Psychological Interventions Lecture 10

Persistant Depressive Disorder

• Duration > 2 years

• More physical and psychological symptoms

• More psychosocial problems

• More suicide attempts

• Longterm care

• More (childhood)trauma

• > 20%of depressions becomes persistent

• In specialistic mental health care higher percentages (>50%)

Childhood Trauma (before age of 16) in people with Persistent Depressive Disorder

• Emotional neglect (people often don’t know)

• Psychological abuse

• Physical abuse

• Sexual abuse

CBASP Meta analysis (Negt e.a. 2016)

• CBASP > CAU (usual care)

• CBASP = AD (medication)

• CBASP + AD > AD

Theory of CBASP

• People with chronic mental disorders:

  • Think and talk in a global terms

  • Have a strong focus on themselves

  • Find it hard to mentalize

  • Have a hard time verbalizing their feelings

  • Feel like a playball of life (no sense of control)

• People are unaware that their primitive verbal thought and behavior patterns serve to keep them perceptually disconnected from the environment → Unresponsive to environmental consequences and feedback

• → Make people feel hopeless and helpless about their situaton → makes it hard to look for help

Developmental Model Piaget

• Persistently depressive patients function on a ‘preoperational’ level:

  • difficulty in understanding others' perspectives

  • not aware they can influence and change their own reality

  • see no connection between what they do and the effects of it

Goal CBASP

• CBASP teaches the patient to move from a ‘preoperational’ level to an ‘operational’ level of functioning: the patient becomes aware of their own role in an interaction and the possibility to change this role.

• Replace disconnectedness with perceived-functionality expectancy set and empathy

• ‘Everything you do has effect’

Transference Domains

• Intimacy / closeness

• Expressing emotional needs

• Making mistakes

• Expressing negative emotions

Transference Hypothesis

• Therapist and patient formulate these hypotheses based on past experiences

• E.g. if I express negative emotions, than my therapist will find me difficult

Impact Message Inventory

• To be completed after a few sessions

• Recognize the patient's behavior

Situational Analysis

• Most important technique of intervention phase

• Goal: Recognize the consequences of interpersonal behavior

• Focus on a concrete problematic situation with an interaction

• A form with several steps/questions to help patients become more aware of their thoughts and behavior and how it affects the outcome of the situation

• To teach them how to think and act differently in order for them to get what they want

• To gain control over social situations

• Exercise consists of elicitation phase and remediation phase

Interpersonal Discrimination Exercise

• Goal: Learn to recognize new interpersonal experiences

• The therapist identifies a “hot-spot situation,” for example based on a Situational Analysis (SA)

• How would your mother/father have reacted in a similar situation?

• How did I react? What did you notice about me? What did I say?

• What is the difference between my reaction and that of your mother/father?

• If I react differently, what does that mean for the relationship between us?

• Are there others who would react in a similar way like me?

Disciplined Personal Involvement

• Goal: Identify the consequences of the patients behavior

• Recognize the interpersonal impact of the patients behavior on the therapist and explain the consequences of the behavior

• Pay attention to alternative (more functional) behaviors and it’s impact

Optimal Therapist Role Characteristics

1. Able to enact a Disciplined Personal Involvement clinical role with the patient

2. Able to implement an acquisition-learning approach to therapeutic administration

3. Able to adhere to the standards of CBASP technique administration

4. Able to implement several facilitative interpersonal skills.

Able to enact a Disciplined Personal Involvement clinical role with the patient

• The therapist is a real, genuine person with the patient instead of acting distant or “robotic.”

• The therapist pays attention to how the patient affects them emotionally.

• They use their own reactions carefully to help the patient learn healthier relationships.

• The therapist creates a safe relationship, especially for patients with trauma or abuse histories.

• “I will relate to you honestly and safely, so you can learn that relationships do not always have to be harmful.”

Able to implement an acquisition-learning approach to therapeutic administration

• CBASP sees therapy as a learning process.

• The therapist acts like a teacher:

  • Patients learn how relationships work.

  • Patients learn how their behavior affects others.

  • Patients practice new ways of thinking and acting.

• “If patients learn new interpersonal skills, their depression becomes more manageable.”

Able to adhere to the standards of CBASP technique administration

• Good therapists know how to properly use the main CBASP tools, such as:

  • Significant Other History (SOH)

  • Interpersonal Discrimination Exercise (IDE)

  • Situational Analysis (SA)

• These techniques help patients:

  • feel safe with the therapist,

  • understand consequences of their behavior,

  • and break old unhealthy patterns.

Able to implement several facilitative interpersonal skills, such as

• patience,

• authenticity,

• handling silence,

• managing anger,

• pacing therapy at the patient’s speed,

• staying calm during difficult emotions,

• and maintaining good communication control.