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  • The Epistemic Relevance of Cognitive Behavioral Therapy
  • Chloe Bamboulis (bio) and Lisa Bortolotti, PhD* (bio)

Ratnayake's interesting paper challenges two claims, that cognitive distortions in depression involve epistemic issues; and that cognitive behavioral therapy (CBT) can rectify those epistemic issues. We are going to discuss both claims here and offer some reasons not to underestimate the epistemic relevance of CBT. First, there may be epistemic issues underlying cognitive distortions in depression that CBT can effectively address, including blind acceptance of negative automatic thoughts and insensitivity to evidence. But, even if CBT were primarily in the business of enhancing utility as opposed to validity, this would have significant, though indirect, epistemic benefits.

Validity and Utility in Depression

All human agents, whether they have a mental health diagnosis or not, behave in ways that diverge from the ideal standards of epistemic and practical rationality, compromising validity and utility. Whereas validity mostly concerns the accuracy of mental representations and the correctness of explanatory hypotheses, utility concerns their adaptiveness. The goal of validity is to see the world, the self, and the future as they are, whereas the goal of utility is to enhance successful and productive behavior avoiding misery. Let's consider Ratnayake's example of a student who "performs mediocrely on a test and consequently believes that they will fail the entire course." Call her Susie.

The depressive realism effect suggests that people with mild depressive symptoms are more accurate than controls when rating themselves and predicting their future, but the same epistemic advantage neither applies to those diagnosed with major depression nor extends to tasks that are not self-related. Suppose that Susie evaluates accurately her performance in the test and also accurately predicts that she will fail the entire course: she may be showing validity at the expense of utility. But what about those other thoughts Susie is likely to have due to her depression, about her social interactions and everyday situations? That the world is a cruel place and luck is always against her, that she is weak and unable to control her circumstances? These thoughts may lack both validity and utility.

If we think that so-called cognitive distortions in depression only involve practical issues and [End Page 91] not epistemic issues, we may also believe that, if a therapy addresses cognitive distortions effectively, it does so because it boosts utility. But this would be misleading. Epistemic issues include generating implausible hypotheses that do not pass rigorous reality testing, but also arriving at hypotheses without taking into account the relevant evidence that is available. If Susie arrives at a self-prediction that turns out to be correct by simply accepting a negative automatic thought, this does not indicate that she has exercised epistemic rationality. Simply accepting that things will go badly due to negative biases may give rise to correct predictions, but the prediction will not reflect a careful consideration of the factors that are likely to contribute to the future outcome. This has implications for the discussion of the aims of CBT: the epistemic relevance of a therapeutic approach does not merely depend on whether it increases the overall number of accurate representations and correct hypotheses, but in whether it encourages grounding representations and hypotheses on experience and evidence.

Does CBT Lead to Epistemic Improvement?

The main thesis in Ratnayake's paper is that CBT does not produce more accurate self-evaluations or more reliable self-predictions but encourages a positive way of interpreting reality that, before engaging in therapy, people might not have taken advantage of. The claim, then, is that CBT does not contribute to validity but boosts utility: it may be instrumental to turning people into more practically rational agents, enabling them to navigate their environment in a more successful way. However, for Ratnayake, CBT does not turn people into more epistemically rational agents, because, instead of eliminating distortions from their reasoning, it promotes an interpretation of the facts that protects people from anxiety and depression.

Take Susie who comes to believe, with high conviction, that she will fail the whole course because she performed mediocrely in one test. By inviting Susie to think about...