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Cognitive Behavioral Assessment System of Psychotherapy (CBASP) for Chronic Depression
Individuals with chronic depression are disconnected from the environment, meaning that the consequences of their behavior do not have a positive impact on informing their future behavior. CBASP is the only treatment model developed specifically for the disconnection involved with chronic depression. It is the subject of the largest study on psychotherapy in history, and has shown to be significantly more effective than any other chronic depression treatments.
Maltreatment and trauma experienced early in life can derail normal psychological development, and results in early-onset chronic depression. Maltreatment can take many forms, from physical abuse to perceived invalidation. Often,this results in children learning early on that they cannot rely on others, that they cannot make mistakes, or that they cannot express what they are really thinking and feeling. As adults, these individuals usually carry the same assumptions, and act in ways that recapitulate the experiences from early childhood. For example, the child who was neglected and learns that others will always let you down, grows up to be the adult who never relies on others, and as a result, never has the experience of feeling supported by others.
Chronic depression can develop in adulthood as well. Significant life events such as the onset of chronic illness, loss, or trauma can trigger an intense mood state that results in more chronic emotion dysregulation. Though not necessarily subject to childhood maltreatment, adults can develop the same sorts of ineffective assumptions, resulting in persistent feelings of emptiness and depression. Research indicates CBASP therapy is one of the few chronic depression treatments than can effectively treat both early and late-onset chronic depression.
In CBASP, patients learn to examine the specific consequences of their interpersonal behavior. By learning to rely less on assumptions and more on the actual environment, people find that they are better able to make more effective assumptions about others. During this retraining, patients become perceptually connected to their environment. Perceptual connectedness means that the person becomes accessible to feedback from others, and learns to get more out of interpersonal interactions. In a way, CBASP helps people to get what they want (i.e. have more meaningful rewarding relationships) from others. This goal is accomplished through a technique known as situational analysis.
In situational analysis, the patient’s attention is directed to the effect of his/her behavior on others as well as the effect of his/her interpersonal behavior on the therapist, real-time. By looking at difficult interpersonal encounters more closely, and identifying better ways of thinking about them and reacting, people learn to develop thoughts and behaviors that are more grounded in the actual situation, and not the past trauma. During CBASP, the interpersonal trauma the patient brings to treatment is healed by piecing apart those elements of the patient’s past she is projecting onto the present, and restructuring the present relationships.