Clinical Round Table 2 - Cognitive Therapy for Depression: Myths and Misconceptions

In the half century since the classic treatment manual Cognitive Therapy of Depression was first published in 1979, much has changed in our understanding of depression: it is far more prevalent than previously recognized and may represent an adaptation that evolved to serve a function. Cognitive therapy has itself evolved to address these new perspectives and has expanded to facilitate the treatment of a broader range of patients across a more diverse array of settings than its earlier incarnation. In our 2024 revision of the original manual, we address the myths and misconceptions regarding the use of cognitive therapy in the treatment of depression and provide an overview of the major ways in which the approach has evolved to address these concerns. Myth #1: Cognitive therapy de-emphasizes affect: We consider affect to be “the royal road to the cognition”. Myth #2: Cognitive therapy ignores behaviors: The most powerful way to change beliefs is to encourage patients to use their own behaviors to test the accuracy of their beliefs. Myth #3: Cognitive therapy has no lasting effect: Cognitive therapy has an enduring effect that cuts risk for subsequent relapse or recurrence by half. Myth #4: Cognitive therapy does not teach lasting skills: Skill acquisition appears to underly cognitive therapy’s long-term enduring effects. Myth #5: Cognitive therapy is too simplistic to treat patients with complicated comorbidities: Cognitive therapy has evolved to incorporate childhood antecedents and the therapeutic relationship in the treatment of such patients, including those with underlying personality disorders (the biggest evolution in the nature of the treatment). Myth #6: Cognitive therapy only works with unipolar patients: It can be a useful adjunct with bipolar patients. Myth #7: Combined treatment retains the advantages of both cognitive therapy and medications: Adding medications may interfere with cognitive therapy’s enduring effect. Myth #8: Cognitive therapy can only be delivered by trained professionals face-to-face: It can be delivered by lay counselors using remote or digital formats. We plan to encourage audience participation to address these and other myths regarding use of cognitive therapy in the treatment of depression.