CBASP Treatment Strategies
In-session focus exercises in an atmosphere of felt safety help patients confront the feared stimuli and modify the Pavlovian fear driving the refractory emotional state. Learning appropriate non-avoidant ways to deal with the fear stimuli also decreases Skinnerian avoidance behavior and prepares the way for mood change. In the beginning of therapy, it should be remembered that the chronic mood associated with trauma or psychological insults may involve stimulus events that remain tacit knowledge (out of awareness) for patients (i.e., the pain, fear and anxiety are clearly observable but the actual precipitating and maintaining stimuli may not be clearly understood or recognized by the patient). Material derived from the Significant Other History (SOH: McCullough, 2000, 2006) often illustrates the tacit knowledge dimension of the patient’s avoidance patterns. In summary, another way to describe what’s going on in the beginning of therapy is to say that patients are avoiding others (including the therapist) and not responding to the interpersonal environment. Interpersonal avoidance always dictates that the patient's primary focus remains on himself or herself (i.e., patients stay “in their heads”). In such a psychosocial functioning state, these individuals remain helpless and hopeless and continue to respond to themselves in a solitary and never-ending circle of pain, fear, anxiety (and depression); hence, they are unable to connect with their interpersonal world in any informing way - we diagnose this pattern of living, Chronic Depression (Comments above taken from McCullough, 2000: pp. 270–274; McCullough, 2006: pp. 124–131).
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