Handouts & questionnaires for depression, CBASP & neuroscience
Originally added on Mon, 18/05/2009 - 09:24Last updated on Tue, 08/12/2009 - 06:16
Here is a mixed bag of handouts and questionnaires. Most are spin-offs from CBASP (pronounced 'seebasp') - the awkwardly named cognitive behavioral analysis system of psychotherapy. There are also a few handouts which are adapted downloads from the neurosciences site "The brain from top to bottom". When in 2000, Keller et al reported on the very impressive results obtained by treating chronic depression with a mixture of CBASP and antidepressants, it seemed likely that a big step forward had been taken in improving the lot of chronic depression sufferers. The "CBASP research results" handout (below) gives the abstracts for 14 research papers that are both relevant to CBASP and also highlight other important related themes like the value of the therapeutic alliance in both psychotherapy and pharmacotherapy, and the way that a traumatic childhood history suggests that someone would be much more likely to benefit from psychotherapy than medication. I wrote more on CBASP in autumn 2008. I have also lectured on CBASP and a copy of the Powerpoint slides is included below. The current state of play (December 2009) is that a major attempt to replicate and extend the initial encouraging results has yielded disappointing outcomes. It's unclear why this has happened - possibly because the patient population involved in this second major study tended to be more disabled than in the first study (e.g. worse socioeconomic and literacy problems). Happily a third study is now under way in Holland and a fourth in Germany (see personal communication from Dr Schramm, below) to check further on the promise of this interesting approach to tackling the sense of powerlessness and interpersonal difficulties of many people suffering from long-term depression. Professor James McCullough, the originator of CBASP, has a website that gives more detail of relevant books, research papers & training opportunities.
At the bottom of the list of handouts and questionnaires (below) are three from the great Canadian Institute of Neurosciences website "The brain from top to bottom: an interactive website on human brain and behavior". I've written before about this web resource and now attach three adapted downloads on fight/flight, pleasure/pain, and memes/memory.
Lecture on CBASP - these are the Powerpoint slides from a talk I gave on CBASP to a group of psychologists back in early 2006. Though I say so myself, it's a pretty good presentation! As I've explained, CBASP received a bit of a set-back with results from an attempted US replication study. Results from a current Dutch replication will help to clarify how helpful CBASP really is.
CBASP research results - Here are 14 research studies relevant to the cognitive behavioral analysis system of psychotherapy (CBASP). The outstanding paper is the Keller et al report in 2000 highlighting how the combination of CBASP and antidepressant medication could produce very encouraging outcomes for people suffering from chronic forms of depression. There were then a series of further papers on different aspects of this potentially landmark research including the Klein et al (2003) report on the importance of the therapeutic alliance for both psychotherapy and pharmacotherapy results, the Nemeroff et al (2003) report on chronic depression sufferers with a history of childhood trauma doing much better with psychotherapy than pharmacotherapy, and the Klein et al (2004) report demonstrating the value of monthly CBASP sessions as a way of maintaining initially successful outcomes. Results from a first replication study were disappointing (personal communication) - possibly because of the severity/complexity of the cases selected for the trial (e.g. problems with literacy, etc). Happily Wiersma et al (2008) describe a fresh attempt at replication which should help considerably in clarifying the value of CBASP in the treatment of chronic depression.
Coping survey questionnaires, classic interpersonal, adapted interpersonal, and adapted other - at the heart of CBASP is "situational analysis" training which maybe produces many of its benefits by helping combat the overgeneralization and sense of powerlessness very characteristic of persistent depression. It also aims to help those using the method to become more goal focused, to realize their own interpersonal behaviours encourage or hinder achieving their goals, to recognize the main problem behaviours that hinder them getting what they want, and to help them learn new interpersonal skills to remedy these problems. The "classic interpersonal" sheet is the standard CBASP form used for this exercise, while in the "adapted interpersonal" sheet I have reshuffled the exercise to be a little more in line with ideas from - for example - ACT, implementation intentions, and self determination theory. Although the interpersonal focus of both these forms is probably entirely appropriate, I've also produced the "adapted other" form which looks at taking charge and acting from values in non-interpersonal situations as well. It's important to emphasise that CBASP's focus is on teaching clients to learn these more self-empowering attitudes and self-correct themselves.
Feelings of choice scale - this is a simple questionnaire I put together to help clients attend to and track their feelings of powerlessness and autonomy.
IIP-48 questionnaire & score sheet - I use these questionnaires about characteristic interpersonal style a lot - in many more situations than when I'm working with a CBASP-influenced approach. To paraphrase Alice Miller and others "The walls we build to protect ourselves, become the prisons in which we live." This assessment tool highlights and helps track changes in our interpersonal "prison walls."
Significant others list - this CBASP exercise is usually completed in the second therapy session. It begins the work of clarifying how clients have been affected by significant others earlier in their lives and how these effects may now negatively affect their current relationships.
Significant others grid - the significant others list is now used as a springboard to predict problems (and potential learning experiences) that are likely to emerge in the therapeutic relationship. It lays the groundwork for the therapeutic relationship itself to become an environment for helpful "behavioural experiments".
Significant others work, suggestions - suggestions for using the significant others approach.
Significant others, therapy relationship suggestions - after the core "situational analysis" method, working within the therapeutic relationship is the other obvious CBASP "technique". Here are further thoughts about making this focus helpful.
Life review charts - CBASP also works with a "time line" that helps client and therapist see how mood has varied over the years. I adapted these ideas a little and produced six related life review charts. Again I use these much more widely than just in CBASP-related interventions. To see, and maybe download, go to the handout section "Life review, traumatic memories & therapeutic writing".
Thoughts after completing a 3 day CBASP training with Prof Jim McCullough - in April '07 I completed a three day training course with Jim McCullough. As can be seen from the '06 Powerpoint lecture handout (above), I had already done a fair amount of studying, trying out, and thinking about CBASP before doing this course. Here are a collection of post-course thoughts.
Fight, flight & freeze circuits - this is a great adapted Canadian Institute of Neurosciences download on the well-known fight/flight/freeze reaction giving a bit more detail than most people will be familiar with.
Pleasure, pain & inhibition - this neurosciences download makes a powerful scientific argument for activation rather than the chronic withdrawal seen in so many anxiety and depression syndromes.
Memes & collective memory - at times quirky & opinionated, this download introduces ideas about memes - units of information transmitted from brain to brain - and scientific paradigms. Much psychotherapy could be seen as working to propagate healthier meme structures.

CBASP studies
Hello,
we also started a larger multicenter study in Germany including 268 patients in 10 centers.
Here is an outline:
COORDINATING INVESTIGATOR PD Dr. Elisabeth Schramm, Dipl.Psych. (PI)
Senior researcher and clinical psychologist; Nationality: German
Freiburg University Medical Centre, Department of Psychiatry and Psychotherapy
Hauptstr. 5 79104 Freiburg Germany
Phone: +49 761 270-6967; Fax: +49 761 270-6619
e-mail: Elisabeth.Schramm@uniklinik-freiburg.de
Co-PI: Prof. Dr. med. Dr. phil. Martin Härter
TITLE OF STUDY A comparison of the Cognitive Behavioural Analysis System of Psychotherapy (CBASP) against supportive psychotherapy
CONDITION Early-onset chronic Major Depression
OBJECTIVE(S) To compare the efficacy of CBASP with non-specific supportive psychotherapy (psychological placebo). Primary hypothesis: CBASP is more effective in reducing depressive symptoms in patients with early-onset chronic MDD than a non-specific psychological control treatment.
INTERVENTIONS Duration of intervention per patient: 20 weeks acute treatment (n=24 sessions)
followed by 28 weeks of continuation treatment (n=8 sessions)
Follow-up per patient: 48 weeks after randomisation
KEY INCLUSION AND EXCLUSION CRITERIA Key inclusion criteria: DSM-IV diagnosis of: 1) chronic Major Depression / MDD (at least 2 years duration), or 2) current MDD superimposed on a pre-existing dysthymic disorder, or 3) recurrent MDD with incomplete remission between episodes; early onset (before the age of 21) according to DSM-IV; age 18-65; score of at least 20 on the 24-item Hamilton Rating Scale of Depression (HRSD).
Key exclusion criteria: Acute risk for suicide assessed according to clinical practice guidelines; history of psychotic symptoms, bipolar disorder, or organic brain disorders; a primary diagnosis of another axis I disorder incl. anxiety disorders, or any severe substance-related abuse or dependence disorder; antisocial, schizotypal, or borderline personality disorder; a serious medical condition; severe cognitive impairment.
OUTCOMES Primary endpoint: Depressive symptoms 20 weeks after randomisation (after acute treatment phase) as measured by the HRSD.
Secondary endpoints: Depressive symptoms after 12 and 48 weeks, and remission after 12, 20, and 48 weeks as measured by the HRSD.
STUDY TYPE Prospective, multicentre, observer blind, randomised, controlled study
SAMPLE SIZE To be assessed for eligibility: n = 450; To be allocated to trial: n = 268
To be analysed: intention-to-treat: n = 268; per protocol: n = 210
SUMMARY
Effective treatment strategies for chronic depression are urgently needed since it is not only a common and particularly disabling disorder, but is also considered treatment resistant by most clinicians. There are only a few studies on chronic depression indicating that traditional interventions are not as effective as in acute, episodic depression. In addition, most of the studies had methodological weaknesses, such as the very short courses of psychotherapy. Usually, chronic depression begins early in life, is often associated with early interpersonal trauma, and results in an even more substantial human capital loss than the late-onset group. Furthermore, it shows a weak response to medication and a high rate of relapse after an initial response. With the present multicentre study, the efficacy of the only specific psychotherapy for chronic depression (Cognitive Behavioural Analysis System of Psychotherapy/CBASP) is compared with a non-specific supportive psychotherapy/SP (a well-designed psychological placebo) in early onset chronically depressives. CBASP faired very well in one large trial but has never been directly compared to a placebo control. Another innovative aspect of the study is the use of an extended course of psychotherapy (32 sessions). Primary hypothesis: CBASP is more effective in reducing depressive symptoms than SP.
CBASP studies
This is great news, Elisabeth. I think this kind of work is exactly what the CBASP field needs. If your results are supportive of CBASP, I think this approach for chronic depression is likely to become a lot better known and a lot more widely practised. Good luck with your research and thank you for letting more people know about it.
With best wishes
James
CBASP
Dear Dr. Hawkins,
I am thrilled to see your posting on CBASP! I am the North American representative for the CBASP Network International and would love to invite you to study with Jim McCullough, if you have not already done so. I was his mentee and student and have been certified in CBASP since 1997 - it is an effective and practical psychotherapy. We have annual CBASP Network meetings internationally and are becoming more organized each year. We currently have several studies running in multiple countries to further evaluate CBASP, including understanding the neurobiology via imaging studies, and development of new applications, such as a group format.
CBASP
Dear Kim
Thank you for this information. I was lucky enough to get three days with Jim McCullough when he was over here in Scotland a couple of years ago. I enjoyed it a lot and the approach hangs together very well. The key issue seems to be the results of attempted replication studies. I very much look forward to these outcomes emerging. Fingers crossed!
With best wishes
James
Other resources
Thanks for the information,
I thought you might be interested in a site I launched earlier this year called Genes to Cognition Online (www.g2conline.org). It has a major section on depression that you may find interesting.
Thanks again,
John
Other resources
Thanks John. I've visited your www.g2conline.org site. It looks great and full of interesting information.
With best wishes for your project,
James