The Plan Virginia Commonwealth University professor James McCullough Jr. is training mental health professionals nationwide to treat the most intractably depressed patients with a scientifically validated but little-used form of therapy. Cognitive Behavioral Analysis System of Psychotherapy (CBASP) "is the only method in the world developed specifically for the chronically depressed patient," said McCullough, who has studied the condition for more than two decades and developed the method.

The Condition Chronic depression, which afflicts 20 million Americans, was considered untreatable until the 1980s. It often begins at puberty and is rooted in a traumatic life event. Untreated, it can last a lifetime. McCullough said his patients have an average age of 41 and have had symptoms for more than 18 years.

"They have an egocentric world view," he said. "The environment can't get in, and they are unable to appreciate that their actions have consequences. They orbit in a cycle of sameness."

The Treatment The six-step process of CBASP requires patients to focus on a stressful "slice of time" in their lives. They describe what happened, their interpretation of what happened, their behavior and its outcome, and their preferred outcome. Past relationships and trauma are explored; the therapist interacts closely with the patient rather than listening passively. The process is repeated in every session.

CBASP is based on cognitive therapy, which gets patients to dispute negative and fallacious thinking. But McCullough said CBASP works better than cognitive therapy for the chronically depressed, who typically have the emotional maturity of a 6-year-old.

"In a repetitive way, we show them that 'you create the mess that you are in,' " he said. "Over time, they become aware that their destructive behavior affects others and how others relate to them."

The Goods CBASP was used in the largest study comparing talk therapy and antidepressant medication for chronic depression. In the study, published in the New England Journal of Medicine (in May 2000), CBASP was shown to be as effective as drugs. (A little more than half in each group reduced symptoms.) When CBASP was combined with medication, 85 percent of patients reported relief. McCullough calls himself a "man on a mission" to teach the therapy to others. Information:

-- Cecilia Capuzzi Simon

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