Cognitive Behavioral Analysis System of Psychotherapy for inpatients with persistent depressive disorder: a naturalistic trial on a general acute psychiatric unit

  • Anne GuhnEmail author
  • Stephan Köhler
  • Eva-Lotta Brakemeier
  • Philipp Sterzer
Original Paper


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 (HAMD24) 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 HAMD24 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.


CBASP Depression Treatment resistance Inpatient psychotherapy 



We would like to thank all other study therapists Anna Bosch, Julia Bretschneider, Sophia Chrysanthou, Barbara Dusswald, Patricia Panneck, Johanna Schöner as well as the multidisciplinary team of the ward 152a for their valuable therapeutic work. We also thank the 60 CBASP patients who participated in this study.

Compliance with ethical standards

Conflict of interests

All authors received honoraria for workshops and presentations relating to CBASP. No other disclosures were reported.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Psychiatry and PsychotherapyCharité - Universitätsmedizin Berlin, Corportate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of HealthBerlinGermany
  2. 2.Department of Clinical Psychology and PsychotherapyPhilipps-University of MarburgMarburgGermany

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