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Der Nervenarzt

, Volume 77, Issue 3, pp 355–371 | Cite as

Spezifische Therapie für chronische Depression

Das „Cognitive Behavioral Analysis System of Psychotherapy“ nach McCullough
  • E. Schramm
  • F. Caspar
  • M. Berger
Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

Chronische Depressionen sind häufige Störungen, die ausgeprägtes Leiden und enorme Kosten verursachen. Traditionelle pharmakologische und psychotherapeutische Behandlungsansätze zeigten bisher nur mäßigen Erfolg. Bei dem „Cognitive Behavioral Analysis System of Psychotherapy“ (CBASP) von James McCullough handelt es sich um ein spezifisch auf chronische Depression zugeschnittenes Verfahren, bei dem behaviorale, kognitive und interpersonelle Strategien integriert werden. Der Ansatz ist empirisch überprüft und hat sich als wirksam erwiesen. Der vorliegende Beitrag erläutert den derzeitigen Forschungsstand bei der psychotherapeutischen Behandlung chronischer Depression. Neben der Herleitung des Ansatzes werden die wichtigsten therapeutischen Strategien und Techniken des CBASP beschrieben.

Schlüsselwörter

Chronische Depression Störungsspezifische Psychotherapie CBASP Kognitiv Interpersonell 

A specific therapy for chronic depression

McCullough’s Cognitive Behavioral Analysis System of Psychotherapy

Summary

Chronic depression is a common disorder which causes significant impairment and enormous treatment costs. Traditional pharmacological and psychological treatment approaches have shown only modest success. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) by James McCullough is the only therapy developed specifically for chronic depression. It integrates behavioral, cognitive, and interpersonal strategies. The approach is supported empirically and shown to be effective. This article presents the state of the art regarding research in psychotherapeutic treatment for chronic depression. In addition, the development of the approach and therapeutic strategies and techniques of CBASP are described.

Keywords

Chronic depression Disorder-specific psychotherapy CBASP Cognitive Interpersonal 

Notes

Interessenkonflikt:

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Literatur

  1. 1.
    Arnow BA, Constantino MJ (2003) Effectiveness of psychotherapy and combination treatment for chronic depression. J Clin Psychol 59: 893–905CrossRefPubMedGoogle Scholar
  2. 2.
    Barrett JE, Williams JW Jr, Oxman TE et al. (2001) Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59 years. J Fam Pract 50: 405–412PubMedGoogle Scholar
  3. 3.
    Beck AT, Rush AJ, Shaw BF et al. (1979) Cognitive therapy of depression. Guilford Press, New YorkGoogle Scholar
  4. 4.
    Browne G, Steiner M, Roberts J et al. (2002) Sertraline and/or interpersonal psychotherapy for patients with dysthymic disorder in primary care: 6-month comparison with longitudinal 2-year follow-up of effectiveness and costs. J Affect Disord 68: 317–330CrossRefPubMedGoogle Scholar
  5. 5.
    Caspar F (1996) Beziehungen und Probleme verstehen. Eine Einführung in die psychotherapeutische Plananalyse. Huber, BernGoogle Scholar
  6. 6.
    Caspar F (2002) Das Impact Message Inventory von Kiesler. In: Brähler E, Schumacher J, Strauss B (Hrsg) Diagnostische Verfahren in der Psychotherapie. Beltz, Weinheim, S 214–216Google Scholar
  7. 7.
    Caspar F, Grossmann C, Unmüssig C et al. (2005) Complementary therapeutic relationship: therapist behavior, interpersonal patterns, and therapeutic effects. Psychother Res 15: 91–102CrossRefGoogle Scholar
  8. 8.
    de Jong R, Treiber R, Henrich G (1986) Effectiveness of two psychological treatments for inpatients with severe and chronic depression. Cognitive Ther Res 10: 645–663CrossRefGoogle Scholar
  9. 9.
    Dunner DL (2001) Acute and maintenance treatment of chronic depression. J Clin Psychiatry 62 [Suppl 6]: 10–16Google Scholar
  10. 10.
    Dunner DL, Schmaling KB, Hendrickson H et al. (1996) Cognitive therapy versus fluoxetine in the treatment of dysthymic disorder. Depression 4: 34–41CrossRefPubMedGoogle Scholar
  11. 11.
    Friedman MA, Detweiler-Bedell JB, Leventhal HE (2004) Combined psychotherapy and pharmacotherapy for the treatment of Major Depressive Disorder. Clin Psychol Sci Pract 11: 47–68CrossRefGoogle Scholar
  12. 12.
    Gelenberg AJ, Trivedi MH, Rush AJ et al. (2003) Randomized, placebo-controlled trial of nefazodone maintenance treatment in preventing recurrence in chronic depression. Biol Psychiatry 54: 806–817CrossRefPubMedGoogle Scholar
  13. 13.
    Gordon DE (1988) Formal operations and interpersonal and affective disturbances in adolescents. In: Nannis ED, Cowan PA (eds) Developmental psychopathology and its treatment. Jossey-Bass, San Francisco, pp 51–73Google Scholar
  14. 14.
    Grawe K (1992) Komplementäre Beziehungsgestaltung als Mittel zur Herstellung einer guten Therapiebeziehung. In: Margraf J, Brengelmann J (Hrsg) Die Therapeut-Patient-Beziehung in der Verhaltenstherapie. Gerhard Röttger, München, S 215–244Google Scholar
  15. 15.
    Hegerl U, Plattner A, Moller HJ (2004) Should combined pharmaco- and psychotherapy be offered to depressed patients? A qualitative review of randomized clinical trials from the 1990s. Eur Arch Psychiatry Clin Neurosci 254: 99–107CrossRefPubMedGoogle Scholar
  16. 16.
    Hellerstein DJ, Yanowitch P, Rosenthal J et al. (1993) A randomized double-blind study of fluoxetine versus placebo in the treatment of dysthymia. Am J Psychiatry 150: 1169–1175PubMedGoogle Scholar
  17. 17.
    Hirschfeld RM, Dunner DL, Keitner G et al. (2002) Does psychosocial functioning improve independent of depressive symptoms? A comparison of nefazodone, psychotherapy, and their combination. Biol Psychiatry 51: 123–133CrossRefPubMedGoogle Scholar
  18. 18.
    Keller MB, McCullough JP, Klein DN et al. (2000) A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med 342: 1462–1470CrossRefPubMedGoogle Scholar
  19. 19.
    Kessler RC, McGonagle KA, Zhao S et al. (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 51: 8–19PubMedGoogle Scholar
  20. 20.
    Kiesler DJ (1996) Contemporary interpersonal theory and research: personality, psychopathology, and psychotherapy. Wiley, New YorkGoogle Scholar
  21. 21.
    Klein DN, Santiago NJ, Vivian D et al. (2004) Cognitive-behavioral analysis system of psychotherapy as a maintenance treatment for chronic depression. J Consult Clin Psychol 72: 681–688CrossRefPubMedGoogle Scholar
  22. 22.
    Klein DN, Schatzberg AF, McCullough JP et al. (1999) Early- versus late-onset dythymic disorder: comparison in out-patients with superimposed major depressive episodes. J Affect Disord 52: 187–196CrossRefPubMedGoogle Scholar
  23. 23.
    Klerman GL, Weissman M, Rounsaville BJ et al. (1984) Interpersonal psychotherapy of depression. Basic Books, New YorkGoogle Scholar
  24. 24.
    Kocsis JH (2003) Pharmacotherapy for chronic depression. J Clin Psychol 59: 885–892CrossRefPubMedGoogle Scholar
  25. 25.
    Manber R, Arnow B, Blasey C et al. (2003) Patient’s therapeutic skill acquisition and response to psychotherapy, alone or in combination with medication. Psychol Med 33: 693–702CrossRefPubMedGoogle Scholar
  26. 26.
    Markowitz JC (1994) Psychotherapy of dysthymia. Am J Psychiatry 151: 1114–1121PubMedGoogle Scholar
  27. 27.
    Makowitz IC, Kocsis IH, Bleiberg KL, Christos PJ, Sacks M (2005) A comparative trial of psychotherapy and pharmacotherapy for „prue“ dysthymic patients. J Affect Disord 89: 167–175CrossRefPubMedGoogle Scholar
  28. 28.
    McCullough JP (2000) Treatment for chronic depression. Cognitive behavioral analysis system of psychotherapy. Guilford Press, New YorkGoogle Scholar
  29. 29.
    McCullough JP (2001) Skills training manual for diagnosing and treating chronic depression: Cognitive Behavioral Analysis System of Psychotherapy. Guilford Press, New YorkGoogle Scholar
  30. 30.
    McCullough JP (2003) Treatment for chronic depression using Cognitive Behavioral Analysis System of Psychotherapy (CBASP). J Clin Psychol 59: 833–846CrossRefPubMedGoogle Scholar
  31. 31.
    Miller IW, Norman WH, Keitner GI (1999) Combined treatment for patients with double depression. Psychother Psychosom 68: 180–185CrossRefPubMedGoogle Scholar
  32. 32.
    Nemeroff CB, Heim CM, Thase ME et al. (2003) Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proc Natl Acad Sci USA 100: 14293–14296CrossRefPubMedGoogle Scholar
  33. 33.
    Piaget J (1926) The language and thought of the child. Harcourt Brace, New YorkGoogle Scholar
  34. 34.
    Piaget J (1981) Intelligence and affectivity: their relationship during child development. Annual Reviews, Palo AltoGoogle Scholar
  35. 35.
    Ravindran AV, Anisman H, Merali Z et al. (1999) Treatment of primary dysthymia with group cognitive therapy and pharmacotherapy: clinical symptoms and functional impairments. Am J Psychiatry 156: 1608–1617PubMedGoogle Scholar
  36. 36.
    Schatzberg AF, Rush AJ, Arnow BA et al. (2005) Chronic depression: medication (nefazodone) or psychotherapy (CBASP) is effective when the other is not. Arch Gen Psychiatry 62: 513–520CrossRefPubMedGoogle Scholar
  37. 37.
    Schramm E (1998) Interpersonelle Psychotherapie, 2. Aufl. Schattauer, StuttgartGoogle Scholar
  38. 38.
    Schramm E, Schweiger U, Hohagen F et al. (2006) Dt. Übersetzung und Bearbeitung von: McCullough JP (2000) Treatment for chronic depression. Cognitive Behavioral Analysis System of Psychotherapy. Elsevier, München (im Druck)Google Scholar
  39. 39.
    Skinner BF (1953) Science and human behavior. Macmillan, New YorkGoogle Scholar
  40. 40.
    Sullivan M (1953) The interpersonal theory of psychiatry. Norton Press, New YorkGoogle Scholar
  41. 41.
    Williams JW Jr, Barrett J, Oxman T et al. (2000) Treatment of dysthymia and minor depression in primary care: a randomized controlled trial in older adults. JAMA 284: 1519–1526CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Abteilung für Psychiatrie und PsychotherapieUniversitätsklinikum Freiburg
  2. 2.Département de PsychologieUniversité de Genève und Sanatorium KilchbergSchweiz
  3. 3.Abteilung für Psychiatrie und PsychotherapieUniversitätsklinikum FreiburgFreiburgDeutschland

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