantly (49%) and 2) severely depressed patients who did not improve (51%). The best predictors of non-response to group therapy include high baseline problems in social functioning and low rates of self-reported Perceived Improvements in overall health. CONCLUSION: Bipolar patients in a depressive episode appear to benefit from the same 20-week group CBASP model designed originally for the treatment of Persistent Depressive Disorder. Bipolar patients seem more easily mobilized both during and outside of group therapy sessions and report more interpersonal confidence and more agency than unipolar depressed patients.

Interpersonal Self-Efficacy, Goals, and Problems of Persistently Depressed Outpatients: Prototypical Circumplex Profiles and Distinctive Subgroups.

Severely and persistently depressed outpatients ( n = 138) completed interpersonal circumplex measures of self-efficacy, problems, and values/goals. Compared with normative samples, patients showed deficits in agency: They reported less self-efficacy, especially for being assertive, tough, and influential; stronger goals, especially to avoid conflict or humiliation; and more problems, especially with being too timid, inhibited, and accommodating. Circular and structural summary indices suggested greater variability among patients in goal profiles than in efficacy or problem profiles; nonetheless, latent profile analyses identified coherent subgroups of patients with distinct patterns of efficacy (e.g., lacking confidence for speaking up vs. setting boundaries) and problems (e.g., being overly inhibited vs. self-sacrificing) as well as goals (e.g., to be included vs. unobtrusive). Women and those with more severe symptoms were overrepresented in the least agentic groups. The results show how observing patients through multiple circumplex surfaces simultaneously can help clarify their interpersonal dispositions and inform interventions.

Interpersonal Circumplex Profiles Of Persistent Depression: Goals, Self-Efficacy, Problems, And Effects Of Group Therapy.

OBJECTIVES: We assessed severely and persistently depressed patients' interpersonal self-efficacy, problems, and goals, plus changes in interpersonal functioning and depression during 20 weeks of group therapy. METHOD: Outpatients (32 female, 26 male, mean age = 45 years) completed interpersonal circumplex measures of goals, efficacy, and problems before completing 20 weeks of manualized group therapy, during which we regularly assessed depression and interpersonal style. RESULTS: Compared to normative samples, patients lacked interpersonal agency, including less self-efficacy for expressive/assertive actions; stronger motives to avoid conflict, scorn, and humiliation; and more problems with being too submissive, inhibited, and accommodating. Behavioral Activation and especially Cognitive Behavioral Analysis System of Psychotherapy interventions produced improvements in depression and interpersonal agency, with increases in "agentic and communal" efficacy predicting subsequent decreases in depression. CONCLUSIONS: While severely and persistently depressed patients were prone to express maladaptive interpersonal dispositions, over the course of group therapy, they showed increasingly agentic and beneficial patterns of cognitions, motives, and behaviors.

Initial Reliability of the Diagnostic Interview for Narcissism Adapted for Preadolescents: Parent Version (P-DIN).

INTRODUCTION: the Diagnostic Interview for Narcissism, an instrument developed by Gunderson and associates to assess pathological narcissistic traits in adults, has been adapted for use with parents of preadolescents as a semi-structured interview. A sixth section has been added to assess the parental narcissistic investment of the child. METHODS: the sample consists of 21 parents of children (aged 8-13 years) at risk for narcissistic personality disorder. An interviewer-observer design, with independent interview evaluation, was used to assess inter-rater reliabilities. Both raters were blind to diagnostic information. RESULTS: Very good inter-rater reliabilities (ranging from .85 to 1.00) were obtained for all 35 statements of this Parent version of the DIN (P-DIN). Good internal consistencies a=0.82, a=0.88, a=0.69, respectively) were obtained for the first three Sections of the P-DIN, which include all the DSM-IV criteria for Narcissistic Personality Disorder. Section V, Social/Moral Adaptation (a=0.54), and Section VI, Parental Narcissistic Investment of the Child (a=0.62), had weaker internal consistencies. Section IV, Mood States, had the lowest internal consistency (a=0.50). Finally, a high reliability coefficient was obtained for the total scale (a=0.92, 32 statements for Sections I to V). CONCLUSION: present results of this pilot study justify further research into the P-DIN psychometric properties.