Guhn Anne, Schön David, Zische Yvonne, Sterzer Philipp, Köhler Stephan
Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany.
Front Psychiatry. 2021 Feb 26;12:620037. doi: 10.3389/fpsyt.2021.620037. eCollection 2021.
The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been tailored specifically to the demands of patients with persistent depressive disorder (PDD). According to the CBASP model, PDD patients are supposed to live perceptually disconnected from their social environment, which consequently maintains depression. While initially developed as an individual treatment modality, the adaptation for group therapy yields an important interpersonal space. However, little is known about the specific factors that contribute to patients' benefit from the CBASP group modality. The analyzed sample comprised = 87 PDD patients who completed a 12 week multimodal inpatient treatment including 2 weekly CBASP-specific individual and group sessions, respectively, as well as CBASP-unspecific medical contacts, pharmacotherapy and complementary therapies. Group sessions included trainings in situational analysis and interpersonal skills. Interpersonal change over therapy was examined based on the patients' self-perceived interpersonal problems (IIP) and the impact messages as perceived by their individual therapists (IMI). Pre and post-treatment data were compared using within-sample -tests. Additionally, patients evaluated CBASP group therapy on a feedback form. They were invited to reflect on individual benefits and its helpful and unhelpful aspects. Qualitative content analysis with inductive category development was used to analyze feedback. Inter-rater reliability was computed to confirm categories before summarizing the frequencies of reported factors. Self-perceived interpersonal distress significantly decreased over therapy. Patients reported reduced interpersonal problems and therapists reported more friendly and dominant impact messages. Interestingly, patients who showed a significant depressive symptom reduction described higher change scores. Regarding qualitative data, patients reported five main benefits from group therapy: Gain in social competence, self-confidence, self-reflection, interpersonal dynamics, and optimism/universality. Patients responding to CBASP identified significantly more factors than non-responders. Compared to studies with individual CBASP only, the present findings suggest that CBASP group therapy may contribute to the improvement of interpersonal behavior. Group therapy is discussed as a potential boosting effect for individual CBASP. However, as the present data were collected in a multimodal inpatient setting without competitor, randomized controlled trials are warranted that investigate the specific benefits of the group modality or the combined individual and group therapy over individual CBASP only.
认知行为分析心理治疗系统（CBASP）是专门针对持续性抑郁症（PDD）患者的需求而设计的。根据CBASP模型，PDD患者在认知上与社会环境脱节，从而导致抑郁症持续存在。虽然CBASP最初是作为一种个体治疗方式开发的，但对其进行团体治疗的改编产生了一个重要的人际空间。然而，对于促使患者从CBASP团体治疗模式中获益的具体因素，人们了解甚少。分析样本包括87名PDD患者，他们完成了为期12周的多模式住院治疗，其中分别包括每周2次CBASP特定的个体和团体治疗，以及CBASP非特定的医疗接触、药物治疗和辅助治疗。团体治疗包括情境分析和人际技能培训。基于患者自我感知的人际问题（IIP）和个体治疗师感知的影响信息（IMI）来检查治疗过程中的人际变化。使用样本内检验比较治疗前后的数据。此外，患者通过反馈表对CBASP团体治疗进行评估。他们被邀请思考个人获益以及治疗的有益和无益方面。采用具有归纳类别发展的定性内容分析来分析反馈。在总结报告因素的频率之前，计算评分者间信度以确认类别。自我感知的人际困扰在治疗过程中显著降低。患者报告人际问题减少，治疗师报告有更友好和占主导地位的影响信息。有趣的是，抑郁症状显著减轻的患者描述的变化得分更高。关于定性数据，患者报告了团体治疗的五个主要益处：社交能力提升、自信、自我反思、人际互动以及乐观/普遍性。对CBASP有反应的患者比无反应者识别出的因素明显更多。与仅采用个体CBASP的研究相比，目前的研究结果表明CBASP团体治疗可能有助于改善人际行为。团体治疗被认为对个体CBASP有潜在的促进作用。然而，由于目前的数据是在没有对照的多模式住院环境中收集的，因此有必要进行随机对照试验，以研究团体治疗模式或个体与团体联合治疗相对于仅个体CBASP的具体益处。
