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The cognitive behavioural analysis system of psychotherapy: a new psychotherapy for chronic depression

John Swan is a clinical lecturer and cognitive–behavioural psychotherapist in Dundee (Section of Psychiatry and Behavioural Neurosciences, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, Tayside, UK. Email: johnswan{at}nhs.net). He is currently the Course Director of the Postgraduate Diploma and MSc in Cognitive–Behavioural Psychotherapy at the University of Dundee. His research interests focus on the effectiveness of psychological therapies for chronic affective disorder and obsessive–compulsive disorder. Alastair Hull is a consultant psychiatrist in psychotherapy in Tayside. His clinical work is predominantly with individuals with chronic depression and/or a history of traumatic experience. His research interests include the follow-up of intensive care patients, legal aspects after trauma, long-term sequelae of trauma, including the role of trauma in chronic depression, and the effectiveness of psychological treatments. John Swan was the first accredited CBASP trainer in the UK and both authors are accredited CBASP therapists.

The cognitive behavioural analysis system of psychotherapy (CBASP) is a new therapy specifically designed to treat chronic depression. Conceptually, the bio-psychosocial signs and symptoms of chronic depression are viewed as the result of either arrested maturational development at a Piagetian preoperational stage (in early-onset patients) or heightened emotionality and general functional regression (in late-onset patients). In this therapy, patients learn how their cognitive and behavioural patterns produce and perpetuate interpersonal problems and how to alter maladaptive patterns of interpersonal behaviour. The focus is primarily on interpersonal interactions, including with the therapist, through the latter’s disciplined personal involvement. In this article we outline the therapy process and key mechanisms of change using examples to illustrate specific techniques. We also outline the theoretical model underpinning CBASP and summarise the evidence from a large clinical trial.