Reconsidering rapid early response in cognitive behavioral therapy for depression

Ilardi and Craighead (1994) observed that 60-70% of symptom improvement in cognitive behavioral therapy (CBT) occurs in the first 4 weeks, and they assumed that cognitive modification techniques are not extensively applied in these weeks. They thus concluded that Beck's cognitive hypothesis of CBT cannot explain this early improvement. However, studies have shown that cognitive modification techniques are applied extensively in early sessions. Also, in most CBT studies there have been two sessions per week for the first: 4 weeks and 1 session per week thereafter Thus, 40-60% of CBT sessions in studies occur in the first 4 weeks, which arguably is enough therapeutic time for cognitive techniques to have a substantial effect on symptoms. Finally, Ilardi and Craighead's method assumes homogeneity among the patients' time courses, which is inconsistent with empirical data. We conclude that symptom change time course data do not contradict Beck's cognitive hypothesis.