Chronic Depression is a depressive disorder in adults that lasts continuously for two or more years; or one year continuously in adolescents.
It is a “Mood Disorder” that arises from traumatic experiences or interpersonal psychological insults delivered by the patient’s Significant Others (nuclear or extended family), particularly in adolescence.
The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is a talking therapy, a synthesis model of interpersonal and cognitive and behavioral therapies developed (and patented) by James P. McCullough Jr of Virginia Commonwealth University.
Basic assumptions of CBASP
- Absence of felt interpersonal safety in patients – Chronic mood (eg chronic depression) denotes an absence of felt safety as regards (a) the precipitating (original) trauma event(s) or on a less sudden and violent level, (b) maltreating-hurtful Significant Others who have inflicted psychological insults on the individual through interpersonal rejection, harsh punishment, censure, or emotional abandonment/neglect. The lack of felt safety (c) has been transferred to a generalized fear of interpersonal relationships.
- No change is possible as long as interpersonal avoidance patterns remain – As noted above, no emotional modification or termination of the chronic depression mood is possible apart from terminating patient interpersonal avoidance by enabling them to encounter the original precipitating trauma (violent/sudden event) or the psychological insults that stem from chronic interpersonal punishment, abuse or emotional neglect. The active arena where change processes are targeted and occur in CBASP psychotherapy involves the current interpersonal milieu within which the patient functions.
Treatment Strategies for Chronic Depression
In-session focus exercises in an atmosphere of felt safety help patients confront the feared stimuli and modify the Pavlovian fear driving the refractory emotional state. Learning appropriate non-avoidant ways to deal with the fear stimuli also decreases Skinnerian avoidance behavior and prepares the way for mood change.
Another way to describe what’s going on in the beginning of therapy is to say that patients are avoiding others (including the therapist) and not responding to the interpersonal environment. Interpersonal avoidance always dictates that the patient’s primary focus remains on himself or herself (ie patients stay “in their heads”). In such a psychosocial functioning state, these individuals remain helpless and hopeless and continue to respond to themselves in a solitary and never-ending circle of pain, fear, anxiety (and depression); hence, they are unable to connect with their interpersonal world in any informing way.
CBASP administers a structured exercise called “Situational Analysis (SA)”. SA teaches patients to recognise the cause and effect relationships in their interpersonal interactions which in turn helps them to identify their contributory role in producing the people-problems they complain about. SA seeks to remedy the patient’s generalised and pernicious assumption: “It doesn’t matter what I do!”
Therapist role – A feature of CBASP is the interpersonal role of the psychotherapist. CBASP clinicians enact a “Disciplined Personal Involvement Role” to heal the injurious interpersonal traumas and psychological insults patients have received at the hands of harmful Significant Others.
The Goals of CBASP Treatment & Beyond
The outcome and goals of CBASP treatment for chronic depressions are:
- To connect patients perceptually and behaviorally to the interpersonal world they live in, so that their behavior is informed by environmental (interpersonal) influences;
- CBASP teaches patients how to make themselves feel better emotionally as well as how to maintain affective control;
- Patients are taught to negotiate interpersonal relationships successfully which means that patients acquire the requisite skills to obtain desirable interpersonal goals;
- And finally, patients learn the crucial importance of “maintaining” the treatment gains after psychotherapy ends. Maintaining the gains, requires daily practice of the in-session learning which protects (perpetuates) the extinction of the old pathological patterns of behavior. Post-therapy practice for the rest of their lives holds in abeyance the ever-present danger of relapse and recurrence.
If you suspect you – or perhaps a loved one – may be struggling with chronic depression, please make an appointment with me.
Author: Dr David Wells, B Psych (Hons), Dip Prof Couns, D Psych (Clin Geropsychology).
David is a Clinical Psychologist, with a keen interest in couples counselling. He strives to provide a safe environment for his clients to explore their issues and, with assistance, develop new techniques which will help them change their unproductive behaviours. The aim is to have a happier life that assists people reach their relationship, personal and life goals.
To make an appointment with Dr David Wells Psychologist, try Online Booking – Mt Gravatt or call Vision Psychology on (07) 3088 5422.