It's Been Utility All Along: An Alternate Understanding of Cognitive Behavioral Therapy and The Depressive Realism Hypothesis

Abstract:Cognitive behavioral therapy (CBT), one of the most popular schools of psychotherapy, associates mental illnesses such as depression, with patterns of distorted thoughts, referred to interchangeably as "cognitive distortions" or "negative automatic thoughts." CBT's theoretical account claims: first, that these distortions involve various epistemic issues and second, that its therapeutic techniques are capable of rectifying these epistemic issues. Together these claims spell out a model of mental illness and a mechanism of action, that is, a means through which CBT's techniques act to address mental illness. In this paper, I challenge both these claims and thus CBT's epistemic characterization of mental illness and its therapeutic mechanism. I begin with the second claim and show that the ability of CBT's therapeutic techniques to address epistemic issues is likely to be overstated. In turning to the first claim, I show that even if CBT were able to rectify epistemic issues, the thinking of mentally ill individuals is not characterized straightforwardly by epistemic issues. In concluding, I suggest an alternate way in which CBTs account of mental illness and its mechanism should be understood.