CBASP is currently being tested in a four-year (2002-2006) National Institute of Mental Health (NIMH) 9-site investigation, “CBASP Augmentation for Treatment of Chronic Depression.” The study will continue two additional years with a naturalistic follow-up phase. The multi-site study involves the Department of Psychiatry at University of Arizona (Principal Investigator: Alan J. Gelenberg, M.D.); Department of Psychiatry, Brown University (PI: Martin B. Keller, M.D.); Department of Psychiatry, Cornell University Medical College (PI: James H. Kocsis, M.D.); Department of Psychiatry, Emory University School of Medicine (PI: Philip T. Ninan, M.D.); Department of Psychology, State University of New York at Stony Brook (PI: Daniel N. Klein, PhD); University of Texas Southwestern Medical Center at Dallas (PI: Madhukar H. Trivedi); Department of Psychology, Virginia Commonwealth University (PI: James. P. McCullough, Jr., PhD); Department of Psychiatry, University of Stanford Medical School (PI: Alan F. Schatzberg, M.D.); and Western Psychiatric Institute and Clinic, University of Pittsburgh (PI: Michael E. Thase, M.D.).

Eight-hundred and fifty chronically depressed outpatients will be enrolled into a Phase I medication-only cell for 12 weeks. At the end of the 3 months period, Full Responders will continue to receive medication for another 12 weeks. Partial and Non-Responders will be randomized into Phase II of the study, which last 12 weeks. Non-responders will be switched to another medication and partial responders will receive augmentation medication. In addition, patients will be assigned in a 2:2:1 ratio to receive CBASP psychotherapy, Brief Supportive Psychotherapy (BSP), or Medication Alone. The BSP therapy model is a non-directive type of psychotherapy developed by Dr. John C. Markowitz, Research Psychiatrist at the New York State Psychiatric Institute and a Clinical Professor of Psychiatry at the Weill Medical College of Cornell University.

Phase I of the study mimics actual clinical practice in that most patients who present for psychiatric treatment and who are diagnosed with either an episodic/acute Major Depression or Chronic Depression usually begin treatment with an antidepressant drug. Patients who do not fully respond will continue to receive medication but will often have their treatment augmented by the addition of some form of psychotherapy. Phase II of this study mirrors this dimension of practice. CBASP, in addition to being tested as an augmentation strategy for chronically depressed outpatients, will be compared to a nonspecific psychotherapy model, Brief Supportive Psychotherapy (BSP). The problem-solving component of CBASP (Situational Analysis) will be compared to the nonspecific model to determine if the specific factor, problem solving coping, adds significantly to treatment outcome. The goal here is to determine the degree to which the specific factor of CBASP (i.e., problem solving training) adds to treatment outcome over and above nonspecific or common therapeutic factors.

This NIMH study will be a landmark investigation in several ways. One, the study is the largest randomized psychotherapy-medication clinical trial for chronic depression ever conducted in either psychology or psychiatry; two, its size will offer a significant test of whether a specific theory-driven technique has significant effects on a common, non-specific factor, the therapeutic alliance; and third and most important, it will test the efficacy of using CBASP as an augmentation strategy for patients who do not respond fully to two state-of-the-art antidepressant medications.