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European Archives of Psychiatry and Clinical Neuroscience

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01-12-2018 | Original Paper

Cognitive Behavioral Analysis System of Psychotherapy as group psychotherapy for chronically depressed inpatients: a naturalistic multicenter feasibility trial

Authors: Lena Sabaß, Frank Padberg, Claus Normann, Vera Engel, Carsten Konrad, Kristina Helmle, Andrea Jobst, Andrew Worlitz, Eva-Lotta Brakemeier

Published in: European Archives of Psychiatry and Clinical Neuroscience | Issue 8/2018

Abstract

The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is a relatively new approach in the treatment of chronic depression (CD). Adapted as group psychotherapy for inpatients, CBASP is attracting increasing attention. In this naturalistic multicenter trial, we investigated its feasibility after 10 sessions of CBASP group therapy over a treatment time of at least 5 to a maximum of 10 weeks. Treatment outcome was additionally assessed. Across four centers, 116 inpatients with CD (DSM-IV-TR) attended CBASP group psychotherapy. Feasibility was focused on acceptance, and evaluated for patients and therapists after five (t1) and ten sessions (t2) of group psychotherapy. Observer- and self-rating scales (Hamilton Depression Rating Scale—24 items, HDRS₂₄; Beck Depression Inventory-II, BDI-II; World Health Organization Quality of Life assessment, WHOQOL-BREF) were applied before group psychotherapy (t0) and at t2. Dropouts were low (10.3%). Patients’ evaluation improved significantly from t1 to t2 with a medium effect size (d = 0.60). Most of the patients stated that the group had enriched their treatment (75.3%), that the size (74.3%) and duration (72.5%) were ‘optimal’ and 37.3% wished for a higher frequency. Patients gave CBASP group psychotherapy an overall grade of 2 (‘good’). Therapists’ evaluation was positive throughout, except for size of the group. Outcome scores of HDRS₂₄, BDI-II, and WHOQOL-BREF were significantly reduced from t0 to t2 with medium to large effect sizes (d = 1.48; d = 1.11; d = 0.67). In this naturalistic open-label trial, CBASP, when applied as inpatient group psychotherapy, was well accepted by patients and therapists. The results point towards a clinically meaningful effect of inpatient treatment with CBASP group psychotherapy on depression and quality of life. Other potential factors that could have promoted symptom change were discussed. A future controlled study could investigate the safety and efficacy of CBASP group psychotherapy for inpatients.

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We received the PEF (n = 101) of almost all patients completing the 10 group sessions. However, we had a smaller sample after 5 sessions (t1) as we handed out the questionnaires and did not receive them back or failed to follow up on this. This left 70 for comparison of t1 and t2.

We had to exclude patients in study center 3, because the study center deviated from the protocol and failed to let the questionnaire being filled out at t2.

All effect sizes of studies were recalculated if necessary using the formula M2 − M1⁄ SD_pooled, where SD_pooled = √((SD ₁ ² + SD ₂ ² )/2) to allow for direct comparisons.

The study by Brakemeier et al. (2015) followed 70 patients in the 12-weeks inpatient program at the Department of Psychiatry and Psychotherapy at the University of Freiburg. Of these 44 patients were also recruited for this study, but time points of assessment were different.

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Title: Cognitive Behavioral Analysis System of Psychotherapy as group psychotherapy for chronically depressed inpatients: a naturalistic multicenter feasibility trial
Authors: Lena Sabaß
Frank Padberg
Claus Normann
Vera Engel
Carsten Konrad
Kristina Helmle
Andrea Jobst
Andrew Worlitz
Eva-Lotta Brakemeier
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Psychiatry and Clinical Neuroscience / Issue 8/2018
Print ISSN: 0940-1334
Electronic ISSN: 1433-8491
DOI: https://doi.org/10.1007/s00406-017-0843-5

At a glance: The STEP trials

Springer Medicine

Cognitive Behavioral Analysis System of Psychotherapy as group psychotherapy for chronically depressed inpatients: a naturalistic multicenter feasibility trial

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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