BABCP spring meeting: CBASP & chronic depression, therapist support, mindfulness & health anxiety, and intrusions & control
Last updated on 21st June 2013
In the last few days I have written a series of posts about the BABCP Spring Conference & Workshops in Belfast - the most recent being "BABCP spring meeting: Arnoud Arntz on schema therapy for personality disorders". Besides Arntz's presentations, the two highlights of this Belfast meeting for me were a fascinating case series by John Swan using "CBASP" to treat chronic depression, and a bloody great rock thrown into the pool of my cosy understanding of intrusive thoughts by David A Clark. Alongside this were a report on the treatment of severely obese clients by the marvellously named Aurelia Ciblis from Dublin, another slightly depressing walk around the findings from the Oxford study on mindfulness for health anxiety by Freda McManus, and a bunch of three studies on support for therapists by Margaret O'Rourke, Craig Chigwedere and Joe Curran.
On this website's "Good knowledge" page "Handouts & questionnaires for depression, CBASP & neuroscience", I have written "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 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 you can download a copy of the Powerpoint slides. The current state of play 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) ... Professor James McCullough, the originator of CBASP, has a website that gives more detail of relevant books, research papers & training opportunities."
After reading the very encouraging initial big CBASP RCT published in 2000, I bought and studied McCullough's books and read his articles. I started trying out a CBASP approach with chronic depression sufferers. In 2007, when McCullough came over to the UK, I did a three day workshop with him. Then with the discouraging 2009 study, I backed off ... partly waiting for results from two further promised replication studies. These papers never materialised and my interest in CBASP dwindled. I was fascinated then when John Swan gave his paper in Belfast on "A case series studying intensive psychotherapy for chronic depression: Patient characteristics and clinical outcomes associated with 6 months of Cognitive Behavioural Analysis System of Psychotherapy (CBASP)" and I was doubly fascinated as it emerged that his outcomes were clearly positive. Again, these notes are from jottings I made during the lecture so they are largely correct but I don't guarantee that they are an entirely accurate description of what John said.
He commented that the typical duration of an acute depressive episode is about 20 weeks. However 20% or so of depression sufferers become chronically distressed. The typical duration of chronic depression is over 17 years. Of people in mental health treatment (I'm guessing this is treatment for depression), about 47% are suffering from chronic depression. John couldn't get the funding for an randomised controlled trial, however his case series consisted of people who had been depressed for an average of about 15 years. They were offered six months' treatment with CBASP. Of those who received > 3 sessions of therapy (e.g. 4 to 20 sessions) 30% ended with a Hamilton Rating Scale score of 8 or less (no longer depressed), 30% didn't achieve this "cure" but benefited significantly, and 40% were not significantly better. So for a group of people who on average had been suffering from chronic depression for 15 years - if they stayed in treatment with CBASP for 4 to 20 sessions - 60% recovered or improved significantly. Mm! Good. I button-holed John at the lunch break to talk more about his study. He commented that it seemed from their research that the CBASP technique of "situational analysis (SA)" was what produced most of the therapeutic benefit, with successful patients receiving 7 to 9 SA sessions. I'm going to dust off my old CBASP materials. I wonder too if situational analysis would produce even more benefit if it was linked with implementation intentions (and possibly mental contrasting) - see, for example, how implementation intentions boosted the benefits of more standard CBT interventions in "Making self-help more helpful: A randomized controlled trial of the impact of augmenting self-help materials with implementation intentions on promoting the effective self-management of anxiety symptoms."
... more to follow ...