Cognitive Behavioral Treatment for Chronic Depression

Individuals with chronic depression are often disconnected from the environment, meaning the consequences of their behavior do not impact  their future behavior. Cognitive Behavioral Assessment System of Psychotherapy (CBASP) is the only treatment model developed specifically for the disconnection involved 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 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 in the late-onset patients 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 dispair. Research indicates CBASP therapy is one of the few treatments than can effectively treat both early- and late-onset chronic depression.

In CBASP, patients examine the specific consequences of their interpersonal behavior. During this retraining, patients learn to become more perceptually connected to their environment, observing where their behavior is working against them. This goal is accomplished through a technique known as situational analysis. In situational analysis, the patient’s attention is directed to the effect of her behavior on others as well as the effect of her interpersonal behavior on the therapist. 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. An Exercise called the Interpersonal Discrimination Exercise helps to highlight this, by demonstrating to the patient how the therapist differs from past maltreating significant others.

This treatment has been shown to be highly effective in people whose depression symptoms do not respond to traditional talk therapy or to antidepressant medication. Click here 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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