Chronic depressions are difficult to treat. A new form of psychotherapy, CBASP, has been specifically developed for this subgroup of depressed patients by James McCullough (USA). In a large multisite randomized controlled trial, the combination of CBASP with antidepressant medication was considerably more effective than antidepressants alone (response rates of 73% versus 48% respectively). Therefore, CBASP is regarded as an evidence based therapy for chronic depression and mentioned in most depression treatment guidelines. Yet, the dissemination of this form of psychotherapy is still limited.

In the Netherlands, 25 therapists were trained by McCullough, and participate in a recently started (June 2007) randomized controlled trial, comparing CBASP with usual care in outpatient psychiatric clinics. The basic structure of the CBASP sessions is cognitive behaviorally oriented. Patients are learned to perform analyses of specific situations, and bring in and discuss a situational analysis form every session. As this approach alone often fails in chronic depressed patients, who are often emotionally detached and avoidant, other techniques are used to develop a therapeutic relationship, and to confront the patient with his/her behavior and opportunities to change. These techniques concern transference issues, and so-called disciplined personal involvement of the therapist.

This presentation will focus on the content of the CBASP therapy and on our experiences in learning and providing CBASP. Additionally, the study design of the randomized controlled trial will be presented.

CBASP is an interesting and promising treatment for chronically depressed patients.