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CompletedNCT00970437Updated Jul 5, 2017

A Comparison of Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and System of Supportive Psychotherapy (SYSP) for Early Onset Chronic Depression

An interventional study of Cognitive Behavioral Analysis System of Psychotherapy and System of Supportive Psychotherapy in Chronic Major Depressive Disorder, sponsored by University Hospital Freiburg. Completed at 1 site in Germany. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2017-07-05.

Sponsored by University Hospital Freiburg · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
268
Allocation
Randomized
Ages
18 Years to 65 Years
Sex
All
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Study summary

The purpose of this study is to compare the efficacy of the Cognitive Behavioural Analysis System of Psychotherapy (CBASP) with the non-specific System of Supportive Psychotherapy (SYSP)in early onset chronically depressives.

Read the detailed description

Effective treatment strategies for chronic depression are urgently needed since it is not only a common and particularly disabling disorder, but is also considered treatment resistant by most clinicians. There are only a few studies on chronic depression indicating that traditional interventions are not as effective as in acute, episodic depression. In addition, most of the studies had methodological weaknesses, such as the very short courses of psychotherapy. Usually, chronic depression begins early in life, is often associated with early interpersonal trauma, and results in an even more substantial human capital loss than the late-onset group. Furthermore, it shows a weak response to medication and a high rate of relapse after an initial response. With the present multicentre study, the efficacy of the only specific psychotherapy for chronic depression (Cognitive Behavioural Analysis System of Psychotherapy/CBASP) is compared with a non-specific System of Supportive Psychotherapy/SYSP in early onset chronically depressives. CBASP faired very well in one large trial but has never been directly compared to a non-specific psychotherapeutic control. Another innovative aspect of the study is the use of an extended course of psychotherapy (32 sessions). Primary hypothesis: CBASP is more effective in reducing depressive symptoms than SYSP.

A naturalistic study following up the patients of the trial up to two years after termination of the study treatments is performed in order to investigate the long-term effectiveness of CBASP compared to the System of Supportive Psychotherapy. The primary outcome of this follow-up study is the rate of well-weeks (weeks with no or minimal depression symptoms) during the two years after termination of the study treatments as measured with the Longitudinal Interval Follow-up Evaluation (LIFE) Interview

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Conditions studied

  • Chronic Major Depressive Disorder
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In context

Lead sponsor

University Hospital Freiburg is the lead sponsor of 94 studies on the registry; 18 are open to participants now.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
18 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  1. DSM-IV criteria for a current episode of chronic MDD, MDD superimposed on a pre-existing dysthymic disorder or recurrent MDD with incomplete remission between episodes in a patient with a current MDD and a total duration of at least 2 years.
  2. Early onset of the disorder according to DSM-IV (onset before the age of 21)
  3. Age between 18 and 65
  4. A score of at least 20 on the 24-item HRSD at screening and, after a 2-week drug-free period, at baseline
  5. Fluent in German language
  6. Provide informed consent

Exclusion criteria

Exclusion Criteria:

  1. Acute risk for suicide (as opposed to suicidal thoughts) assessed according to clinical practice guidelines. Suicidal patients are eligible, as long as outpatient treatment is deemed safe by the clinician.
  2. A history of psychotic symptoms, bipolar disorder, or organic brain disorders
  3. A primary diagnosis of another axis I disorder including anxiety disorders (e.g. Posttraumatic Stress Disorder), or any severe substance-related abuse or dependence disorder as evaluated with the SCID-I
  4. Antisocial, schizotypical, or borderline personality disorder (SCID-II);
  5. Severe cognitive impairment
  6. Absence of a response to previous adequate trial of CBASP, and/or SYSP
  7. Other ongoing psychotherapy or medication
  8. A serious medical condition (i.e. a history of seizures, severe head trauma, stroke or heart attack within six months before the study began)
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Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
268 participants (actual)

Study arms

  • Active comparator
    CBASP

    CBASP as the experimental intervention will follow a manual (McCullough, 2000; German version: Schramm et al., 2006). The approach is specifically tailored for the treatment of chronic forms of depression, particularly with early-onset by focusing on the problems resulting from an inhibition of maturation in early childhood and by using the therapeutic relationship in a personal, disciplined way as well as other specific techniques (e.g. Interpersonal Discrimination Exercise, Situation Analysis). CBASP integrates behavioural, cognitive, and interpersonal strategies.

    Behavioral: Cognitive Behavioral Analysis System of Psychotherapy

  • Placebo comparator
    SYSP

    The comparator for CBASP is SYSP, a system of supportive psychotherapy, an active but less specific, manualized control treatment. SYSP - defined as non-interpersonal and non-cognitive-behavioral therapy - resembles supportive clinical management, client-centered therapy, counseling, and psychoeducation about depression. There is no specific explanatory mechanism for treatment effect offered to the patient and it does not focus on specific themes.

    Behavioral: System of Supportive Psychotherapy

Interventions

  • BehavioralCognitive Behavioral Analysis System of Psychotherapy

    Duration of intervention per patient: 20 weeks acute treatment (n=24 sessions) followed by 28 weeks of continuation treatment (n=8 sessions) Follow-up per patient: 48 weeks after randomisation

  • BehavioralSystem of Supportive Psychotherapy

    Duration of intervention per patient: 20 weeks acute treatment (n=24 sessions) followed by 28 weeks of continuation treatment (n=8 sessions) Follow-up per patient: 48 weeks after randomisation

    Also known as: Brief Supportive Psychotherapy

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What researchers measure

Primary outcomes

  1. Depressive symptoms as measured by the HRSD (24-item Hamilton Rating Scale of Depression)

    Time frame: 20 weeks after randomization (after acute treatment phase)

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Study locations

1 site
  • University Medical Center Freiburg, Department of Psychiatry and Psychotherapy
    Freiburg im Breisgau, 79104, Germany
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References and documents

Publications

  • Schramm E, Kriston L, Zobel I, Bailer J, Wambach K, Backenstrass M, Klein JP, Schoepf D, Schnell K, Gumz A, Bausch P, Fangmeier T, Meister R, Berger M, Hautzinger M, Harter M. Effect of Disorder-Specific vs Nonspecific Psychotherapy for Chronic Depression: A Randomized Clinical Trial. JAMA Psychiatry. 2017 Mar 1;74(3):233-242. doi: 10.1001/jamapsychiatry.2016.3880. PubMed 28146251 ↗
  • Echterhoff J, Kriston L, Klein JP, Harter M, Schramm E, Schumacher L. Symptom-specific improvement across therapies and their putative mediators: A mediation network intervention analysis. Psychother Res. 2025 Apr;35(4):546-557. doi: 10.1080/10503307.2024.2320349. Epub 2024 Mar 3. PubMed 38431848 ↗
  • Schumacher L, Klein JP, Elsaesser M, Harter M, Hautzinger M, Schramm E, Kriston L. Implications of the Network Theory for the Treatment of Mental Disorders: A Secondary Analysis of a Randomized Clinical Trial. JAMA Psychiatry. 2023 Nov 1;80(11):1160-1168. doi: 10.1001/jamapsychiatry.2023.2823. PubMed 37610747 ↗
  • Humer E, Schramm E, Klein JP, Harter M, Hautzinger M, Pieh C, Probst T. Effects of alliance ruptures and repairs on outcomes. Psychother Res. 2021 Nov;31(8):977-987. doi: 10.1080/10503307.2021.1874070. Epub 2021 Jan 17. PubMed 33455531 ↗
  • Meister R, Lanio J, Fangmeier T, Harter M, Schramm E, Zobel I, Hautzinger M, Nestoriuc Y, Kriston L. Adverse events during a disorder-specific psychotherapy compared to a nonspecific psychotherapy in patients with chronic depression. J Clin Psychol. 2020 Jan;76(1):7-19. doi: 10.1002/jclp.22869. Epub 2019 Oct 1. PubMed 31576565 ↗
  • Assmann N, Schramm E, Kriston L, Hautzinger M, Harter M, Schweiger U, Klein JP. Moderating effect of comorbid anxiety disorders on treatment outcome in a randomized controlled psychotherapy trial in early-onset persistently depressed outpatients. Depress Anxiety. 2018 Oct;35(10):1001-1008. doi: 10.1002/da.22839. Epub 2018 Sep 10. PubMed 30199128 ↗
  • Eich HS, Kriston L, Schramm E, Bailer J. The German version of the helping alliance questionnaire: psychometric properties in patients with persistent depressive disorder. BMC Psychiatry. 2018 Apr 23;18(1):107. doi: 10.1186/s12888-018-1697-8. PubMed 29685124 ↗
  • Erkens N, Schramm E, Kriston L, Hautzinger M, Harter M, Schweiger U, Klein JP. Association of comorbid personality disorders with clinical characteristics and outcome in a randomized controlled trial comparing two psychotherapies for early-onset persistent depressive disorder. J Affect Disord. 2018 Mar 15;229:262-268. doi: 10.1016/j.jad.2017.12.091. Epub 2018 Jan 4. PubMed 29329058 ↗
  • Schramm E, Hautzinger M, Zobel I, Kriston L, Berger M, Harter M. Comparative efficacy of the Cognitive Behavioral Analysis System of Psychotherapy versus supportive psychotherapy for early onset chronic depression: design and rationale of a multisite randomized controlled trial. BMC Psychiatry. 2011 Aug 17;11:134. doi: 10.1186/1471-244X-11-134. PubMed 21849054 ↗
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Timeline

Tracking since Sep 25, 2026
Not marked actual or estimatedDates not marked actual or estimated

The record gives a start of Apr 2010, a primary completion of Oct 2013 and a completion of Dec 2014. It does not say whether these dates are actual or estimated.

How these figures are worked out, and which studies are left out of them.

Registered
Sep 1, 2009
First posted
Sep 2, 2009
Start
Apr 2010
Primary completionActual
Oct 2013
CompletionActual
Dec 2014
Last update
Jul 5, 2017
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Jul 5, 2017, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT00970437
Lead sponsor
University Hospital Freiburg
Responsible party
Elisabeth Schramm (PhD, University Hospital Freiburg) — Principal investigator
First posted
Sep 2, 2009
Start date
Apr 2010
Primary completion
Oct 2013
Completion
Dec 2014
Last update
Jul 5, 2017

Study contacts

Elisabeth Schramm, PhD
principal investigator · University Medical Center Freiburg, Department of Psychiatry and Psychotherapy
Martin Härter, MD, PhD
principal investigator · University Medical Center Hamburg

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Jul 2017. You cannot join it, but the record below documents what was studied.

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