title: Exploring preoperational features in chronic depression.
abstract: BACKGROUND
  The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) by James McCullough is the first psychotherapeutical approach specifically designed for chronic depression. Whereas its efficacy has recently been studied, empirical investigations on the underlying etiopathological hypotheses are missing. McCullough postulates that chronically depressed patients - particularly those with early onset - think preoperationally. This term was coined by J. Piaget and includes egocentrism in the views of self and others and incapacity for authentic interpersonal empathy. In accordance, empirical studies indicate a deficit in theory of mind (ToM) in depressed individuals.
  
  
  METHODS
  Sixteen patients with early onset chronic depression were compared to sixteen matched healthy controls using three measurements: 1) the Movie for the Assessment of Social Cognition (MASC) as a new video-based theory of mind test, 2) self-rated questionnaires on empathy (Interpersonal Reactivity Index (IRI), and a scale assessing individual competence in relationships), and 3) a structured evaluation by the patients' therapists.
  
  
  RESULTS
  The groups did not differ in their theory of mind performance on any aspect assessed by the used test. However, patients rated their empathy in daily life as significantly inferior to healthy controls. In addition, the therapists assigned a considerable amount of preoperational behavior to their patients. No meaningful correlations between these three types of measurements were found.
  
  
  CONCLUSIONS
  Small sample size, no structural assessment of possible psychopathology in the control group, control group was not rated by clinicians concerning preoperational behaviors.
  
  
  CONCLUSIONS
  Lack of empathy exists in the daily life of early onset chronically depressed patients according to their own and their therapists' evaluation. However, a video-based test failed to pick up deficits in their theory of mind capacities. Further research is needed to investigate theory of mind deficits using real life interpersonal interactions demanding the patient's personal involvement.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstr. 5, D-79104 Freiburg, Germany. wilbertz@psychologie.uni-freiburg.de
authors.forename: Gregor
authors.initials: G
authors.lastname: Wilbertz
authors.forename: Eva-Lotta
authors.initials: EL
authors.lastname: Brakemeier
authors.forename: Ingo
authors.initials: I
authors.lastname: Zobel
authors.forename: Martin
authors.initials: M
authors.lastname: Härter
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schramm
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D003674:Defense Mechanisms; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D004645:Empathy; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D018187:Personal Construct Theory; D010552:Personality Assessment / Q000706:statistics & numerical data; D011594:Psychometrics; D011795:Surveys and Questionnaires