Evidence map›Paper›PMID 41922057›Full record

ArticleBMJ open2026

Efficacy, moderators and mediators of cognitive behavioural analysis system of psychotherapy (CBASP) versus behavioural activation (BA) in persistently depressed treatment-resistant inpatients: study protocol for the multicentre, randomised controlled

Eva-Lotta Brakemeier, Jan Philipp Klein, Johannes Zimmermann, Maike Hollandt, Matthias A Reinhard, Sabrina Boger, Luisa Daldrup, Luk Eldem, Philippa Gebhardt, Susanne Heinrich and 48 more

Registry-linked trialAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04996433 (Cognitive Behavioral Analysis System of Psychotherapy), which is not on this map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04996433 narecruitingnot on this map

Cognitive Behavioral Analysis System of Psychotherapy (CBASP) vs. Behavioral Activation (BA) in Persistently Depressed Treatment-resistant Inpatients: Efficacy, Moderators, and Mediators of Change

TypeinterventionalSponsorUniversity of GreifswaldRan2021 to 2028Enrolled396ConditionsPersistent Depressive Disorder, Treatment-resistant DepressionArmsinpatient CBASP individual therapy, inpatient CBASP group therapy, inpatient CBASP nurse contact, inpatient CBASP exercise therapy, outpatient CBASP group therapy
3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

58 authors.

Eva-Lotta BrakemeierDepartment of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany eva-lotta.brakemeier@uni-greifswald.de.ORCID http://orcid.org/0000-0001-9589-3697
Jan Philipp KleinDepartment of Psychiatry, Psychosomatics and Psychotherapy, Lübeck University, Lübeck, Germany.ORCID http://orcid.org/0000-0001-9882-2261
Johannes ZimmermannDepartment of Psychology, University of Kassel, Kassel, Germany.
Maike HollandtDepartment of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany.
Matthias A ReinhardDepartment of Psychiatry and Psychotherapy, University Hospital LMU Munich, Munich, Germany.ORCID http://orcid.org/0000-0002-8374-5467
Sabrina BogerDepartment of Psychiatry and Psychotherapy, University Hospital LMU Munich, Munich, Germany.
Luisa DaldrupDepartment of Psychiatry and Neurosciences, Charité Universitätsmedizin Berlin, Berlin, Germany.
Luk EldemDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
Philippa GebhardtDepartment of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
Susanne HeinrichDepartment of Psychiatry and Neurosciences, Charité Universitätsmedizin Berlin, Berlin, Germany.
Matthias HirsmuellerUniversity Hospital for Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany.
Jacob MillerowskiDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
Martina RichterDepartment of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany.
Isabelle C RidderbuschDepartment of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
Svenja SuerigDepartment of Psychiatry, Psychosomatics and Psychotherapy, Lübeck University, Lübeck, Germany.
Lennart SchroeterDepartment of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
Kerstin Velten-SchurianUniversity Hospital for Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany.
Stefan EngeliCoordinating Center for Clinical Studies (KKS), University Medicine Greifswald, Greifswald, Germany.
Amelie WitteCoordinating Center for Clinical Studies (KKS), University Medicine Greifswald, Greifswald, Germany.
Malek BajboujDepartment of Psychiatry and Neurosciences, Charité Universitätsmedizin Berlin, Berlin, Germany.
Andreas J FallgatterUniversity Hospital for Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany.
Kai G KahlDepartment of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
Tilo KircherDepartment of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
Stephan KöhlerDepartment of Psychiatry and Neurosciences, Charité Universitätsmedizin Berlin, Berlin, Germany.
Alexandra PhilipsenDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
Martin WalterDepartment of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany.
Johannes WolfDepartment of Psychiatry and Psychotherapy, University Hospital LMU Munich, Munich, Germany.
Anne GuhnDepartment of Psychiatry and Neurosciences, Charité Universitätsmedizin Berlin, Berlin, Germany.ORCID http://orcid.org/0000-0003-1481-0269
Ulrich SchweigerDepartment of Psychiatry, Psychosomatics and Psychotherapy, Lübeck University, Lübeck, Germany.
Jürgen HoyerDepartment of Clinical Psychology and Psychotherapy, University of Dresden, Dresden, Germany.
Dennis GutzmerDepartment of Psychiatry and Neurosciences, Charité Universitätsmedizin Berlin, Berlin, Germany.
Stephan MauersbergerDepartment of Psychiatry and Neurosciences, Charité Universitätsmedizin Berlin, Berlin, Germany.
Selin DemirDepartment of Psychiatry and Neurosciences, Charité Universitätsmedizin Berlin, Berlin, Germany.
Sarah StapelDepartment of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany.
Jonas HallgansDepartment of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany.
Cornelius SchüleDepartment of Psychiatry and Psychotherapy, University Hospital LMU Munich, Munich, Germany.
Christian FrischholzUniversity Hospital for Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany.
Ivo HeitlandDepartment of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
Stephanie RekDepartment of Psychiatry and Psychotherapy, University Hospital LMU Munich, Munich, Germany.
Andrea JobstDepartment of Psychiatry and Psychotherapy, University Hospital LMU Munich, Munich, Germany.
Ina KlugeDepartment of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
Silke LuxDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
Nils OpelDepartment of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany.
Svenja OrlowskiDepartment of Psychiatry, Psychosomatics and Psychotherapy, Lübeck University, Lübeck, Germany.
Christina ReinertUniversity Hospital for Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany.
Henrike VoelzDepartment of Psychiatry and Neurosciences, Charité Universitätsmedizin Berlin, Berlin, Germany.
Isabel M BerwianResearch Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Helge FrielingDepartment of Psychiatry, Social Psychiatry and Psychotherapy, Medizinische Hochschule Hannover, Hannover, Germany.
Hannah B MaierSocial Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
Henrik WalterDepartment of Psychiatry and Neurosciences, Charité Universitätsmedizin Berlin, Berlin, Germany.
Eva FassbinderDepartment of Psychiatry, Psychosomatics and Psychotherapy, Lübeck University, Lübeck, Germany.
Tim KaiserDepartment of Methods and Evaluation/Quality Assurance, Free University Berlin, Berlin, Germany.
Jonathan KanterDepartment of Psychology, University of Washington, Seattle, Washington, USA.
John SwanDepartment of Psychiatry, State University of New York, University at Buffalo, Buffalo, New York, USA.
Pim CuijpersDepartment of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.ORCID http://orcid.org/0000-0001-5497-2743
Martin HautzingerDepartment of Psychology, Clinical Psychology, and Psychotherapy, University of Tuebingen, Tübingen, Germany.
Philipp SterzerDepartment of Psychiatry and Neurosciences, Charité Universitätsmedizin Berlin, Berlin, Germany.
Frank PadbergDepartment of Psychiatry and Psychotherapy, University Hospital LMU Munich, Munich, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionUp to 30% of individuals with depression develop persistent depressive disorder (PDD), an often disabling and difficult to treat condition. The Cognitive Behavioural Analysis System of Psychotherapy (CBASP) is the only psychotherapy developed specifically for treating individuals with PDD. While several randomised controlled trials (RCTs) have demonstrated its efficacy in outpatient settings, evidence for its use in inpatient settings remains limited. Pilot studies of CBASP inpatient programmes in Germany have shown promising feasibility and effectiveness; however, no RCTs to date have systematically evaluated their outcomes. This study represents the first RCT to compare the short- and long-term efficacy and safety of CBASP with Behavioural Activation (BA), a first-line psychotherapy for depression, within an intensive multimodal inpatient setting. METHODS AND ANALYSIS: In this prospective, multicentre, rater-blinded RCT with an active control group, we aim to recruit 396 adults (aged 18-70 years) with treatment-resistant PDD at eight German university hospitals. Participants will be randomly assigned to receive either (1) CBASP or (2) BA within an intensive treatment programme consisting of 10 weeks acute treatment in an inpatient and/or day clinic setting, followed by 6 weeks of outpatient continuation treatment. Primary and secondary outcome assessments will be conducted at multiple time points: baseline (T0), treatment onset (T1), after 5 and 10 weeks of acute treatment (T2, T3), at the end of continuation treatment (T4, week 16) and every 2 months up to week 64 (T5, naturalistic follow-up).The primary outcome measure will be the change in depression severity, as assessed by the Hamilton Depression Rating Scale (24-item version), after 16 weeks of treatment (from T0 to T4). Secondary outcomes will include response, remission, deterioration and relapse rates, self-reported depression and anxiety symptoms and additional psychological variables. A cost-benefit analysis will evaluate the health-economic benefits of both interventions. Additionally, this RCT will explore personalised treatment selection and mechanisms of change, including potential moderators and mediators of treatment effects. The findings from this trial are expected to provide clinicians with evidence-based guidance on choosing CBASP versus BA for inpatients with treatment-resistant PDD. ETHICS AND DISSEMINATION: This study has received ethical approval from the ethics committees of all participating university hospitals. All participants will provide written informed consent before enrolment. Study findings will be published in peer-reviewed journals and presented at national and international conferences. We have involved people with lived experience from the earliest pilots onward, using their feedback to refine our study design. Ongoing consultation at conferences and public events has further ensured that our research remains grounded in patient perspectives. TRIAL REGISTRATION NUMBER: NCT04996433.

Indexed as

Cognitive Behavioral TherapyDepressive Disorder, Treatment-ResistantAdolescentAdultAgedFemaleGermanyHumansInpatientsMaleMiddle AgedMulticenter Studies as TopicProspective StudiesRandomized Controlled Trials as TopicTreatment OutcomeYoung AdultAdult psychiatryDepression & mood disordersRandomized Controlled Trial

Identifiers

PMID41922057
PMCPMC13052729

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.