Treating Chronic Depression with Disciplined Personal Involvement

"Research growing out of practice" best describes the way Dr. James P. McCullough, Jr., Professor of Psychology & Psychiatry of Virginia Commonwealth University, has conducted his 35-year university career. During the mid-1970s, Dr. McCullough began working with chronically depressed outpatients. At the time, chronic depression was considered to be a personality disorder and not thought to be responsive to medication or psychotherapy. Dr. McCullough developed his therapy model, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), while working with chronically depressed patients. He investigated the treatment efficacy of CBASP using single-case design methodology and published the first articles on CBASP in 1980 and 1984. With the publication of the Diagnostic and Statistical Manual of Mental Disorders-Third Edition (DSM-III) in 1980, the American Psychiatric Association removed chronic depression from personality disorder status and redefined it (dysthymia) as a psychological disorder. Chronic depression was suddenly thrust into the mainstream of clinical treatment and research where it has remained ever since. In addition to developing a psychotherapy method to treat the disorder, in 1980, Dr. McCullough began a series of diagnostic investigations studying chronically depressed nonpatients for extended periods of time. The aims of this research were to investigate the psychological characteristics of chronically depressed individuals over time, to determine when the disorder began, and to see if the disorder would remit spontaneously with time. He found very few remissions (13%) and of those who did, over half relapsed within two years. The majority of the nonpatients reported an onset which began during adolescence. Dr. McCullough concluded that chronic depression is in large measure a "disorder of adolescence" and indeed a lifetime problem that doesn't improve over time without adequate treatment. His diagnostic research continues up to the present time. In the late 1980s, Dr. McCullough served as a Field Trial Site Coordinator studying dysthymia, major depression, and two minor depressions in the American Psychiatric Association's DSM-IV revision project. He has also participated as a Principal Investigator in two national, multi-site investigations involving 1316 chronically depressed outpatients. The second study utilized CBASP alone and in combination with medication and compared both groups to a medication alone group. Patients who completed the acute phase of the study and who received combination treatment obtained the highest response rates (85%) ever reported in a depression study. The results were published in a lead article in May of 2000 in The New England Journal of Medicine. Dr. McCullough is currently participating as Principal Investigator in a 4-year NIMH treatment project enrolling 910 chronically depressed outpatients at 8 sites in the U.S. CBASP is being used as an augmentation strategy for patients who do not fully remit during a three months medicine-only acute phase. He currently remains at Virginia Commonwealth University in the Department of Psychology teaching psychotherapy to clinical psychology graduate students and training mental health professionals both in this country and abroad to administer CBASP. His books have been translated into German, Japanese, and Spanish. See www.cbasp.org link for more psychotherapy training information.

"McCullough's Treating Chronic Depression With Disciplined Personal Involvement is a breath of fresh air. It is edgy, innovative, gutsy, and engaging. McCullough places his therapeutic approach in context by comparing it with other therapies, making his book both scholarly and absorbing. He presents a high-risk-high-gain approach for chronically depressed patients, an extremely difficult group with which to work. The volume contains extensive and intense patient-therapist dialogue. This dialogue provokes tension, anxiety, and self-reflection in the reader and is extremely useful for conveying a feel for this approach. Congratulations to McCullough on this remarkable work. He has made an extremely important contribution to both the treatment of chronic depression and the larger literature on the curative power of the therapist-patient relationship." -Laurence P. Riso, PsycCRITIQUES, Contemporary Psychotherapy - APA Review of Books, Volume 52, Issue 33 "Dr. McCullough's incredible insights led him to develop a unique form of psychotherapy for chronic depression that has a staggering rate of success, as reported in the NEJM, 2000. World-wide application of this therapy, based upon his remarkable text, The Treatment for Chronic Depression, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), is comparable to Fleming's discovery of Penicillin. This newest text, Treating Chronic Depression with Disciplined Personal Involvement, is a major contribution to the scientific refinement of therapy and is applicable, in my judgment, to virtually all who committed to understanding and relieving the unspeakable suffering of depression." - Robert S. Brown, Sr., M.D., Ph.D.,Clinical Professor of Psychiatric Medicine, School of Medicine,University of Virginia, Richmond, VA, USA "Combining a series of deftly interwoven case examples and written commentary, Dr. McCullough provides a clear indication of the major methods of CBASP in this volume. His passion for patients with chronic depression comes through clearly in these pages, as does the desire to integrate theory and research in the further development of this approach to treating this mental health problem. This volume will undoubtedly go a long distance to making CBASP better known and used in helping patients with chronic depression." - Keith S. Dobson, Ph.D., President-elect, International Association of Cognitive Psychotherapy, Professor and Head, Department of Psychology, University of Calgary, Alberta, Canada "Sixty years of empirical research on the therapeutic bond has shown that the patient-therapist relationship is of fundamental importance, but the theories and applications have tended to be overly general and vague. In his revolutionary new book, Professor McCullough has filled the void and the practice of psychotherapy, thankfully, will never be the same. With firm historical precedent, straightforward theory and engaging constructs, and a wealth of detailed and intriguing case histories followed by sage clinical commentary, this work is both a call to arms and a detailed training manual for a new (and better) generation of psychotherapists." - Kent Bailey, Ph.D., Professor Emeritus, Virginia Commonwealth University, Richmond, VA, USA "McCullough is a pioneer in the psychotherapy of chronic depression. The techniques outlined in this volume are truly innovative and thoughtful and he brings obvious passion and compassion to the therapeutic endeavor. I am touched by his wisdom and dedication and highly recommend this book." -James H. Kocsis, M.D., Professor of Psychiatry,Weill Cornell Medical College, New York, NY, USA

• Preface.- Chapter 1. Disciplined Personal Involvement. Disciplined Personal Involvement Scenarios. Disciplined Personal Involvement for the Chronically Depressed Patient. Use of the Word "patient". The Self-Disclosure Research Literature. The Aims of the Book.- Part I. The Personal Involvement Taboo and the Needs of the Patient. Chapter 2. The History of the Personal Involvement Taboo. Sigmund Freud (1856-1939). Carl Rogers (1902-1987). The Therapeutic Alliance Research Tradition (1936-present). The Interpersonal Psychotherapy of Donald J. Kiesler. Personal Involvement Pioneers: Gary Prouty and Kent G. Bailey.- Chapter 3. Treating the Chronically Depressed Patient. Overestimating the Capability of the Chronically Depressed Patient. The Psychopathology of the Chronically Depressed Patient. Interpersonal Isolation of the Chronically Depressed Patient Case History: Sara.- Part II. Pedagogy of CBASP Training.- Chapter 4. Disciplined Personal Involvement Training. Introduction. Rationale for Using Disciplined Personal Involvement.- Personal Issues and Questions of CBASP Trainees. CBASP Therapist Reactions to Personal Involvement Training. Conclusions.- Part III.-Pedagogy of CBASP Treatment. Chapter 5. Creating Contingent Environments Using Disciplined Personal Involvement. Introduction.-Therapist Role Characteristics. Situational Examples of Disciplined Personal Responsivity. Conclusion.- Chapter 6. Healing Interpersonal Trauma Using the Interpersonal Discrimination Exercise. Introduction. Normal and Preoperational Models of Cognitive-Emotional Functioning.- Sessions One and Two of CBASP Therapy. CBASP Transference Hypothesis Construct. The IDE: Discriminating Malevolent Affective Experiences from Healing Ones. IDE Verbatim Scenarios: Demonstrations of the Method. Conclusion. Afterword.- Appendix. Research Investigations to Determine "How" CBASP Works. Two Types of Dependent Variables. Needed Stage II CBASP Research. Performance Measures Reflecting In-Session Acquisition Learning. GTE Measures that Can Be Used In Future Stage II Trials.- Summary of Remaining Stage II Research Questions.