Cognitive Behavioral Analysis System of Psychotherapy: Treatment, Effects & Risks

Cognitive Behavioral Analysis System of Psychotherapy, henceforth CBASP, is a psychotherapeutic treatment method for chronic depression. The approach, which is based on various psychological procedures, can be traced back to the American psychologist James P. Mccullough. The development of CBASP began in the 1980s. It has been in a mature state since about 2005.

What is the Cognitive Behavioral Analysis System of Psychotherapy?

CBASP is a collection of psychological explanatory models and resulting forms of interaction between therapists and patients. The goal of CBASP is to cure chronic depression. Depending on the situation and the discretion of the people involved, CBASP is the sole method of therapy or psychotropic drugs, namely antidepressants, are also used. CBASP alone without psychotropic drugs has about as much treatment success as psychotropic drugs without CBASP. The joint use of CBASP and psychotropic drugs increases the healing success, but leads to medical side effects, which should be prevented by the use of psychological methods after all. Because of the specific explanatory models and the resulting psychotherapy, CBASP is not suitable for every type of depression. The method is specifically designed for chronic depression that has been present since childhood. The explanatory model of CBASP assumes that such chronic depression has been caused by trauma or prolonged abusive situations. As a result, the ability in the patient to communicate naturally with others has been disrupted. It is at the reprocessing and restoration of these natural communication and empathy skills that CBASP addresses.

Function, effect, and goals

CBASP is based on the assumption that chronic depression is caused by a complex of causes characterized as patients’ lack of self-confidence in communicating and living with others. Patients with chronic depression avoid fellow human beings. Even caregivers who care deeply for the patients experience rejection or even openly hostile reactions by the chronically depressed. Presumably, therefore, chronic depression is not just a matter of pure emotion, but a serious developmental psychological behavioral disorder that has its roots in the patients’ lack of empathy and communication skills. According to Jean Piaget, children develop beyond an egocentric self-concept even before puberty and learn to empathize with fellow human beings and to use these insights into the diversity of interpersonal reactions gained through empathy to build their interpersonal relationships. A developmental defect at this stage leads to chronic depression, which affects human interaction well into adulthood. The function of CBASP is to analyze and critically examine the patient’s understanding of interpersonal responses and then replace it with an expanded understanding. The goal, then, is to supplement and expand the basic negative assumptions that have been embedded since childhood with more realistic and life-affirming assumptions about interpersonal reactions. In the course of this expansion of access to interpersonal communication in the respective environment of the patients, the patients ideally also gain introspective access to the trauma that caused in themselves this disturbance of the child development process according to Jean Piaget. This trauma, which has been the cause of years of depression, may have been a brief traumatic event, but it may also have been a longer lasting state of abuse or neglect. Patients and therapists analyze interactions with others in situation analyses, thinking also of possible alternative ways of dealing; they work out lists of formative attachment figures and consider what these relationships have been like; they practice interpersonal discrimination exercises, through which patients learn to replace problematic interpretations of others’ behavior with more favorable interpretations. In this way, patients develop self-assurance and self-confidence. CBASP uses interpersonal, psychodynamic, and behavioral therapy methods.Therapists who practice CBASP know that patients’ behavioral disturbances in their interactions with others naturally manifest themselves in their interactions with the therapists themselves. Therefore, therapists expect to encounter hostility and even exaggerated submissiveness from patients during treatment. They are trained to respond appropriately. CBASP is a highly specialized form of psychotherapy that also deals with patients’ hurtful memories.

Risks, side effects, and dangers

CBASP has an explanatory model for chronic depression. However, it is not scientifically proven that all chronic depression has this exact complex of causes. Psychological treatments are an alternative for psychiatric drugs, which have many side effects. In fact, however, the side effects of psychotherapeutic forms of treatment are as yet poorly understood. Psychotherapy costs time and money. However, people with chronic depression are often dependent on other caregivers. Since the therapy itself is strongly aimed at finding alternative ways of dealing with caregivers, the patients themselves can radically question and change this whole life situation. This sometimes leads to new life crises. Is depression really the result of a developmental psychological disorder in the ability to form relationships with other people, or does depression perhaps have entirely different causes? CBASP is based on the assumption of trauma in childhood. The classic form of trauma psychotherapy deals with people who have been shown to have suffered trauma in war or in an accident. In the case of chronic depression, however, the situation is more difficult because it is not even known whether there was any trauma, neglect or abuse. The trauma then remains in many cases only a vague hypothesis that is difficult to prove.