Exposure Aspects of the Interpersonal Discrimination Exercise (IDE) and the Situational Analysis (SA) in Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

CBASP with Intensified Significant Other History Exercise for Chronic Major Depression with Antecedent Dysthymic Disorder in Outpatient Treatment: Rationale, Assessment and Effects on the Hypothesized Core Content of the Patient’s in-Session Interpersonal

“…Then the key frontiers in the administration of the I-SOH procedure are outlined. These frontiers include the prerequisites prior to out-patient CBASP psychotherapy (patient variable) as well as the "therapist" variable (Schoepf et al, 2007;, and Neudeck et al, 2012. With respect to CBASP`s interpersonal focus, and particularly it's emphasis using the patient-therapist relationship as a therapeutic tool, in the following section the focus is laid on how the hypothesized core content of the patient`s interpersonal fear is specifically counter-conditioned in the SA/IDE phase of treatment.…”

“…CBASP is a highly disorder-oriented psychotherapy method from the "third generation" of behaviour therapy models that is based on modern learning theory considerations (McCullough et al, 2011;Neudeck et al, 2012). From a modern learning theory perspective, the origin of chronic MDD with antecedent dysthymic disorder is due to classical conditioned interpersonal fear that often goes hand in hand with traumatically processed experiences of learned helplessness during childhood and the adolescent epoch.…”

“…The TH represents the hypothesized core content of the patient's interpersonal fear in the form of a predictive-hypothesis that informs the therapist about how the patient is likely to behave interpersonally in "hot spot" in-session events as well as what the patient is likely to expect interpersonally from the therapist. The TH also informs the CBASP therapist how he has to behave in order to address, train and thereby "repair" developmental trauma arising from experiences of felt helplessness with SOs in the SA/IDE phase of treatment (McCullough et al, 2010;Neudeck et al, 2012). It is important to note, that after the I-SOH procedure is finished an in-session zone of felt-safety has usually come into being, but the patient has yet not developed the ability to perceptually discriminate the behaviour of the therapist from the behaviour of his SO`s in "hot spot" situations.…”

“…The multiple negative effects on quality of life and physical health in combination with an increased risk of suicide, as well as the burden that patients are unlikely to remit over time compared to pure The pathogenesis of chronic MDD with antecedent dysthymic disorder results, to a large degree, from bi-directional interaction between disturbed stress regulation on the one hand and a developmental history that implicates a dysfunctional home life during childhood and the intervening adolescence epoch on the other hand. As a rule, a diagnosis of chronic MDD with antecedent dysthymic disorder is accompanied by a dysfunctional learning environment with-or without early-life adversities, ranging from childhood maltreatment (sexual abuse, physical abuse or emotional abuse) to experiencing neglect to witnessing domestic violence or to having a life-threatening injury (Schoepf et al, 2007;Schoepf & McCullough, 2009;McCullough et al, 2010;Schoepf & Penberthy, 2010;McCullough, 2012a;Neudeck et al, 2012). From a learning theory perspective a dysfunctional learning environment -in which the child's emotional capacities are recurrently exceeded without providing a (behavioral) solution to stop the condition -may involve survival circuits that detect key conditioned stimuli as a behavioural phenomenon for life.…”

“…Such classical conditioned stimuli particularly trigger emotional and behavioral species-specific defence reactions, as well as stress associated changes in the inner workings of the body's organs and glands. Increasing evidence suggests that such exposed children may endure long-lasting neural consequences that place them at increased risk for the development of an interpersonal stile that is characterized by either moving away from or moving against the other person, and respectively the self (Schoepf et al, 2007;Schoepf & Penberthy, 2010;McCullough et al, 2011;Neudeck et al, 2012). Anatomically, predefined pathways that connect the limbic system with the neocortex are considerably stronger than those from the neocortex to the limbic system.…”