CBT Treatment for Chronic Depression

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Most people who suffer from depression experience depressive symptoms for a limited duration, on average, 20 weeks. This is what is considered acute depression, meaning an episode of depression lasting a discrete period of time. However, some who experience acute depression go on to have symptoms that endure for an extended period, lasting many months or years. This is considered chronic depression. Chronic depression lasts at least six months, in which more days than not significant depressive symptoms are present. Research has shown that chronic depression can be more difficult to treat, requiring a longer course of treatment and different interventions than acute depression. Cognitive Behavioral Assessment System of Psychotherapy (CBASP) is the only treatment model developed specifically for people with chronic depression (Shatzberg et al., 2005). It is the subject of the largest study on psychotherapy in history, and has shown to be significantly more effective than other treatments for chronic depression. 

According to the CBASP model, maltreatment and trauma experienced early in life can derail normal psychological development, and sometimes results in early-onset chronic depression. Such maltreatment can take many forms, from physical abuse to perceived invalidation. Alternatively, an out-of-control mood state later in life can also undermine psychological functioning in people with no history of neglect or abuse. Significant life events such as the onset of chronic illness, loss, and divorce can trigger such a mood state and result in lasting feelings of sadness and despair. Research has shown CBASP therapy is one of the few treatments than can effectively treat both early- and late-onset chronic depression.

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Through CBASP treatment, people learn to objectively examine the consequences of their interpersonal behavior in specific kinds of interactions. Through this process, patients learn to become more perceptually connected to their environment, observing where their behavior is working against them and identifying behavior more consistent with their desired outcome. It is this process that, over time, helps people move from persistent feelings of helplessness to an increased sense of mastery and contentment. These gains are accomplished through a technique known as situational analysis.

In situational analysis, one’s attention is repeatedly directed to the effect of one’s behavior on others as well as the effect of one’s own interpersonal behavior on the therapist. Working through the situational analysis over time, the interpersonal trauma the patient brings to treatment is healed by separating those elements of the patient’s past she is projecting onto the present.

CBASP treatment has been shown to be highly effective in people whose depression symptoms do not respond to traditional talk therapy or to antidepressant medication. If you or someone you know is struggling with chronic depression, click for more information about cognitive behavioral treatment of depression


Shatzberg, A.F. et al. (2005). Medication or therapy is effective when the other is not. Archives of General Psychiatry, 62, 513-520.

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