Treating Chronic Depression with Disciplined Personal Involvement

Preface Foreword

Chapter 1: Disciplined Personal Involvement

Chapter 2: The History of the Personal Involvement Taboo

Chapter 3: Treating the Chronically Depressed Patient

Chapter 4: Disciplined Personal Involvement Training

Chapter 5: Creating Contingent Environments Using Disciplined Person Involvement

Chapter 6: Healing Interpersonal Trauma Using the Interpersonal Discrimination Exercise Appendix: Research Investigations to Determine "How" CBASP Works References

Index

"Research growing out of practice" best describes the way Dr. James P. McCullough, Jr., Professor of Psychology & Psychiatry of Virginia Commonwealth University, has conducted his 35-year university career. During the mid-1970s, Dr. McCullough began working with chronically depressed outpatients. At the time, chronic depression was considered to be a personality disorder and not thought to be responsive to medication or psychotherapy. Dr. McCullough developed his therapy model, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), while working with chronically depressed patients. He investigated the treatment efficacy of CBASP using single-case design methodology and published the first articles on CBASP in 1980 and 1984. With the publication of the Diagnostic and Statistical Manual of Mental Disorders-Third Edition (DSM-III) in 1980, the American Psychiatric Association removed chronic depression from personality disorder status and redefined it (dysthymia) as a psychological disorder. Chronic depression was suddenly thrust into the mainstream of clinical treatment and research where it has remained ever since.

In addition to developing a psychotherapy method to treat the disorder, in 1980, Dr. McCullough began a series of diagnostic investigations studying chronically depressed nonpatients for extended periods of time. The aims of this research were to investigate the psychological characteristics of chronically depressed individuals over time, to determine when the disorder began, and to see if the disorder would remit spontaneously with time. He found very few remissions (13%) and of those who did, over half relapsed within two years. The majority of the nonpatients reported an onset which began during adolescence. Dr. McCullough concluded that chronic depression is in large measure a "disorder of adolescence" and indeed a lifetime problem that doesn't improve over time without adequate treatment. His diagnostic research continues up tothe

"McCullough's Treating Chronic Depression With Disciplined Personal Involvement is a breath of fresh air. It is edgy, innovative, gutsy, and engaging.  McCullough places his therapeutic approach in context by comparing it with other therapies, making his book both scholarly and absorbing. He presents a high-risk-high-gain approach for chronically depressed patients, an extremely difficult group with which to work. The volume contains extensive and intense patient-therapist dialogue. This dialogue provokes tension, anxiety, and self-reflection in the reader and is extremely useful for conveying a feel for this approach. Congratulations to McCullough on this remarkable work.  He has made an extremely important contribution to both the treatment of chronic depression and the larger literature on the curative power of the therapist-patient relationship."

-Laurence P. Riso, PsycCRITIQUES, Contemporary Psychotherapy - APA Review of Books, Volume 52, Issue 33

"Dr. McCullough's incredible insights led him to develop a unique form of psychotherapy for chronic depression that has a staggering rate of success, as reported in the NEJM, 2000. World-wide application of this therapy, based upon his remarkable text, The Treatment for Chronic Depression, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), is comparable to Fleming's discovery of Penicillin. This newest text, Treating Chronic Depression with Disciplined Personal Involvement, is a major contribution to the scientific refinement of therapy and is applicable, in my judgment, to virtually all who committed to understanding and relieving the unspeakable suffering of depression."



- Robert S. Brown, Sr., M.D., Ph.D.,Clinical Professor of Psychiatric Medicine, School of Medicine,University of Virginia, Richmond, VA, USA