Treatment for Chronic Depression

James P. McCullough, Jr., PhD, is a fellow of the American Psychological Association and was elected a Diplomate in Clinical Psychology by the American Board of Psychological Forensic Examiners. He is is Emeritus Professor of Psychology at Virginia Commonwealth University, where he served on the faculty for 45 years. An award-winning educator and researcher, Dr. McCullough's areas of special interest are dysthymia, double depression, and chronic major depression, particularly diagnostic criteria; unipolar diagnostic category psychosocial comparisons; and cognitive and single-case methodology evaluating both private practice and research.

Chronic depressions are often complex and not very responsive to standard approaches in cognitive and behavior therapy. The approach developed by Dr. James McCullough overcomes common barriers to effective psychotherapy by helping the chronically depressed patient become more specific and focused on achieving goals and improving interpersonal relationships. CBASP is an important and highly useful addition to our treatment regimens. --Michael E. Thase, MD, Department of Psychiatry, Western Psychiatric Institute & ClinicCBASP--a distillation of 25 years of clinical and research work--is a practical, teachable, and now empirically tested time-limited psychotherapy for chronic depression. This volume will be a standard for training social workers, nurses, psychologists, psychiatrists, and counselors in how to treat this most disabling and difficult condition. Case vignettes bring the treatment principles to life, illustrating how to motivate patients, use the therapist-patient relationship, and evaluate how well patients are acquiring needed perceptual, behavioral, and cognitive skills. This is the first clearly articulated therapy specifically designed and tested with chronically depressed patients. A 'must read.' --A. John Rush, MD, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TXMcCullough has developed a unique and synthetic approach specifically geared to chronic depressions, distilled from years of research and practice with this challenging population. The approach brings together key aspects of interpersonal and cognitive-behavioral approaches within a structured short-term format that focuses on the functional implications of the depressed individual's behavior. As McCullough describes, the approach recently received strong empirical support in a large multi-site clinical trial. Rich in clinical detail and concrete examples, this volume will be useful for both experienced psychotherapists and trainees from all mental health disciplines who work with persons suffering from chronic depression. --Daniel N. Klein, PhD Professor of Psychology and Director of Clinical Training State University of New York at Stony BrookJames McCullough has devoted his career to treating chronic depression, a challenging syndrome that often drives patients and their therapists to despair. His CBASP approach, a practical amalgam of behavioral, cognitive, interpersonal and psychodynamic interventions, helps patients to master the social functioning they find so difficult. And it works! A major study has found CBASP to have efficacy equal to medication, and CBASP plus medication to work better than either alone. Clinicians who face the prevalent problem of chronic depression should read this impressive book --John C. Markowitz, MD, Associate Professor of Psychiatry, Cornell University Medical College; Author of Interpersonal Psychotherapy for Dysthymic Disorder[A] very exciting book....Complicated problems cannot readily be resolved by simple solutions, and our currently available interventions, which are theoretically pure, may not have the conceptual and procedural breadth to provide what chronically depressed patients need. McCullough's approach does. It focuses on the depressed patient's problems in living and, while acknowledging the influence of biological factors, offers a creative integration of the contributions to our understanding of human behavior made by such seemingly diverse individuals as Sullivan, Piaget, and Skinner....McCullough has given us a clinically sound and empirically grounded approach to the treatment of chronic depression. --From the Foreword by Marvin R. Goldfried, PhD, State University of New York at Stony Brook - [This] book will become more than compulsory reading: it will become a keystone for advanced training in the psychotherapy of patients with chronic depression....For the researcher, McCullough demonstrates a clinically significant therapy approach for chronic depression that begs consideration of certification in this method....I recommend the book very strongly for the treatment of chronically depressed patients by therapists who have been in practice for 24 months to 24 years. --Journal of Clinical Psychiatry, 8/29/2003ƒƒ The book is exciting because it presents a stimulating integrative theory of psychopathology and therapy and because it describes a complex and multifaceted treatment that has been shown to be effective in a large clinical trial....It is likely to be widely read by advanced graduate students, clinicians, and researchers interested in cognitive-behavioral and eclectic treatment. It should also be of great interest to dynamic therapists trying to help treatment-resistant patients. --Contemporary Psychology, 8/29/2003

• I. CBASP and the Psychopathology of the Patient1. A Therapist's Problems with a Chronically Depressed Patient2. Introduction to Chronically Depressed Patients and the CBASP Program3. Understanding the Psychopathology of Chronically Depressed Patients4. Course Patterns, Comorbidity, and Psychological CharacteristicsII. CBASP Method and Procedures5. Strategies to Enhance Motivation for Change6. Elicitation Phase of Situational Analysis7. Remediation Phase of Situational Analysis8. Using the Therapist-Patient Relationship to Modify Behavior 9. Measuring Acquisition Learning and Generalized Treatment EffectsIII. History and Other Aspects of CBASP10. CBASP Emergence on the National Scene11. Training CBASP Psychotherapists12. Comparison of CBASP to Beck's Cognitive Therapy and Klerman's Interpersonal Psychotherapy Models 13. Resolving Common Patient Problems and CrisesAppendix A: Therapist Prompts for Administering Situational Analysis (PASA)Appendix B: Rating Scales for Adherence Monitoring and for Evaluating the Quality of the Interpersonal RelationshipAppendix C: Rating the Presence of Optimal CBASP Psychotherapist Qualities and Abilities