Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corportate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10117, Berlin, Germany.
Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany.
Eur Arch Psychiatry Clin Neurosci. 2021 Apr;271(3):495-505. doi: 10.1007/s00406-019-01038-5. Epub 2019 Jul 12.
The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was originally developed for outpatients with persistent depressive disorder (PDD). We adapted CBASP as inpatient treatment on a general acute psychiatric ward and evaluated its outcome and feasibility. Sixty PDD patients received a 12-week multidisciplinary CBASP program. Hamilton Depression Rating Scale (HAMD) and Beck Depression Inventory (BDI-II) served as primary and secondary outcome measures. Childhood maltreatment at baseline and change in interpersonal distress from pre to post were investigated as predictors of treatment outcome. A 6-month follow-up assessment was conducted. Feasibility was assessed through dropouts and satisfaction with the program. Fifty patients completed the program (16.7% dropouts). An ANOVA with three repeated measurements (pre, post, FU) in the ITT sample revealed a main effect of time. For the primary outcome, depressive symptoms decreased from pre (28.3) to post (11.5, response rate: 72.7%, d = 1.8), and from pre to FU (13.9, d = 1.2). Four patients relapsed. The secondary outcome confirmed the results; however, the response rate was lower (BDI-II: 31.7%, pre to post: d = 0.8, pre to FU: d = 0.3), and ten patients relapsed at FU. Reduction in interpersonal distress, but not childhood maltreatment, predicted BDI-II response. Key limitations of this naturalistic open trial are the lack of a comparison group and non-blinded HAMD ratings. Inpatient CBASP for PDD appears feasible on a general acute psychiatric ward with effect sizes comparable to specialized psychotherapy wards and to the outpatient setting.
认知行为分析系统疗法（CBASP）最初是为持续性抑郁障碍（PDD）的门诊患者开发的。我们将 CBASP 改编为普通急性精神病病房的住院治疗，并评估了其结果和可行性。60 名 PDD 患者接受了为期 12 周的多学科 CBASP 方案。汉密尔顿抑郁量表（HAMD）和贝克抑郁量表第二版（BDI-II）作为主要和次要结果测量指标。以基线时的儿童期虐待和治疗前后人际困扰的变化作为预测治疗结果的因素。进行了 6 个月的随访评估。通过脱落和对方案的满意度来评估可行性。50 名患者完成了该方案（16.7%的脱落率）。在 ITT 样本中进行的具有三个重复测量（预、后、FU）的 ANOVA 显示时间存在主要影响。对于主要结果，抑郁症状从预（28.3）下降到后（11.5，反应率：72.7%，d=1.8），从预到 FU（13.9，d=1.2）。有 4 名患者复发。次要结果证实了这些结果；然而，反应率较低（BDI-II：31.7%，从预到后：d=0.8，从预到 FU：d=0.3），10 名患者在 FU 时复发。人际困扰的减少，但不是儿童期虐待，预测了 BDI-II 的反应。本自然开放试验的主要局限性是缺乏对照组和非盲 HAMD 评分。在普通急性精神病病房中，对 PDD 进行住院 CBASP 似乎是可行的，其效果大小与专门的心理治疗病房和门诊设置相当。
