Q&A with the Author
Congratulations on the publication of Cognitive Therapy of Depression, Second Edition, which you coauthored with a host of other distinguished psychologists —A. John Rush, Brian F. Shaw, Gary Emery, Robert J. DeRubeis—and the late Aaron T. Beck, the developer of Cognitive Behavior Therapy (CBT). American Psychologist called Dr. Beck “one of the five most influential psychotherapists of all time.” What was it like to work with him?
Aaron Temkin Beck ("Tim" to his friends) was one of the most influential theorists and therapists of the last century. Originally trained dynamically, he started his research career trying to confirm the psychodynamic notion that depression was a consequence of "anger turned inward.” However, his early explorations of the dreams and free associations of his patients found no evidence for this hypothesis—rather what he found was the same collections of negative self-beliefs and denigrations that dominated their waking conversation. It began to dawn on him that what his depressed patients told him was not only what they believed, but also the source of their distress and dysfunction. With this understanding, he was off to the races developing a novel approach to treatment that treated his patients' negative beliefs as hypotheses to be tested empirically via modifying their own behaviors.
On a more personal note, on the occasion of Tim’s 100th birthday, Rob DeRubeis and Tim’s daughter Judy Beck (a superb clinical theorist in her own right) organized a birthday party over Zoom. Virtually everyone told the same story—Tim spotted something special in them while they were still in training and boosted their careers, introducing them to leaders in the field and squiring them around conferences.
In his foreword to the book, David M. Clark, PhD, writes “In view of the success and wide impact of the first edition of Cognitive Therapy of Depression, one might ask whether a second edition is really needed.” So tell us—why is this second edition needed?
Cognitive therapy has evolved greatly over the last half century. While the core theory and principles remain, new strategies have been developed (mostly drawn from Tim's earlier dynamic training) that deal more effectively with complicated patients, such as those coping with chronic depression or underlying personality disorders. Our book brings therapists up to date on these new techniques.
The first edition of Cognitive Therapy of Depression was published in 1979. A lot has changed since then! In fact, 85% of the second edition is new material. Could you point out two or three major updates that are beneficial to a new generation of clinicians? How about the “three-legged stool”?
Among the major additions to the second edition is the notion of the "three-legged stool." Traditionally, cognitive therapy has focused on a patient’s current life problems (the first leg). Now, we have added their childhood antecedents (the second leg), and the vicissitudes of the therapeutic relationship (the third leg). Most patients, and especially those with chronic and comorbid depressions, benefit from this new modality.
The “third leg”—dealing with issues that arise in the therapeutic relationship—provides an opportunity for therapists and patients to work through the kinds of compensatory strategies that interfere with the patient’s relationships in the real world. The notion of “compensatory strategies” is itself an important and novel contribution to the second edition.
A highlight of Cognitive Therapy of Depression, Second Edition is the chapter-length case example. Can you explain what that is? What was it like to work on that chapter? What makes it such a helpful tool for clinicians?
Rob provides a chapter-long description of his therapy with a very difficult client (angry and dismissive) that demonstrates the use of the "three-legged stool" and relies heavily on actual vignettes from therapy. The chapter not only describes what to do with tough clients but shows examples of how to do it.
Considerable media attention has been devoted to the current state of mental health in America. (The CDC reports that in 2021, two in five U.S. adults reported experiencing symptoms of anxiety and depression, and 44% of teens reported struggling with feelings of sadness or hopelessness.) What do you make of these statistics? How is Cognitive Therapy of Depression, Second Edition uniquely positioned to help reduce emotional suffering today?
Social isolation is never a good idea (as happened during the pandemic), and teens are particularly vulnerable to its negative effects (adolescence is the period in life when you learn how to get along with people outside of your nuclear family). Mix in the increased reliance on social media and the opioid crisis and we are only pouring fuel on the fire. The principles and strategies we describe in the revision work every bit as well with teens as they do with adults (preadolescent children need something more concrete with an emphasis on parental involvement) and provide as much acute relief as medications with an enduring effect that lasts across the course of adolescence and likely beyond.
Thank you so much! Now that the book is out, is there a project that you are excited to work on next (a presentation, a workshop, writing another book, etc.)?
I am off the UK next month to do my annual training for IAPT and do other training workshops at least a half dozen times a year. Likely my coauthors provide training opportunities of their own.
See all titles by and read more about Steven D. Hollon on his author page!
