Reflections on 50 Years in Psychiatry: An Interview with Jesse H. Wright, MD, PhD

Photo by Thom Shelby

CLINICAL CONVERSATIONS

Jesse H. Wright, MD, PhD, is an internationally recognized psychiatrist, the Kolb Endowed Professor of Psychiatry at the University of Louisville, and a pioneer in cognitive behavior therapy (CBT). His contributions to psychiatry span 5 decades, during which he has influenced countless psychiatrists, developed innovative teaching methods, and advanced digital mental health interventions.

Wright is the author of Learning Cognitive-Behavior Therapy: An Illustrated Guide, a best-selling standard text for CBT, and Breaking Free From Depression, described as a “must-have for finding a way through the pain of depression.” He also is the lead developer of Good Days Ahead, a scientifically tested online program for depression and anxiety that has helped thousands on their path to recovery. He was the principal investigator of multiple National Institutes of Health-funded research studies on computer-assisted CBT and has lectured widely across the globe. Beyond psychiatry, he is an accomplished novelist, an avid gardener, and a passionate fly-fisherman.

As Wright completes his 50th year in academic psychiatry, he reflects on his journey, career milestones, and the future of the field.

Career Reflections and Achievements

Pahwa, Adereti: Looking back at your career, what are you most proud of accomplishing as an academic psychiatrist?

Wright: I have had the good fortune to teach 50 classes of psychiatry residents—nearly 500 psychiatrists over the years. And early on, I embraced CBT and developed a novel teaching program that was one of the first to be part of a residency curriculum. After doing some writing on CBT, I was invited with colleagues to develop the book Learning Cognitive-Behavior Therapy: An Illustrated Guide—the first to integrate video with text. This book and others that followed are used in teaching programs around the world. Being the principal author of the first multimedia computer program for CBT and testing it in multiple randomized controlled trials was another step forward in my career.

Pahwa, Adereti: You have mentored numerous trainees and junior faculty. What do you consider the most critical traits for success in psychiatry?

Wright: I always return to the wisdom of William Osler, who emphasized equanimity—remaining calm in the eye of the storm. Beyond that, curiosity about the mind, a deep understanding of the biopsychosocial model for psychiatry, and the ability to integrate knowledge into case formulations are crucial.

Jesse H. Wright, MD, PhD with Aaron T. Beck, MD

Pahwa, Adereti: Can you share a defining moment in your career that shaped the psychiatrist, educator, or researcher you became?

Wright: Meeting Aaron T. Beck, MD, the architect of CBT, was transformative. He came to the University of Louisville early in my career to begin training our faculty, and our first encounter remains a flashbulb memory for me. Beck became my mentor and profoundly influenced my work in CBT.

Pahwa, Adereti: Which of your academic or clinical contributions do you hope will have the most lasting impact?

Wright: I hope the residents I have taught and the books I have written will continue to influence the care provided to patients. If my work has helped even a small fraction of psychiatrists improve patient outcomes, that would be a meaningful legacy.

Pahwa, Adereti: What motivated you to pursue psychiatry and how has your passion evolved throughout your career?

Wright: I was not a natural fit for psychiatry at first. When I was a medical student, choosing psychiatry was considered unconventional. Initially, I debated between psychiatry and primary care, but I am grateful I chose psychiatry. My passion for understanding the mind and my appreciation for the intersection of science and art in medicine have made this a deeply fulfilling career.

Education and Mentorship

Pahwa, Adereti: How has psychiatric education evolved over the years?

Wright: Psychiatric training has changed a great deal since I began my residency in the early 1970s. When I was a first-year resident at the University of Michigan, faculty rarely appeared on inpatient units and training in psychopharmacology was rudimentary.

Now faculty are deeply involved in daily inpatient care, and biological psychiatry is at the epicenter of our profession. Psychotherapy training has shifted from psychoanalysis to evidence-based treatments like CBT, behavioral activation, and short-term dynamic therapy. The rise of online education has been a great asset, though I still prefer in-person interaction when possible.

Pahwa, Adereti: As a pioneer in CBT, what are the key qualities of a great therapist?

Wright: A great therapist needs strong listening skills, accurate empathy, and deep clinical wisdom. Beyond these core qualities, specific evidence-based techniques can improve outcomes. Some examples are exposure therapy for anxiety, behavioral activation for depression, and cognitive restructuring for automatic negative thoughts.

Pahwa, Adereti: What are your thoughts on eclectic therapy vs sticking to one model like CBT?

Wright: This is one of the major controversies in psychotherapy—should we integrate multiple approaches or adhere strictly to one? Evidence suggests that nonspecific factors like the therapeutic alliance and understanding play a huge role in outcomes. That said, specific interventions are essential in certain cases.

For example, patients with agoraphobia and panic attacks may not improve with general supportive therapy alone—they may need structured exposure therapy and other CBT methods to break patterns of avoidance and gain skills in managing their fears. Patients with treatment-resistant depression who have not had a course of evidence-based therapy deserve a trial of a psychotherapy that has been shown to be effective for that condition. CBT and mindfulness-based cognitive therapy might be considered.

I advise residents to learn at least 1 evidence-based therapy in depth, possibly 2, and select an approach that aligns with their temperament and communication style. There is no one-size-fits-all therapy, but all effective psychotherapies share common elements. And in some cases, combining elements of different approaches may help with delivering a personalized therapy that is best suited to the patient’s unique blend of problems, opportunities, and strengths.

Pahwa, Adereti: What do you think about the role of CBT in neuroplasticity and its future alongside interventional treatments like transcranial magnetic stimulation (TMS) or psychedelics?

Wright: There is growing evidence that CBT induces neuroplastic changes in the brain like those seen with pharmacological treatments. In the future, combining CBT with novel interventions like TMS or psychedelics may enhance treatment outcomes, particularly for resistant cases.

Pahwa, Adereti: How do you see the future of CBT evolving with technology, AI, and digital health?

Wright: I hesitate to make predictions, but I suspect there will be greater adoption of digital tools for CBT that can improve access and the efficiency of treatment. AI-driven therapy may eventually fulfill the promise of computer-assisted CBT. AI could enhance digital adjuncts to psychotherapy through personalized interventions, real-time monitoring and feedback, and customized support.

Mehak Pahwa, MBBS

Iyanjesu Adereti, MBBCh

Concluding Thoughts

Wright’s 5 decades in psychiatry have helped to shape modern psychiatric education, digital mental health, and psychotherapy training. His legacy is woven into the practices of psychiatrists he has trained, the books he has authored, and the patients whose lives have been enhanced through CBT.

Dr Pahwa is a PGY-3 resident in psychiatry at the University of Louisville, KY. Dr Adereti is a PGY-3 resident in psychiatry at the University of Louisville, KY. Dr Wright is an internationally recognized psychiatrist, the Kolb Endowed Professor of Psychiatry at the University of Louisville, and a pioneer in cognitive behavior therapy.