Psychotherapy for dysthymia. A naturalistic study of ten patients.

Ten early and late onset dysthymia cases, diagnosed by DSM-III criteria, were treated with the Cognitive-Behavioral Analysis System of Psychotherapy, a standardized, three-stage therapy system developed specifically for the treatment of dysthymia. The cases are presented as naturalistic, direct-replication studies. Reliability of data trends within and across stages of treatment and generalization of effects across patients were demonstrated. The out-of-control depressive state at treatment outset is challenged by demonstrating to each patient that their depressive predicament is self-produced and maintained by maladaptive living strategies. The essential goals of therapy are teaching the patient a) to accept total responsibility for their depression and b) to achieve and maintain mood control by enacting adaptive daily living strategies. The progressive assumption of personal responsibility for the debilitative mood state is accompanied by a corresponding shift in a locus of control set from externality to internality. Patients were then taught situational coping strategies, and treatment ended when mood control was evinced. All cases were treated by J.P.M. The 10 cases met therapy termination criteria, and nine (one exception) were found in remission for dysthymia at follow-up of 2 years or more. Cognitive behavior psychotherapy, which directly attacks the helplessness and hopelessness plight of the dysthymic and teaches adaptive coping skills, appears to be an effective therapeutic strategy for the disorder.