Group Cognitive Behavioural Analysis System of Psychotherapy (CBASP) for persistently depressed outpatients: a retrospective chart review

Abstract

Background. Cognitive behavioural analysis system of psychotherapy (CBASP) is an effective individual treatment for persistent depressive disorder (PDD), but evidence on group treatment (Group-CBASP) is limited. Our aim was to review the effect of Group-CBASP on self-report depression severity in outpatients with PDD, overall and by age of depression-onset. Methods. A retrospective chart review study (November 2011-March 2017) in 54 patients with PDD (29 late-onset, 25 early-onset). Patients were previously treated by pharmacotherapy (92.6%), psychotherapy (98.1%) and/or electroconvulsive therapy (11.1%). Group-CBASP involved 24 weekly sessions during 6 months, followed by individual appointments over 6 months. The Inventory of Depressive Symptoms-self rating(IDS-SR) was used at baseline and after 3, 6, 9 and 12 months, computing mean differences and response rates. Results. The mean IDS-SR score decreased significantly from 39.83 at baseline to 33.78 at 6 months: a decrease from severe to moderate depression after 24 weeks of Group-CBASP, with a medium effect size (Cohen's d = .49). At 12 months, the mean IDS-SR score was 32.81, indicating moderate symptom levels remained. At 6 and 12 months, mean IDS-SR scores were similar among late-versus early-onset patients, but at 12 months response rates were higher among late-onset patients. Limitations. Although results of our study provide valuable input for future prospective studies, limitations were the use of a retrospective design and the small group size. Conclusion. Group-CBASP offered to an outpatient population with PDD was associated with clinically relevant decrease in self-reported symptom severity, and with sustained response particularly in patients with late onset of depression. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

EffECTively Treating Depression: A Pilot Study Examining Manualized Group CBT as Follow-Up Treatment After ECT

“…Likewise, quality of life also seems to be reduced in subsyndromal as well as remitted patients (Angermeyer et al, 2002;da Silva Lima and de Almeida Fleck, 2007;Shimizu et al, 2013), while the increased psychological quality of life and reduced mental pain are one of the most important treatment outcomes according to self-reports of depressed patients (Chevance et al, 2020) and thus should be targeted in a comprehensive antidepressant treatment. In general, psychotherapeutic interventions tend to show sustainable effects even after treatment end which makes them an especially appealing follow-up treatment (Hensley et al, 2004;Schramm et al, 2019;Potijk et al, 2020).…”

“…Thus, CBASP focuses primarily on interpersonal interactions and social problemsolving skills. Group psychotherapy in general has certain advances (cost efficiency, model learning, and universality of suffering; McDermut et al, 2001, Burlingame et al, 2011, Yalom and Leszcz, 2020, and group therapy with CBASP elements seems to be an effective treatment option for both inpatients and outpatients suffering from severe, chronic depression, further emphasizing the focus on social interactions (Brakemeier et al, 2014;Sabaß et al, 2018;Potijk et al, 2020). Thus, while not all patients seem to benefit sufficiently from ECT treatment, it can be assumed that the majority of these patients is suffering from severe, rather chronic depression, which is why group CBT with CBASP elements might be an effective treatment option for ECT responders and non-responders.…”

Identifying predictors of a favourable outcome for outpatients with a persistent depressive disorder treated with Cognitive Behavioural Analysis System of Psychotherapy: A prospective cohort study

“…This finding was described as unexpected, since there is a theorized association between the chronicity of PDD and impaired interpersonal functioning that began in adolescence, which is targeted by the interpersonal focus in CBASP (McCullough, 2003). One possible explanation for the finding of Potijk et al (2020) is the difference in family composition between early-and late-onset patients; late-onset patients more often lived with a spouse in this study, which may have impacted their baseline level of interpersonal functioning, and could have provided them with more opportunities to practise new interpersonal behaviour in everyday life. Also, the impaired interpersonal skills targeted by CBASP may be more specifically associated with the presence of childhood trauma, which was associated with improved treatment response in the previously mentioned studies of individual CBASP (Bausch et al, 2020;Furukawa et al, 2018;Serbanescu et al, 2020).…”

“…Consequently, the aim of this study, which used an expanded version of the database by Potijk et al (2020), was to identify predictors of favourable outcome in patients with PDD treated with group CBASP after 6 and 12 months. In line with the findings of Potijk et al (2020), it was hypothesized that late-onset depressive disorders would be associated with increased treatment response, potentially explained by the aforementioned differences in family composition in late-onset participants compared to individuals with late-onset depressive disorders.…”

Interpersonal Change During Inpatient CBASP Treatment: Focus on Group Therapy

“…Group-CBASP may further provide a social network for exercising personal agency and communion, thereby fostering the patients' perceived functionality in the social domain. Previous studies have pointed to the feasibility (29) and effectiveness of CBASP group therapy regarding the reduction of depressive symptoms and the improvement of interpersonal functioning (17,(31)(32)(33)(34)(35), also as continuation therapy after acute treatment (36). However, little is known about the specific factors that contribute to patients' benefit from the group modality or a potential deterioration of symptoms that may be caused by the group setting itself.…”