title: Overcoming treatment resistance in chronic depression: a pilot study on outcome and feasibility of the cognitive behavioral analysis system of psychotherapy as an inpatient treatment program.
abstract: BACKGROUND
  The Cognitive Behavioral Analysis System of Psychotherapy (CBASP), initially developed as an outpatient treatment for chronic depression (CD), has been adapted as a multidisciplinary 12-week inpatient program for CD.
  
  
  METHODS
  Seventy inpatients with CD and treatment resistance were included in a noncontrolled trial. The Hamilton Depression Rating Scale served as the primary outcome measure. Prospective naturalistic follow-up assessments were conducted 6 and 12 months after discharge.
  
  
  RESULTS
  Dropout rate was 7.1%; 90.4% perceived the program as helpful. Pre-post comparisons yielded strong effect sizes; 75.7% of the intention-to-treat sample responded, and 40.0% remitted. Nonremission was associated with experiencing temporary deterioration of symptoms during treatment. After 6 months 75.0% and after 12 months 48.0% of patients sustained response.
  
  
  CONCLUSIONS
  The CBASP program appears as a feasible acute treatment for treatment-resistant CD inpatients with promising outcome. However, the continuation of treatment after discharge should be optimized especially for patients with subjective deterioration during treatment.
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany.
authors.forename: Eva-Lotta
authors.initials: EL
authors.lastname: Brakemeier
authors.forename: Martina
authors.initials: M
authors.lastname: Radtke
authors.forename: Vera
authors.initials: V
authors.lastname: Engel
authors.forename: Johannes
authors.initials: J
authors.lastname: Zimmermann
authors.forename: Brunna
authors.initials: B
authors.lastname: Tuschen-Caffier
authors.forename: Martin
authors.initials: M
authors.lastname: Hautzinger
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schramm
authors.forename: Mathias
authors.initials: M
authors.lastname: Berger
authors.forename: Claus
authors.initials: C
authors.lastname: Normann
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D055815:Young Adult