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Guhn A, Schön D, Zische Y, Sterzer P, Köhler S. Interpersonal Change During Inpatient CBASP Treatment: Focus on Group Therapy. Front Psychiatry 2021; 12:620037. [PMID: 33716820 PMCID: PMC7952983 DOI: 10.3389/fpsyt.2021.620037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/05/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been tailored specifically to the demands of patients with persistent depressive disorder (PDD). According to the CBASP model, PDD patients are supposed to live perceptually disconnected from their social environment, which consequently maintains depression. While initially developed as an individual treatment modality, the adaptation for group therapy yields an important interpersonal space. However, little is known about the specific factors that contribute to patients' benefit from the CBASP group modality. Methods: The analyzed sample comprised N = 87 PDD patients who completed a 12 week multimodal inpatient treatment including 2 weekly CBASP-specific individual and group sessions, respectively, as well as CBASP-unspecific medical contacts, pharmacotherapy and complementary therapies. Group sessions included trainings in situational analysis and interpersonal skills. Interpersonal change over therapy was examined based on the patients' self-perceived interpersonal problems (IIP) and the impact messages as perceived by their individual therapists (IMI). Pre and post-treatment data were compared using within-sample t-tests. Additionally, patients evaluated CBASP group therapy on a feedback form. They were invited to reflect on individual benefits and its helpful and unhelpful aspects. Qualitative content analysis with inductive category development was used to analyze feedback. Inter-rater reliability was computed to confirm categories before summarizing the frequencies of reported factors. Results: Self-perceived interpersonal distress significantly decreased over therapy. Patients reported reduced interpersonal problems and therapists reported more friendly and dominant impact messages. Interestingly, patients who showed a significant depressive symptom reduction described higher change scores. Regarding qualitative data, patients reported five main benefits from group therapy: Gain in social competence, self-confidence, self-reflection, interpersonal dynamics, and optimism/universality. Patients responding to CBASP identified significantly more factors than non-responders. Conclusions: Compared to studies with individual CBASP only, the present findings suggest that CBASP group therapy may contribute to the improvement of interpersonal behavior. Group therapy is discussed as a potential boosting effect for individual CBASP. However, as the present data were collected in a multimodal inpatient setting without competitor, randomized controlled trials are warranted that investigate the specific benefits of the group modality or the combined individual and group therapy over individual CBASP only.
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Affiliation(s)
- Anne Guhn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - David Schön
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Yvonne Zische
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
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Probst T, Schramm E, Heidenreich T, Klein J, Michalak J. Patients' interpersonal problems as moderators of depression outcomes in a randomized controlled trial comparing mindfulness-based cognitive therapy and a group version of the cognitive-behavioral analysis system of psychotherapy in chronic depression. J Clin Psychol 2020; 76:1241-1254. [PMID: 31997369 PMCID: PMC7318258 DOI: 10.1002/jclp.22931] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Interpersonal problems were examined as moderators of depression outcomes between mindfulness-based cognitive therapy (MBCT) and cognitive behavioral analysis system of psychotherapy (CBASP) in patients with chronic depression. METHODS Patients received treatment-as-usual and, in addition, were randomized to 8-weeks of MBCT (n = 34) or 8-weeks of CBASP (n = 34). MBCT and CBASP were given in a group format. The Hamilton depression rating scale (HAM-D) was the primary and the Beck Depression Inventory (BDI-II) the secondary outcome. The subscales of the Inventory of interpersonal problems (IIP-32) were moderators. Multilevel models were performed. RESULTS Higher scores on the "vindictive/self-centered" subscale were associated with a better outcome in MBCT than in CBASP (HAM-D: p < .01; BDI-II: p < .01). Higher scores on the "nonassertive" subscale were associated with a better outcome in CBASP than in MBCT (HAM-D: p < .01; BDI-II: p < .01). CONCLUSIONS If these results can be replicated in larger trials, MBCT should be preferred to CBASP in chronically depressed patients being vindictive/self-centered, whereas CBASP should be preferred to MBCT in chronically depressed patients being nonassertive.
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Affiliation(s)
- Thomas Probst
- Department for Psychotherapy and Biopsychosocial HealthDanube University KremsKrems an der DonauAustria
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of MedicineUniversity of FreiburgFreiburg im BreisgauGermany
| | - Thomas Heidenreich
- Faculty Social Work, Health, and NursingEsslingen University of Applied SciencesEsslingen am NeckarGermany
| | - Jan‐Philipp Klein
- Department of Psychiatry and PsychotherapyUniversity of LübeckLübeckGermany
| | - Johannes Michalak
- Department of Psychology and PsychotherapyWitten/Herdecke UniversityWittenGermany
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Bollmann S, Spies J, Hodzic J, Hohl-Radke F, Brakemeier EL. Feasibility and Outcome of an Inpatient Interpersonal Skills Group for Older Adults (65+) With Acute or Chronic Depression. GEROPSYCH 2020. [DOI: 10.1024/1662-9647/a000224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. In light of ongoing demographic changes, it is essential to tailor psychotherapeutic approaches and interventions to the specific needs and characteristics of older adults. An interpersonal skills group (ISG) for older adults consisting of modified Cognitive Behavioral Analysis System of Psychotherapy (CBASP) elements (Situational Analysis, Kiesler Circle Training) was integrated into the treatment schedule of an inpatient setting in routine clinical care. Feasibility and outcome were evaluated in a pilot study including 13 older patients ( Mage = 77.3, range 66–87 years) diagnosed with a major depressive disorder. Results indicate very good feasibility as well as a significant reduction of depressive symptoms in self-report measures and observer rating at discharge ( d = 1.00 to d = 5.62). No significant changes were observed in interpersonal distress, whereas significant changes in the Emotion Regulation Questionnaire (ERQ reappraisal: p < .001) and the Impact Message Inventory (IMI: p = .002 to p < .001) were reported and discussed. However, the results in the observer rating are likely to have been overestimated through a nonblinded rater. Further studies should examine the efficacy of age-tailored CBASP programs for older adults in large randomized controlled trials.
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Affiliation(s)
- Simon Bollmann
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Germany
| | - Jan Spies
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany
| | | | | | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Germany
- Department of Clinical Psychology and Psychotherapy, University of Greifswald, Germany
- Schoen Clinic, Bad Arolsen, Germany
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Sayegh L, Touré EH, Farquhar E, Beaulieu S, Renaud S, Rej S, Perreault M. Group Cognitive Behavioral Analysis System of Psychotherapy (CBASP): A Pilot Study for Bipolar Depression. Front Psychiatry 2020; 11:565681. [PMID: 33173513 PMCID: PMC7538805 DOI: 10.3389/fpsyt.2020.565681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/03/2020] [Indexed: 01/30/2023] Open
Abstract
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.
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Affiliation(s)
- Liliane Sayegh
- Bipolar Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychology, McGill University, Montreal, QC, Canada
| | - El Hadj Touré
- Department of Sociology, University of Montreal, Montreal, QC, Canada.,Douglas Research Center, Douglas Mental Health University Institute, Montreal, QC, Canada
| | | | - Serge Beaulieu
- Bipolar Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Suzane Renaud
- Bipolar Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,Complex Mood, Comorbid and Personality Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Soham Rej
- Bipolar Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,GeriPARTy Research Group, Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | - Michel Perreault
- Douglas Research Center, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
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Sabaß L, Padberg F, Normann C, Engel V, Konrad C, Helmle K, Jobst A, Worlitz A, Brakemeier EL. Cognitive Behavioral Analysis System of Psychotherapy as group psychotherapy for chronically depressed inpatients: a naturalistic multicenter feasibility trial. Eur Arch Psychiatry Clin Neurosci 2018; 268:783-796. [PMID: 28956140 DOI: 10.1007/s00406-017-0843-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/14/2017] [Indexed: 11/27/2022]
Abstract
The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is a relatively new approach in the treatment of chronic depression (CD). Adapted as group psychotherapy for inpatients, CBASP is attracting increasing attention. In this naturalistic multicenter trial, we investigated its feasibility after 10 sessions of CBASP group therapy over a treatment time of at least 5 to a maximum of 10 weeks. Treatment outcome was additionally assessed. Across four centers, 116 inpatients with CD (DSM-IV-TR) attended CBASP group psychotherapy. Feasibility was focused on acceptance, and evaluated for patients and therapists after five (t1) and ten sessions (t2) of group psychotherapy. Observer- and self-rating scales (Hamilton Depression Rating Scale-24 items, HDRS24; Beck Depression Inventory-II, BDI-II; World Health Organization Quality of Life assessment, WHOQOL-BREF) were applied before group psychotherapy (t0) and at t2. Dropouts were low (10.3%). Patients' evaluation improved significantly from t1 to t2 with a medium effect size (d = 0.60). Most of the patients stated that the group had enriched their treatment (75.3%), that the size (74.3%) and duration (72.5%) were 'optimal' and 37.3% wished for a higher frequency. Patients gave CBASP group psychotherapy an overall grade of 2 ('good'). Therapists' evaluation was positive throughout, except for size of the group. Outcome scores of HDRS24, BDI-II, and WHOQOL-BREF were significantly reduced from t0 to t2 with medium to large effect sizes (d = 1.48; d = 1.11; d = 0.67). In this naturalistic open-label trial, CBASP, when applied as inpatient group psychotherapy, was well accepted by patients and therapists. The results point towards a clinically meaningful effect of inpatient treatment with CBASP group psychotherapy on depression and quality of life. Other potential factors that could have promoted symptom change were discussed. A future controlled study could investigate the safety and efficacy of CBASP group psychotherapy for inpatients.
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Affiliation(s)
- Lena Sabaß
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
- School of Psychology, Hochschule Fresenius, University of Applied Sciences, Munich, Germany.
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Claus Normann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Vera Engel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carsten Konrad
- Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
- Agaplesion Diakonieklinikum, Rotenburg, Germany
| | - Kristina Helmle
- Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Andrea Jobst
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | | | - Eva-Lotta Brakemeier
- Philipps-University Marburg, Marburg, Germany
- Psychologische Hochschule Berlin, Berlin, Germany
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Functional Analytic Group Therapy (FAGT) for Depression: a Pilot Study. PSYCHOLOGICAL RECORD 2018. [DOI: 10.1007/s40732-018-0288-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Negt P, Brakemeier EL, Michalak J, Winter L, Bleich S, Kahl KG. The treatment of chronic depression with cognitive behavioral analysis system of psychotherapy: a systematic review and meta-analysis of randomized-controlled clinical trials. Brain Behav 2016; 6:e00486. [PMID: 27247856 PMCID: PMC4864084 DOI: 10.1002/brb3.486] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/16/2016] [Accepted: 04/01/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Chronic depression is a severe and disabling condition. Compared to an episodic course, chronic depression has been shown to be less responsive to psychopharmacological and psychological treatments. The cognitive behavioral analysis system of psychotherapy (CBASP) has been developed as a specific psychotherapy for chronic depression. However, conflicting results concerning its efficacy have been reported in randomized-controlled trials (RCT). Therefore, we aimed at examining the efficacy of CBASP using meta-analytical methods. METHODS Randomized-controlled trials assessing the efficacy of CBASP in chronic depression were identified by searching electronic databases (PsycINFO, PubMed, Scopus, Cochrane Central Register of Controlled Trials) and by manual searches (citation search, contacting experts). Searching period was restricted from the first available entry to October 2015. Identified studies were systematically reviewed. The standardized mean difference Hedges' g was calculated from posttreatment and mean change scores. The random-effects model was used to compute combined overall effect sizes. A risk of publication bias was addressed using fail-safe N calculations and trim-and-fill analysis. RESULTS Six studies comprising 1.510 patients met our inclusion criteria. The combined overall effect sizes of CBASP versus other treatments or treatment as usual (TAU) pointed to a significant effect of small magnitude (g = 0.34-0.44, P < 0.01). In particular, CBASP revealed moderate-to-high effect sizes when compared to TAU and interpersonal psychotherapy (g = 0.64-0.75, P < 0.05), and showed similar effects when compared to antidepressant medication (ADM) (g = -0.29 to 0.02, ns). The combination of CBASP and ADM yielded benefits over antidepressant monotherapy (g = 0.49-0.59, P < 0.05). LIMITATIONS The small number of included studies, a certain degree of heterogeneity among the study designs and comparison conditions, and insufficient data evaluating long-term effects of CBASP restrict generalizability yet. CONCLUSIONS We conclude that there is supporting evidence that CBASP is effective in the treatment of chronic depression.
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Affiliation(s)
- Philip Negt
- Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Hannover Germany
| | - Eva-Lotta Brakemeier
- Department for Clinical Psychology and Psychotherapy Berlin University of Psychology Berlin Germany
| | - Johannes Michalak
- Department of Psychology and Psychotherapy Witten/Herdecke University Witten Germany
| | - Lotta Winter
- Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Hannover Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Hannover Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Hannover Germany
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Dowgwillo EA, Pincus AL. Differentiating Dark Triad Traits Within and Across Interpersonal Circumplex Surfaces. Assessment 2016; 24:24-44. [DOI: 10.1177/1073191116643161] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent discussions surrounding the Dark Triad (narcissism, psychopathy, and Machiavellianism) have centered on areas of distinctiveness and overlap. Given that interpersonal dysfunction is a core feature of Dark Triad traits, the current study uses self-report data from 562 undergraduate students to examine the interpersonal characteristics associated with narcissism, psychopathy, and Machiavellianism on four interpersonal circumplex (IPC) surfaces. The distinctiveness of these characteristics was examined using a novel bootstrapping methodology for computing confidence intervals around circumplex structural summary method parameters. Results suggest that Dark Triad traits exhibit distinct structural summary method parameters with narcissism characterized by high dominance, psychopathy characterized by a blend of high dominance and low affiliation, and Machiavellianism characterized by low affiliation on the problems, values, and efficacies IPC surfaces. Additionally, there was some heterogeneity in findings for different measures of psychopathy. Gender differences in structural summary parameters were examined, finding similar parameter values despite mean-level differences in Dark Triad traits. Finally, interpersonal information was integrated across different IPC surfaces to create profiles associated with each Dark Triad trait and to provide a more in-depth portrait of associated interpersonal dynamics.
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Locke KD, Sayegh L, Penberthy JK, Weber C, Haentjens K, Turecki G. Interpersonal Circumplex Profiles Of Persistent Depression: Goals, Self-Efficacy, Problems, And Effects Of Group Therapy. J Clin Psychol 2016; 73:595-611. [DOI: 10.1002/jclp.22343] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 04/04/2016] [Accepted: 05/21/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | - Liliane Sayegh
- Douglas Mental Health University Institute and McGill University
| | | | | | | | - Gustavo Turecki
- Douglas Mental Health University Institute and McGill University
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