J Psychother Pract Res
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J Psychother Pract Res 10:286-287, October 2001
© 2001 American Psychiatric Association


Book Reviews

Scientific Foundations of Cognitive Theory and Therapy of Depression

By David A. Clark, Aaron T. Beck, and Brad A. Alford, New York, John Wiley and Sons, 1999, 494 pages, ISBN 0-47118-970-7, $85.00

Michael E. Thase, M.D.

Key Words: Books Reviewed

Although there are dozens of books on cognitive therapy of depression, a majority are edited volumes and relatively few are distinguished by the comprehensive mastery of the material and clarity of exposition apparent in this book by Clark, Beck, and Alford. This volume offers a relatively up-to-date (circa 1999) and scholarly review of the phenomenology of depressive disorders from the cognitive perspective, along with detailed evaluations of the literature pertaining to the key hypotheses of the cognitive model of depression.

The book is well written, but it is not for the cognitive therapy neophyte. It is rather lengthy and detailed. Moreover, as might be expected, the discussions of criticisms of the cognitive model are somewhat partisan, and the authors consistently present the cognitive model as dynamic and organic (as opposed to static) in response to new and at times contradictory data. Nevertheless, it provides a valuable source companion to the classic but outdated treatment manual originally published in 1979 by Dr. Beck and colleagues (Cognitive Therapy of Depression) and the excellent how-to book by Dr. Judith Beck, Cognitive Therapy: Basics and Beyond, which was published in 1995.

Subheads, periodic summaries, and statements of key points within each chapter focus the reader's attention and enhance comprehension; the authors are, after all, expert cognitive therapists. There is a minimum of redundancy across the 11 chapters, and although the copyediting is not infallible (e.g., influential early behaviorist Charles Ferster is referred to as "Fester" in both the text and the reference list), typographical errors are few.

As a treatment researcher, I was disappointed that the authors did not devote at least one chapter to reviewing the comparative outcome research studies of CT. Outcomes data has been one of the key aspects of the scientific foundation of CT for nearly 25 years.1 This is a shortcoming, particularly in view of work linking early evidence of CT's superiority (over other therapies) to strong allegiance effects2 and the increasing number of studies in which CT has not performed so well under more "neutral"3,4 or even potentially "allegiance-disadvantaged"57 conditions. Ultimately, the most pragmatic benefit of an elegant, scientifically strong model of psychopathology is the ability to translate such knowledge into greater or more enduring benefits for our patients. In this regard, it is not yet clear that the elaborate suprastructure of schema theory actually adds such benefits relative to simpler behavioral5 or interpersonal6 models of intervention.

FOOTNOTES

Dr. Thase is Professor of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.

REFERENCES

  1. Rush AJ, Beck AT, Kovacs M, et al: Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients. Cognitive Therapy Research 1977; 1:17-37
  2. Luborsky L, Diguer L, Seligman DA, et al: The researcher's own therapy allegiances: a "wild card" in comparisons of treatment efficacy. Clinical Psychology Science and Practice 1999; 6:95-106
  3. Elkin I, Shea MT, Watkins JT, et al: National Institute of Mental Health Treatment of Depression Collaborative Research Program: general effectiveness and treatments. Arch Gen Psychiatry 1989; 46:971-982[Abstract]
  4. Scott AIF, Freeman CPL: Edinburgh Primary Care Depression Study: treatment outcome, patient satisfaction, and cost after 16 weeks. BMJ 1992; 304:883-887
  5. Jacobson NS, Dobson KS, Truax PA, et al: A component analysis of cognitive-behavioral treatment for depression. J Consult Clin Psychol 1996; 64:295-304[Medline]
  6. Markowitz JC, Kocsis JH, Fishman B, et al: Treatment of depressive symptoms in human immunodeficiency virus-positive patients. Arch Gen Psychiatry 1998; 55:452-457[Abstract/Free Full Text]
  7. Ravindran AV, Anisman H, Merali Z, et al: Treatment of primary dysthymia with group cognitive therapy and pharmacotherapy: clinical symptoms and functional impairments. Am J Psychiatry 1999; 156:1608-1617[Abstract/Free Full Text]




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