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Cognitive Behavioral Analysis System of Psychotherapy (CBASP) als schulenübergreifende Psychotherapie der chronischen Depression

Published Online:February 17, 2015https://doi.org/10.1026/1616-3443/a000281

Abstract

Die chronische Depression ist eine schwer beeinträchtigende psychische Störung, welche meist schon während der Kindheit beginnt. Viele der betroffenen Patienten berichten über frühe traumatisierende Beziehungserfahrungen mit wichtigen Bezugspersonen. Aufgrund der hohen Therapieresistenz stellt sie eine therapeutische Herausforderung dar. Das Cognitive Behavioral Analysis System of Psychotherapy (CBASP) ist die erste Psychotherapie, welche speziell für diese Patientengruppe entwickelt wurde. CBASP kombiniert schulenübergreifend behaviorale, kognitiv-emotionale, interpersonelle und psychodynamisch-analytische Theorien, indem Kindheits- und Lebenserfahrungen in einen Zusammenhang zu aktuellen interpersonellen Problemen gestellt werden. Zentrale Therapie-Elemente sind die Liste prägender Bezugspersonen mit Übertragungshypothesen, Situationsanalysen mit Verhaltenstrainings durch Rollenspiele, interpersonelle Strategien und Transferübungen. Die therapeutische Rolle ist gekennzeichnet durch das disziplinierte Preisgeben eigener Gefühle und Reaktionen auf die Verhaltensweisen chronisch Depressiver, um dem Patienten korrigierende und heilsame Beziehungserfahrungen zu ermöglichen. Randomisiert kontrollierte Studien und Einzelfallstudien konnten die Wirksamkeit von CBASP in der Behandlung der chronischen Depression nachweisen. Nach den Kriterien der American Psychiatric Association kann CBASP mittlerweile als empirisch validiert angesehen werden. Weitere Studien, insbesondere zum Vergleich mit anderen Psychotherapien sowie Prozess- und Prädiktorstudien, sind jedoch wichtig und laufen derzeit. Zudem wird CBASP für verschiedene Settings (stationär, in Gruppen) und andere Störungsbilder modifiziert.Im Beitrag erfolgt abschließend eine kritische Diskussion und Würdigung des Ansatzes.


The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) as Treatment for Chronic Depression

Chronic depression (CD) is a severe and disabling disorder that often begins in early childhood. Most of the patients underwent traumatic experiences in interpersonal relationships. Because of high treatment resistance, treating CD often poses a therapeutic challenge. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is the first treatment tailored to the particular needs of CD patients. It integrates cognitive-emotional, behavioral, interpersonal, and psychodynamic/psychoanalytical theories from different schools by putting childhood and life experiences in relation with current interpersonal problems. Main treatment elements are the significant other history with transference hypotheses, situational analyses with role play, interpersonal strategies, and transfer exercises. The therapist’s role is characterized by the disciplined disclosure of own feelings and reactions according to the needs of chronic depressive patients making corrective and healing interpersonal experiences possible. Randomized-controlled studies and case studies have proven the efficacy of CBASP in the treatment of chronic depression. According to the criteria of the American Psychiatric Association, CBASP could be labeled as an empirically supported treatment. Further studies, especially studies comparing CBASP to other psychotherapies as well as process and predictor studies, are crucial and ongoing. In addition, CBASP was modified for other settings (inpatients, groups) and other disorders. The article ends with a critical discussion and appreciation of the CBASP approach.

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