Comparing the Efficacy of CBASP with Two Versions of CBT for Depression in a Routine Care Center: A Randomized Clinical Trial

Rief, Winfried; Bleichhardt, Gabi; Dannehl, Katharina; Euteneuer, Frank; Wambach, Katrin

doi:10.1159/000487893

Cited by 22 publications

(9 citation statements)

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“…These variables are also important in the CBASP model because interpersonal fear avoidance mediates the association between emotional abuse and specific social skill deficits in PDD [7]. Also, further studies are needed which compare CBASP to established treatments of depression (such as cognitive behavioral therapy) [8] to be able to examine whether the mechanism we have described here is specific to CBASP.…”

Section: Karger@kargercommentioning

confidence: 97%

Changes in Therapeutic Alliance and in Social Inhibition as Mediators of the Effect of the Cognitive Behavioral Analysis System of Psychotherapy: A Secondary Analysis from a Randomized Clinical Trial

Klein

Probst

Kriston

et al. 2020

Psychother Psychosom

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adult outpatients with early-onset PDD, CBASP leads to greater improvements in depression at the end of treatment [3] and 1 year later (but not beyond that) [4]. We conducted a sequential mediation analysis testing the hypothesis that the treatment effect (CBASP vs. SP) on outcome is mediated by a sequential indirect effect of treatment-specific improvements in the therapeutic relationship and a subsequent decrease in social inhibition.The inclusion and exclusion criteria of this RCT are described elsewhere [3]. Briefly, the acute-phase treatment consisted of 24 sessions of CBASP or SP over 20 weeks. In the continuation phase, 8 further sessions were administered between week 20 and 48. In CBASP, the therapeutic relationship is explicitly targeted using techniques that are collectively labeled disciplined personal involvement. For example, positive in-session experiences with the therapist are contrasted with hurtful reactions from significant others to promote safety in the therapeutic dyad (interpersonal discrimination exercise). SP calls for a far less structured approach to the therapeutic relationship and relies on the broader common factors of psychotherapy.Our analysis was performed in a modified intention-to-treat population that included all randomized patients for whom data were available for the mediating variables for at least 1 of the assessments (256 out of 268 patients, 95.5%). These mediating variables were the Helping Alliance Questionnaire (HAQ) and the Inventory of Interpersonal Problems (IIP). Outcome was measured using the clinician-rated Hamilton Rating Scale for Depression (HRSD-24). Out of the subsample analyzed in the current report, 130 patients (50.8%) were randomized to CBASP and 126 patients (49.2%) to SP. The mean age of the patients was 45.05 years (SD 11.8), 64.8% were female (n = 166). We imputed missing values for the HAQ, the IIP, and the HRSD-24 by using the mean of the posterior distribution from the fully conditional specification method obtained by the iterative Markov Chain Monte Carlo estimation.We examined sequential mediation via an ordinary leastsquares path analysis using a bootstrapping approach facilitated by the PROCESS macro version 2.16. The independent variable was group allocation (CBASP vs. SP), the dependent variable was the total score of the HRSD at week 48 (end of treatment), and the putative mediating variables were change of the HAQ between week 1 and the end of the acute treatment phase at week 20 (M 1 ) and subsequent change in the social inhibition subscale of the IIP during the continuation phase from week 20 to 48 (M 2 ). These time points were chosen to establish a temporal sequence of treatmentinduced changes in the therapeutic relationship followed by improvement in interpersonal functioning. For further details of the analysis, see Figure 1.This analysis revealed that a significant part of the association between treatment and outcome is mediated through the sequential indirect effect of improvement in HAQ (M 1 ) and reduction in the IIP social i...

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Section: Karger@kargercommentioning

confidence: 97%

Changes in Therapeutic Alliance and in Social Inhibition as Mediators of the Effect of the Cognitive Behavioral Analysis System of Psychotherapy: A Secondary Analysis from a Randomized Clinical Trial

Klein

Probst

Kriston

et al. 2020

Psychother Psychosom

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“…This is of great relevance in patients with lipoedema, most of whom have an increased psychological vulnerability or suffer from chronic mental stress. Sporting activity in conjunction with basic psychotherapy is more effective in persons with a depressive tendency than a more sophisticated psychotherapy alone [46].…”

Section: ) Optimising Daily Functioning and Physical Capacitymentioning

confidence: 99%

“…Dies ist vor allem auch bei Lipödem-Patientinnen mit meist erhöhter psychischer Vulnerabilität oder chronischer Stressbelastung von großer Bedeutung. Sportliche Aktivität wirkt im Zusammenspiel mit einer basalen Psychotherapie bei depressiven Personen sogar noch besser als eine ausgefeilte Depressionstherapie allein [46]. [50].…”

Section: ) Optimierung Der Funktionsfähigkeit Im Alltag Und Der Körpunclassified

Lipoedema – myths and facts, Part 5

Bertsch¹,

Erbacher²,

Corda³

et al. 2020

Phlebologie

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The four previous articles in this series addressed the myths and facts surrounding lipoedema. We have shown that there is no scientific evidence at all for the key statements made about lipoedema – which are published time and time again. The main result of this “misunderstanding” of lipoedema is a therapeutic concept that misses the mark. The patient’s real problems are overlooked.The national and especially the international response to the series, which can be read in both German and English, has been immense and has exceeded all our expectations. The numerous reactions to our articles make it clear that in other countries, too, the fallacies regarding lipoedema have led to an increasing discrepancy between the experience of healthcare workers and the perspective of patients and self-help groups, based on misinformation mostly generated by the medical profession.Parts 1 to 4 in this series of articles on the myths surrounding lipoedema have made it clear that we have to radically change the view of lipoedema that has been held for decades. Changing our perspective means getting away from the idea of “oedema in lipoedema” – and hence away from the dogma that decongestion is absolutely necessary – and towards the actual problems faced by our patients with lipoedema. Such a paradigm shift in a disease that has been described in the same way for decades cannot be left to individuals but must be put on a much broader footing. For this reason, the lead author of this series of articles invited renowned lipoedema experts from various European countries to discussions on the subject. Experts from seven different countries took part in the two European Lipoedema Forums, with the goal of establishing a consensus. The consensus reflects the experts’ shared view on the disease, having scrutinized the available literature, and having taken into account the many years of clinical practice with this particular patient group. Appropriate to the clinical complexity of lipoedema, participants from different specialties provided an interdisciplinary approach. Nearly all of the participants in the European Lipoedema Forum had already published work on lipoedema, had been involved in drawing up their national lipoedema guidelines, or were on the executive board of their respective specialty society.In this fifth and final part of our series on lipoedema, we will summarise the relevant findings of this consensus, emphasising the treatment of lipoedema as we now recommend it. As the next step, the actual consensus paper “European Best Practice of Lipoedema” will be issued as an international publication.Instead of looking at the treatment of oedema, the consensus paper will focus on treatment of the soft tissue pain, as well as the psychological vulnerability of patients with lipoedema. The relationship between pain perception and the patient’s mental health is recognised and dealt with specifically. The consensus also addresses the problem of self-acceptance, and this plays a prominent role in the new therapeutic concept. The treatment of obesity provides a further pillar of treatment. Obesity is recognised as being the most common comorbid condition by far and an important trigger of lipoedema. Bariatric surgery should therefore also be considered for patients with lipoedema who are morbidly obese. The expert group upgraded the importance of compression therapy and appropriate physical activity, as the demonstrated anti-inflammatory effects directly improve the patients’ symptoms. Patients will be provided with tools for personalised self-management in order to sustain sucessful treatment. Should conservative therapy fail to improve the symptoms, liposuction may be considered in strictly defined circumstances.The change in the view of lipoedema that we describe here brings the patients’ actual symptoms to the forefront. This approach allows us to focus on more comprehensive treatment that is not only more effective but also more sustainable than focusing on the removal of non-existent oedema.

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“…One of the most promising approaches based on posttreatment outcome [8] is the only disorder-specific psychotherapy for chronic depression, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) [9], although not all findings investigating it have been fully supportive [10, 11]. The evidence for the long-term effectiveness of CBASP is limited.…”

Section: Introductionmentioning

confidence: 99%

Two-Year Follow-Up after Treatment with the Cognitive Behavioral Analysis System of Psychotherapy versus Supportive Psychotherapy for Early-Onset Chronic Depression

Schramm

Kriston

Elsaeßer

et al. 2019

Psychother Psychosom

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Background: Evidence on the long-term efficacy of psychotherapeutic approaches for chronic depression is scarce. Objective: To evaluate the effects of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) compared to Supportive Psychotherapy (SP) 1 year and 2 years after treatment termination. Methods: In this study, we present 1- and 2-year follow-up assessments of a prospective, multicenter, evaluator-blinded, randomized clinical trial of outpatients with early-onset chronic major depression (n = 268). The initial treatment included 32 sessions of CBASP or SP over 48 weeks. The primary outcome was the rate of “well weeks” (Longitudinal Interval Follow-Up Evaluation; no/minimal symptoms) after 1 year and 2 years. The secondary outcomes were, among others, clinician- and self-rated depressive symptoms, response/remission rates, and quality of life. Results: Of the 268 randomized patients, 207 (77%) participated in the follow-up. In the intention-to-treat analysis, there was no statistically significant difference between CBASP and SP patients in experiencing well weeks (CBASP: mean [SD] of 48.6 [36.9] weeks; SP: 39.0 [34.8]; rate ratio 1.26, 95% CI 0.99–1.59, p = 0.057, d = 0.18) and in remission rates (CBASP: 1 year 40%, 2 years 40.2%; SP: 1 year 28.9%, 2 years 33%) in the 2 years after treatment. Statistically significant effects were found in favor of CBASP 1 year after treatment termination regarding the rate of well weeks, self-rated depressive symptoms, and depression-related quality of life. Conclusions: CBASP lost its superiority over SP at some point between the first and the second year. This suggests the necessity of maintenance treatment for early-onset chronically depressed patients remitted with CBASP during the acute therapy phase, as well as the sequential integration of other treatment strategies, including medication for those who did not reach remission.

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Comparing the Efficacy of CBASP with Two Versions of CBT for Depression in a Routine Care Center: A Randomized Clinical Trial

Cited by 22 publications

References 54 publications

Changes in Therapeutic Alliance and in Social Inhibition as Mediators of the Effect of the Cognitive Behavioral Analysis System of Psychotherapy: A Secondary Analysis from a Randomized Clinical Trial

Changes in Therapeutic Alliance and in Social Inhibition as Mediators of the Effect of the Cognitive Behavioral Analysis System of Psychotherapy: A Secondary Analysis from a Randomized Clinical Trial

Lipoedema – myths and facts, Part 5

Two-Year Follow-Up after Treatment with the Cognitive Behavioral Analysis System of Psychotherapy versus Supportive Psychotherapy for Early-Onset Chronic Depression

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