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Handouts & questionnaires for depression, CBASP & neuroscience

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. 


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