In the current issue of Psychotherapy and Psychosomatics, Klein and colleagues report the effect of childhood maltreatment on the outcome of psychotherapy. In the treatment of major depression, childhood maltreatment has been associated with an unfavorable outcome. One possible exception might be psychotherapy with the cognitive behavioral analysis system of psychotherapy (CBASP). CBASP is a treatment model that has been developed specifically for patients with persistent depressive disorder. CBASP targets specific maladaptive interpersonal behaviors that are associated with persistent depressive disorder and childhood maltreatment. We have therefore hypothesized that CBASP is more effective than supportive psychotherapy in patients retrospectively reporting childhood maltreatment.
The study compared the efficacy of Cognitive Behavioral Analysis System of Psychotherapy with nonspecific supportive psychotherapy in adult with early-onset chronic depression. Three quarters of the patients reported at least moderate to severe childhood maltreatment. The most common forms of childhood maltreatment were emotional neglect (65.5%) and emotional abuse (59.0%). Results show that CBASP was superior to supportive psychotherapy in the reduction of depressive symptoms. In addition, the presence of childhood maltreatment had a moderating influence on the efficacy of treatment. Specifically, emotional neglect was associated with a less favorable outcomes.
Based on the relevance of childhood maltreatment in chronic depression, CBASP might emerge as the treatment of choice for persistently depressed patients suffering from early interpersonal trauma.