James P Mccullough

Virginia Commonwealth University | VCU · Department of Psychology

The characteristics of the optimal CBASP therapist role for the treatment of the Persistent Depressive Disorder patient (chronic depression) is delineated in this paper. This paper contains the opinions and experiences of the creator of CBASP who has developed and revised the model over more than 4 decades. The paper is not a rigorous study nor a r...

The cognitive behavioral analysis system of psychotherapy (CBASP) is designed specifically for chronic depression and is based on Donald Kiesler’s interpersonal model, with the role of the psychotherapist being administered from a disciplined personal involvement perspective. To achieve its learning goals, CBASP has been operationalized such that t...

Objective: Childhood maltreatment, interpersonal fear and a specific kind of interpersonal skills deficit (preoperational thinking) have all been associated with persistent depressive disorder (PDD). We hypothesize that interpersonal fears mediate the association between childhood maltreatment and preoperational thinking. Method: A total of 108 mat...

Dysthymia was introduced in DSM-III as a form of chronic depression, while DSM-III-R added a second diagnostic category for chronic depression and labeled it chronic MD. Persistent depression disorder (PDD) is maintained by two pathological core problems the patient has not been able to resolve. First core problem is a pervasive fear avoidance stat...

Assessment of clinical course to aid in the diagnosis of patients and to guide treatment planning has gained momentum in recent years. A course-graphing scale for the DSM-5 Mood Disorders is presented to facilitate clinical history-Taking and diagnosis of the mood disorders during the screening interview. The scale can be administered in the more t...

Assessment of the variations of clinical course to aid in diagnosis, assessment of patients’ functioning and to guide treatment planning has gained momentum in recent years. A specific scale is introduced to plot the temporal course to assist empirically-minded psychotherapists and researchers who treat the DSM-5 Disorders and who want to monitor t...

Assessment of the variations of clinical course to aid in diagnosis, assessment of patients' functioning and to guide treatment planning has gained momentum in recent years. A specific scale is introduced to plot the temporal course to assist empirically-minded psychotherapists and researchers who treat the DSM-5 Disorders and who want to monitor t...

Background: It is widely agreed that chronic depression is difficult to treat, knowledge about optimal treatment approaches is emerging. Method: A multisite randomized controlled trial was conducted comparing the cognitive behavioral analysis system of psychotherapy (CBASP), a psychotherapy model developed specifically to treat chronic depressio...

Objective: We evaluated whether childhood trauma moderated the treatment effect on depression and smoking outcomes in pregnant smokers. Method: The sample included pregnant smokers participating in a randomized trial evaluating the efficacy of a 10-session interpersonally focused therapy-cognitive behavioral analysis system of psychotherapy (CBA...

Studies researching psychotherapeutic interventions for treatment-resistant depression (TRD) are quite new to the field. The Cognitive Behavioural Analysis System of Psychotherapy (CBASP) is the only model developed specifically to treat the chronically depressed patient. While empirical evidence indicates that CBASP is an effective treatment for c...

»Für die Rolle des Analytikers gibt es im wahren Leben kein Vorbild. A. Hoff er (2000)«

» Mich persönlich einzubringen widerstrebte meinem Verständnis von der therapeutischen Beziehung. Ich hatte Bedenken dabei, mit einem Patienten etwas Persönliches zu teilen. Ich hatte das Gefühl, dass es eine bestimmte Grenze gibt, die ein Therapeut nicht überschreiten darf, damit Psychotherapie eff ektiv ist. DPG, Klinischer Psychologe in Ausbildu...

» »Prinzip A: Gutes tun und nicht schaden. Psychologen streben danach, den Menschen mit denen sie arbeiten, zu nützen und dafür zu sorgen, dass sie ihnen nicht schaden… Da sich die wissenschaftlichen und professionellen Bewertungen von Psychologen auf das Leben anderer auswirken können, sind sie aufmerksam und beugen persönlichen, finanziellen, soz...

»Am 3. September 2004 erschien ein interessanter Artikel im Wall Street Journal über Therapeuten, die mit ihren Patienten über persönliche Erfahrungen sprechen. … Für uns Therapeuten der alten Schule ist dieses Therapeutenverhalten schockierend. Man hat uns vermittelt, während der Therapiesitzungen nicht über unser persönliches Leben zu sprechen. M...

»Wenn wir wissenschaftliche Methoden in Humanwissenschaften anwenden, müssen wir annehmen, dass Verhalten Gesetzen gehorcht und determiniert ist. Wir müssen erwarten, zu entdecken, dass das, was ein Mensch tut, das Ergebnis spezifi zierbarer Bedingungen ist und dass, sobald diese Bedingungen deutlich geworden sind, wir seine Handlungen vorhersagen...

»Psychologische Veränderungen können auch später im Leben auftreten durch den Einfluss von einer oder mehreren ‚neuen‛ Bezugspersonen im Zusammenspiel mit der Entwicklung formaloperatorischen Denkens. Katherine L. Schaefer (2004)«

An interpersonal-emotional history procedure, the Significant Other History, is administered to the early-onset chronically depressed patient during the second therapy session in the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Patients are asked to name up to six significant others and answer two questions: (1) What was it like g...

IntroductionCase of Sam SmithEnd of Therapy AssessmentSummary

An intensive empirical methodology is introduced to evaluate the efficacy of Cognitive Behavioral Analysis System of Psychotherapy (CBASP) treatment for outpatients with early onset chronic depression. The patient with chronic illness presents a unique measurement challenge to psychotherapists. One of the most prominent reasons is the refractory na...

The objective of this study was to evaluate a depression-focused treatment for smoking cessation in pregnant women versus a time and contact health education control. We hypothesized that the depression-focused treatment would lead to improved abstinence and reduced depressive symptoms among women with high levels of depressive symptomatology. No s...

The Cognitive Behavioral Analysis System of Psychotherapy (CBASP; Keller, McCullough, Klein, Arnow, Dunner, Gelenberg et al., 2000; McCullough, 1984, 2000, 2006) is a psychological treatment program developed specifically for chronically depressed patients (Klein, in press; McCullough, Klein, Borian, Howland, Riso, Keller, et al., 2003). In the Dia...

I've tried to show that CLT may offer clinicians a way to increase response rates and reduce relapse and recurrence rates following treatment termination. Before such conclusions can be drawn, however, randomized clinical trials must be undertaken demonstrating that treatment outcomes are related to the degree of learning that occurs in practice; s...

This study examined coping styles and attributions for negative events among chronically depressed outpatients to determine whether these variables mediated differences in depression treatment outcome between combined nefazodone and cognitive behavioral analysis system of psychotherapy (CBASP), versus nefazodone and CBASP alone. Chronically depress...

'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP) is a form of psychotherapy specifically developed for patients with chronic depression. In a study in the U.S., remarkable favorable effects of CBASP have been demonstrated. However, no other studies have as yet replicated these findings and CBASP has not been tested outside the United...

The Luborsky et al. (2002) meta-analytic article is discussed in terms of (1) its lack of treatment-patient (independent variable) specificity concerns and (2) its failure to address an essential goal of psychotherapy research: “What treatment, by whom, is most effective for this individual with that specific problem, under which set of circumstanc...

In this chapter I discussed the rationale underlying the IDE and illustrated how disciplined personal involvement is integrated in the IDE and used to heal developmental trauma. CBASP therapists, by highlighting their salubrious strivings with patients in IDE work, expose patients to positive interpersonal experiences that contrast sharply with lea...

In this chapter I discussed the rationale underlying the IDE and illustrated how disciplined personal involvement is integrated in the IDE and used to heal developmental trauma. CBASP therapists, by highlighting their salubrious strivings with patients in IDE work, expose patients to positive interpersonal experiences that contrast sharply with lea...

This study examined the influences of proposed specific and common psychotherapeutic factors in a sample of chronically depressed adult outpatients. Participants (N = 324) were drawn from a multi-site clinical trial that compared the efficacies of the cognitive behavioral analysis system of psychotherapy (CBASP), nefazodone, and their combination....

Major depressive disorder is associated with considerable morbidity, disability, and risk for suicide. Treatments for depression most commonly include antidepressants, psychotherapy, or the combination. Little is known about predictors of treatment response for depression. In this study, 681 patients with chronic forms of major depression were trea...

The present study examines the contribution of psychotherapist variables to change in depressive symptoms in a large clinical trial comparing the efficacy of the cognitive-behavioral analysis system of psychotherapy, the antidepressant nefazodone, and the combination of both in the treatment of chronic depression. Greater change on the Hamilton Rat...

Although the efficacy of maintenance pharmacotherapy for the prevention of recurrence in major depressive disorder (MDD) is well documented, few studies have tested the efficacy of psychotherapy as a maintenance treatment. The authors examined the efficacy of the cognitive-behavioral analysis system of psychotherapy (CBASP) as a maintenance treatme...

Although many studies report that the therapeutic alliance predicts psychotherapy outcome, few exclude the possibility that this association is accounted for by 3rd variables, such as prior improvement and prognostically relevant patient characteristics. The authors treated 367 chronically depressed patients with the cognitive-behavioral analysis s...

This study examined whether reactance would negatively influence treatment outcome in 347 patients diagnosed with chronic forms of depression and treated at 9 sites with either Nefazodone, cognitive-behavioral analysis system of psychotherapy (CBASP), or combination therapy. Contrary to our hypotheses, reactance positively predicted treatment outco...

The nosology of chronic depression in Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994) is highly complex and requires clinicians to differentiate among several chronic course subtypes. This study replicates an earlier investigation (J. McCullough et al., 2000; see record 2000-05424-007)...

Major depressive disorder is associated with considerable morbidity, disability, and risk for suicide. Treatments for depression most commonly include antidepressants, psychotherapy, or the combination. Little is known about predictors of treatment response for depression. In this study, 681 patients with chronic forms of major depression were trea...

When one introduces a new psychotherapy model to professional colleagues, one must do 3 things: (a) define the patient for whom the program has been developed; (b) describe hoiv the model addresses the pro blemns of the patient, which entails some description of the techniques; and (c) present any efficacy data that are available that justify the u...

The article presents an overview of the chronic depression construct in the Diagnostic and Statistical Manual of Mental Disorders (DSMs) since 1980, including developmental etiology and psychopathological patterns of the chronically depressed adult. Then the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), an empirically supported psy...

We tested the hypotheses that the addition of medication to psychotherapy enhances participation in the latter by: (1) speeding the acquisition of the psychotherapy's targeted skill; and (2) facilitating higher skill level acquisition. Participants were 431 chronically depressed patients who received Cognitive Behavioral Analysis System of Psychoth...

Chronic subtypes of depression appear to be associated with high rates of Axis II personality disorder comorbidity. Few studies, though, have systematically examined the clinical correlates of Axis II personality disorder comorbidity or its effect on treatment response or time to response. 635 patients diagnosed with DSM-III-R chronic major depress...

A case is presented of an adolescent female with double depression who was treated using the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). CBASP is designed to teach a social problem-solving procedure called Situational Analysis (SA). Generalized treatment effects were measured through monitoring of diagnostic status, two administr...

We examined the relationship between patient characteristics and the working alliance in a multisite trial for chronic depression. Patients treated with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), alone (n = 169) or combined with nefazodone (n = 198), completed the Working Alliance Inventory during the 2nd week of treatment....

This article presents data from an ABAB single case design study of a 60-year-old Caucasian male diagnosed with chronic major depressive disorder. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was utilized throughout treatment, and both BDI scores and diagnostic interviews revealed states of partial, and ultimately full remissio...

While the sex difference in prevalence rates of unipolar depression is well established, few studies have examined gender differences in clinical features of depression. Even less is known about gender differences in chronic forms of depression. 235 male and 400 female outpatients with DSM-III-R chronic major depression or double depression (i.e.,...

The authors examined gender differences in treatment response to sertraline, a selective serotonin reuptake inhibitor (SSRI), and to imipramine, a tricyclic antidepressant, in chronic depression. A total of 235 male and 400 female outpatients with DSM-III-R chronic major depression or double depression (i.e., major depression superimposed on dysthy...

The nosology of chronic depression has become increasingly complex since the publication of the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987), but there are few data available to evaluate the validity of the distinctions between the subtypes of chronic depressi...

The treatment of Katrina, a chronically depressed 25-year-old female who presented with a comorbid PTSD disorder, is discussed. The cognitive behavioral analysis system of psychotherapy (CBASP; McCullough, 2000) is used to treat the psychopathology. Inhibiting the patient's tendency to leave therapy prematurely constitutes the first task of therapy...

The nosology of chronic depression has become increasingly complex since the publication of the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987), but there are few data available to evaluate the validity of the distinctions between the subtypes of chronic depressi...

Patients with chronic forms of major depression are difficult to treat, and the relative efficacy of medications and psychotherapy is uncertain. We randomly assigned 681 adults with a chronic nonpsychotic major depressive disorder to 12 weeks of outpatient treatment with nefazodone (maximal dose, 600 mg per day), the cognitive behavioral-analysis s...

This manual provides a step-by-step guide to the clinical strategies and tools presented in "Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP)" (J. P. McCullogh, Jr., 2000). Each chapter summarizes one step of the CBASP technique and details precisely how to implement the skills training procedures. Fea...

The clinical and etiological significance of the early-late onset distinction in chronic major depressive disorder was explored. Subjects were 289 outpatients with DSM-III-R chronic major depression drawn from a multi-site study comparing the efficacy of sertraline and imipramine in the acute and long-term treatment of chronic depression. Patients...

This study examined the validity of the early-late onset subtyping distinction in dysthymic disorder. Participants were 340 out-patients meeting DSM-III-R criteria for dysthymia and a concurrent major depressive episode (MDE). The sample was drawn from a 12-site double-blind randomized parallel group trial comparing the efficacy of sertraline and i...

The chronic form of major depression is associated with a high rate of prevalence and disability, but no controlled research has examined the impact of long-term treatment on the course and burden of illness. To determine if maintenance therapy with sertraline hydrochloride can effectively prevent recurrence of depression in the high-risk group of...

Chronic depression appears to be a common, frequently disabling illness that is often inadequately treated. Unlike episodic depressions with shorter illness duration, neither acute nor long-term treatment approaches for chronic depression have been well studied. 635 outpatients at 12 sites who met DSM-III-R criteria for chronic major depression or...

Background: Chronic depressions are common, disabling, and undertreated, and prior chronicity predicts future chronicity. However, few studies directly inform the acute or maintenance phase treatments of chronic depressions and even less is known about the effects of treatment on psychosocial functioning. Method: We describe the design and ratio...

The lists of associated symptoms included in the DSM-III, DSM-III-R, and DSM-IV criteria for dysthymic disorder have been criticized for lacking content and discriminant validity. The literature on the content and discriminant validity of dysthymic symptoms was reviewed and relevant data from the DSM-IV Mood Disorders Field Trial were presented. Th...

This article has traced the development of the diagnostic nomenclature for the chronic affective disorders during the past four decades. Much has been accomplished. In fact, our current differential diagnostic capabilities have surpassed our knowledge of how to treat the chronic depressions. It is hoped that in the next decade there will be notable...

The DSM-IV mood disorders field trial, a multisite collaborative study, was designed to explore the reliability of a course-based diagnostic classification system for major depression, evaluate the symptom criteria for dysthymia, and explore the need for additional diagnostic categories for milder forms of mood disorder (e.g., minor and recurrent b...

Despite the prevalence of chronic depression and its associated morbidity, there has been little systematic study of pharmacotherapy for this disorder. In this article, we report a preliminary analysis of the first 12-week phase of a multicenter clinical trial that will eventually include approximately 635 patients in acute, continuation, crossover...

This study replicates an earlier naturalistic-prospective investigation of nontreatment, community DSM-III-R dysthymia subjects. Major goals were to determine spontaneous remission rates and monitor the stability of psychosocial functioning levels over time. Twenty-four dysthymia subjects were followed for 1 year. Three remissions (13%) were diagno...

The primary goal of the study was to compare the psychosocial functioning of an untreated, community sample of DSM-III-R dysthymia subjects (N = 24) at screening to that of a matched sample of community nondepressed volunteers (N = 18) with no lifetime or current history of axis I disorders. Subjects were compared across a number of psychosocial in...

The present study investigated affective and characterologic psychopathology in a sample of 41 community, non-treatment unipolar depressed subjects. Based on DSM-III-R diagnostic criteria, subjects were placed into one of three groups: pure dysthymia, double depression, or pure major depression. All subjects were then administered the Personality D...

The study describes social adjustment and coping style among three DSM-III-R unipolar depression diagnostic groups (pure dystbymia, double depression, and pure major depression). The primary goal was to determine if these variables would discriminate between the groups. Also studied were the clinical course features of the unipolar groups. Data fro...

Ten early and late onset dysthymia cases, diagnosed by DSM-III criteria, were treated with the Cognitive-Behavioral Analysis System of Psychotherapy, a standardized, three-stage therapy system developed specifically for the treatment of dysthymia. The cases are presented as naturalistic, direct-replication studies. Reliability of data trends within...

The present investigation compares early and late onset community dysthymia groups on insidious onset patterns, cognitive, coping, and symptom measures testing the assumption implicit in DSM-III-R that the two groups are qualitatively dissimilar. The results suggest that, regardless of age of onset, the groups did not differ except on some features...

No significant differences were found between community samples of 27 Ss with major depressive disorder superimposed on dysthymia and 34 Ss with only dysthymia on cognitive, coping, or personality measures. This suggests homogeneity between these groups on these measures. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

The current study represents one of the first psychological investigations that attempts to describe the untreated course of late onset characterological dysthymia. Of 34 dysthymic subjects who were studied for 9 months, six women remitted (18%). Twenty-eight subjects (82%) remained unchanged. Among the nonremitters, we found stable patterns of fun...

Recent reports indicate that some individuals experience increased anxiety during formal relaxation training; however, there has been just one controlled investigation of this phenomenon (Heide and Borkovec, 1983). The present study was designed to replicate and extend the findings of Heide and Borkovec by providing evidence of "relaxation-induced...

Introduces the stage process design as a predictive confirmation (PC) structure for the single case and contends that PC can be assessed when the clinician operationally defines the important goals of therapy before introducing the change strategies in therapy. To the degree that patient change matches the predictions, PC is achieved. (PsycINFO Dat...

Dysthymic disorder, a troublesome problem for many young adults, can be effectively treated by focusing the client's attention on the interactional problems the person reports to the therapist. In therapy, interactional issues frequently take a backseat to the more obvious intrapersonal symptoms that many contemporary theories of depression emphasi...

Asserts that a new research approach is needed to intra-S investigations that deals as seriously with actual clinical goals as it does with experimental design criteria. It is contended that the work of M. B. Shapiro published from 1951 to 1979 offers the nonoperant clinician a patient-oriented approach to evaluate the efficacy of clinical treatmen...

Examines the current domination of intra-S methodology by applied operant psychology. The fusion of operant theory and N = 1 methodology is analyzed in terms of 4 implicit assumptions that govern the structure of most applied intensive research today. These assumptions focus on the interrelationships between dependent and independent variables and...

Examined heart rate, skin conductance, and finger pulse amplitude at rest and in response to stress in a group of 10 chronically depressed Ss and a closely matched set of controls. While all physiological channels revealed a significant main effect attributable to the conditions of rest, anticipation of stress, and stress, only the skin conductance...

This experiment represented an exploratory investigation of the effects of the emotional loading (anxiety-arousing potential) of questions in a dyadic interview. 40 male subjects (inmates in a correctional institution) participated as interviewees. The four variables evaluated were: emotional loading, kinesic behavior, paralinguistic behavior, and...

A 16 yr old male, who presented an 11 yr history of severe temper outbursts, was apparently successfully treated by a self control treatment program. The treatment procedure is described in detail. The case is noteworthy because it demonstrates that self control training is a useful treatment approach when environmental control is very limited. The...

Describes the treatment procedure for an adolescent male with an 11-yr history of severe temper outbursts. He was apparently successfully treated by a self-control treatment program. The case demonstrates that self-control training is a useful approach when environmental control is very limited, and it shows the relevance of A. Bandura's reciprocal...

Investigated the efficacy of symbolic modeling and role-playing therapy in the reduction of avoidance behaviors in 48 undergraduates. Carefully selected snake-phobic Ss were administered either self-regulated symbolic modeling, self-regulated role-playing instructions, or exposure to a snake-only videotape, or they received no treatment. After brie...

Reports the case history of a 22-yr-old female student who suffered aproximately 1 colitis attack/day who was apparently successfully treated by a procedure in which the therapist labeled antecedent stress events that appeared to be precipitating the attacks. The client was then taught a behavioral coping strategy to counter the stress events. (Psy...

The present study sought to investigate the effect of flooding and the order of serial-cue presentation on the extinction of a conditioned avoidance response. Previous research efforts have investigated the effect of flooding on extinction using a single conditional stimulus. 40 female albino rats, approximately 100 days old and weighing 250 to 300...

Reports the case history of a 22-yr-old female student who suffered aproximately 1 colitis attack/day who was apparently successfully treated by a procedure in which the therapist labeled antecedent stress events that appeared to be precipitating the attacks. The client was then taught a behavioral coping strategy to counter the stress events.