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The American Psychiatric Association has concured that the study was "strong" and "rigorously designed" and will be considered when they revise their treatment guidelines in the future. The guidelines were last updated five years ago. They questioned, however, whether the depressed patients in the study were truly representative of people with major depression, since those with psychosis were excluded from the study, even though many who suffer from major depression are also psychotic. They also questioned whether those seeking cognitive therapy in the general community can get the same level of care as the study's participants.