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"McCullough, James P"
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A Learning Theory Proposal that May Strengthen the Effectiveness of Psychological Treatments
This paper stands in the learning tradition of H. J. Eysenck who, sixty-three years ago in 1961, wrote that pathological/psychological disorders are learned/conditioned responses or habits that are non-adaptive. Eysenck argued that persons who receive Psychological Treatment (i.e. ‘psychotherapy’) are best served when their symptom complaints are addressed with well-established learning guidelines. In a similar vein, our proposal presents a general overview of learning and following Eysenck’s lead, describes six general characteristics (Eysenck listed 6 characteristics of ‘psychotherapy’) of a learning-based proposal for Psychological Treatment. Our proposal places a heavy emphasis on the therapist’s role as teacher. In addition, four acquisition learning examples are presented showing how one constructs a learning approach that addresses psychological symptom categories.
Journal Article
Pilot Study Dismantling the Cognitive Behavioral Analysis System of Psychotherapy: Identifying the Active Ingredients
BackgroundCBASP is a learning acquisition model of psychotherapy and until this present study, has not been systematically dismantled to identify the active ingredient.MethodsThe present investigation is the first formal dismantling pilot-study conducted to date on the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). The two major treatment components of CBASP, Situational Analysis (SA) and the Interpersonal Discrimination Exercise (IDE), were administered alone and with CBASP treatment-as-usual (the combination of both) to determine if there were active ingredients operative in the model. Secondly, we questioned if the dismantling of CBASP should continue in a larger study in an effort to answer the greater dismantling question of whether to administer both SA and IDE separately based on the active ingredient outcomes.ResultsThe study did achieve visually inspected differential data patterns across the three groups of the dependent measures. Based on these outcomes, a larger dismantling study seems warranted and is recommended.ConclusionsWe strongly urge that a larger dismantling study using a similar design be conducted in an effort to further the dismantling process of the CBASP model.
Journal Article
The Effectiveness of the Cognitive Behavioral Analysis System of Psychotherapy for Chronic Depression
Background: It is widely agreed that chronic depression is difficult to treat, knowledge about optimal treatment approaches is emerging. Method: A multisite randomized controlled trial was conducted comparing the cognitive behavioral analysis system of psychotherapy (CBASP), a psychotherapy model developed specifically to treat chronic depression (n = 67) with care as usual (CAU; evidence-based treatments, n = 72) over a period of 52 weeks, with 23 sessions on average, in 3 outpatient clinics in the Netherlands. In both arms algorithm-based pharmacotherapy was provided. Patients (aged 18-65) met criteria for a DSM-IV diagnosis of major depressive disorder with diagnostic specifiers (chronic, without interepisode recovery) or with co-occurring dysthymic disorder indicating a chronic course. The Inventory for Depressive Symptomatology (IDS) Self-Report was used as the primary outcome measure. Mixed-effects linear regression analysis was used to compare the changes on the IDS scores between CBASP and CAU. The IDS was administered before treatment, and after 8, 16, 32 and 52 weeks. Results: At week 52, patients assigned to CBASP had a greater reduction of depressive symptoms compared to patients assigned to CAU (t = -2.00, p = 0.05). However, CBASP and CAU did not differ from each other on the IDS after 8 weeks (t = 0.49, p = 0.63), 16 weeks (t = -0.03, p = 0.98) and 32 weeks (t = -0.17, p = 0.86) of treatment. Conclusions: This trial shows that CBASP is at least as effective as standard evidence-based treatments for chronic depression. In the long run, CBASP appears to have an added effect.
Journal Article
Differential Responses to Psychotherapy versus Pharmacotherapy in Patients with Chronic Forms of Major Depression and Childhood Trauma
Major depressive disorder is associated with considerable morbidity, disability, and risk for suicide. Treatments for depression most commonly include antidepressants, psychotherapy, or the combination. Little is known about predictors of treatment response for depression. In this study, 681 patients with chronic forms of major depression were treated with an antidepressant (nefazodone), Cognitive Behavioral Analysis System of Psychotherapy (CBASP), or the combination. Overall, the effects of the antidepressant alone and psychotherapy alone were equal and significantly less effective than combination treatment. Among those with a history of early childhood trauma (loss of parents at an early age, physical or sexual abuse, or neglect), psychotherapy alone was superior to antidepressant monotherapy. Moreover, the combination of psychotherapy and pharmacotherapy was only marginally superior to psychotherapy alone among the childhood abuse cohort. Our results suggest that psychotherapy may be an essential element in the treatment of patients with chronic forms of major depression and a history of childhood trauma.
Journal Article
Introducing a Clinical Course-Graphing Scale for DSM-5 Mood Disorders
Assessment of clinical course to aid in the diagnosis of patients and to guide treatment planning has gained momentum in recent years. A course-graphing scale for the DSM-5 Mood Disorders is presented to facilitate clinical history-taking and diagnosis of the mood disorders during the screening interview. The scale can be administered in the more traditional history-taking portion of the screening interview. The only difference is that it is a more systematic approach especially when the clinician suspects the presence of a mood disorder. The Timeline Course Graphing Scale for the DSM-5 Mood Disorders (TCGS) is described and accompanied with guidelines for administration.
Journal Article
A Procedure to Graph the Quality of Psychosocial Functioning Affected by Symptom Severity
Assessment of the variations of clinical course to aid in diagnosis, assessment of patients' functioning and to guide treatment planning has gained momentum in recent years. A specific scale is introduced to plot the temporal course to assist empirically-minded psychotherapists and
researchers who treat the DSM-5 Disorders and who want to monitor the quality of the course of psychosocial functioning over time. A Timeline Course Graphing Scale to Chart the Quality of Psychosocial Functioning Affected by Symptom Severity (PFS) is described and accompanied by administration guidelines.
Journal Article
The Significant Other History: An Interpersonal-Emotional History Procedure Used with the Early-onset Chronically Depressed Patient
An interpersonal-emotional history procedure, the Significant Other History, is administered to the early-onset chronically depressed patient during the second therapy session in the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Patients are asked to name up to six
significant others and answer two questions: (1) What was it like growing up with or being around this person? (2) What is the emotional \"stamp\" you take from this relationship that informs who you are today? An interpersonal-emotional theme reflecting the early learning history
of the patient is derived from these \"stamps\" or causal theory conclusions. One transference hypothesis (TH) is derived from the Significant Other History (SOH) and is formulated in one sentence, such as \"If I do this, then the therapist will likely do that\" (e.g.,
\"If I make a mistake around Dr. E, then Dr. E will label me 'stupid' or 'incompetent'\"). The transference hypothesis highlights the interpersonal content that most likely informs the patient's expectancy of the therapist's reactions toward him or her. Throughout the therapy process,
the therapist will proactively employ the transference hypothesis in a technique known as the Interpersonal Discrimination Exercise to help patients cognitively and emotionally discriminate the practitioner from hurtful significant others. The goal here is to increase the patient's felt safety
within the therapeutic dyad and eventually to generalize the felt safety to the patient's other relationships.
Journal Article
Cognitive Behavioural Analysis System of Psychotherapy for Treatment-Resistant Depression: Adaptation to a Group Modality
Studies researching psychotherapeutic interventions for treatment-resistant depression (TRD) are quite new to the field. The Cognitive Behavioural Analysis System of Psychotherapy (CBASP) is the only model developed specifically to treat the chronically depressed patient. While empirical evidence indicates that CBASP is an effective treatment for chronic depression, little is known about its adaptation to a group modality. Treating these patients in a group approach would have the added benefits of being cost-effective and providing in vivo previously avoided interpersonal situations for practising social skills and role-plays. This single arm study asks whether CBASP adapted to a group modality can be effective. All patients received 12 CBASP group therapy sessions with two to four individual preparatory sessions before the group. Our results suggest that CBASP group treatment demonstrated positive effects on patient outcomes. Specifically, patients showed significant decreases in symptoms of depression and the use of emotion-oriented coping, as well as increases in overall social adjustment and interpersonal self-efficacy when compared to pretreatment levels. However, patients did not achieve normative levels in these areas by the end of treatment. These pilot results are encouraging and support further study of the effectiveness of CBASP group treatment with a control group.
Journal Article
A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression
Traditionally thought of as an episodic, remitting illness, major depressive disorder often has a chronic course, with protracted episodes or incomplete remission between episodes.
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At any given time, at least 3 percent of the U.S. population suffers from chronic depression.
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Chronic forms of major depression are associated with more marked impairments in psychosocial function and work performance,
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increased health care utilization,
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and more frequent suicide attempts and hospitalization
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than acute depression. Because they frequently begin early in life
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and are often lifelong, chronic forms of major depression account for an inordinate proportion of the enormous burden . . .
Journal Article