A Lasting Cure for Persistent Depression?
An article in the Washington Post appearing on November 8, 2005

The Plan
Virginia Commonwealth University Professor James P. McCullough, Jr. is training mental health professionals nationwide to treat the most intractably depressed patients with a scientifically validated but little-known form of therapy. Cognitive Behavioral Analysis System of Psychotherapy (CBASP) "is the only method in the world developed specifically for the chronically depressed patient," said McCullough, who has studied the condition for more than two decades and developed the method.

The Condition
Chronic depression, which afflicts 20 million Americans, was considered untreatable until 1980. It often begins at puberty and is rooted in an early traumatic life. Untreated, it can last a lifetime. McCullough said his patients have an average age of 41 and have had symptoms for more than 18 years. "They have an egocentric world view," he said. "The environment can't
get in, and they are unable to recognize that their interpersonal actions have consequences. They orbit in a cycle of sameness."

The Treatment
The six-step procedure of one CBASP technique (Situational Analysis) requires patients to focus on a stressful "slice of time" in their lives. They describe what happened, their interpretation of what happened, their behavior and its outcome, and their preferred outcome; then, they look at whether or not they obtained what they wanted in the situation. Past relationships and trauma are explored; the therapist interacts closely with the patient rather than listening passively. The process is repeated in every session. CBASP compared to traditional Cognitive Therapy is different. It teaches patients that their life dilemma is self-produced and maintained. But McCullough said that CBASP appears to be more effective than Cognitive Therapy for the chronically depressed patient.

"In a repetitive way, we show patients that you create the life problems that you complain of, " he said, "and this is accomplished, over time, as patients become aware of how their destructive behavior affects others and how their behavior maintains their depression."

The Treatment
CBASP was used in the largest study comparing talk therapy and antidepressant medication for chronic depression. In the study, published in the New England Journal of Medicine (in May 2000), CBASP was shown to be as effective as drugs (a little more than half in each group reported reduced symptoms). When CBASP was combined with medication, 85 percent of the patients who completed the study reported full or partial remission. McCullough calls himself a "man on a mission" to teach this therapy method to others.

-- Cecilia Capuzzi Simon
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