Beck and Cognitive Therapy

¶ … cognitive therapy is a widely accepted, empirically validated treatment for a number of conditions, including most especially depression. The theorist who responsible for developing cognitive therapy is Aaron T. Beck, a nonagenarian who is currently the University of Philadelphia Professor Emeritus of Psychiatry and a member of The Institute of Medicine. To date, Dr. Beck has been the recipient of countless awards and honors in recognition of his contributions to the field of psychotherapy and he continues to research and write despite his advanced age. This paper provides a biographical description of Dr. Beck, followed by an analysis of an application of his cognitive therapy to depression. Finally, a summary of the research and important findings concerning Dr. Beck and cognitive therapy are presented in the paper's conclusion.

Aaron T. Beck and Cognitive Therapy

Introduction

One of the early pioneers of research into psychoanalytic theories of depression is Aaron Temkin Beck whose empirically validated treatments include cognitive therapy, an increasingly popular intervention for a wide range of psychiatric conditions including depression. A growing body of evidence indicates that many individuals who suffer from unipolar depression in particular can benefit from cognitive therapy, and has demonstrated efficacy on the same level as pharmacological interventions for mild to moderate cases (Hoffman & Nazario, 2015). To gain some fresh insights into the biographical details of Beck and to determine how cognitive therapy achieves these desirable outcomes, this paper reviews the relevant literature followed by a summary of the research and important findings concerning Beck and cognitive therapy in the conclusion.

Biographical Description of Theorist

Born in Providence, Rhode Island in 1921, Aaron Temkin Beck was the youngest of the five children born to Elizabeth and Harry Beck who married in 1909 (Spicher, 2008). Although Beck's professional interests in psychology began relatively late in the career, an early childhood experience was clearly a formative influence on his life. For instance, Spicher (2008) reports that, "Beck notes that his mother was quite depressed prior to his birth due to the loss of two of her children" (para. 2). In his autobiography, Aaron T. Beck, the theorist reported that "he believed himself to be a replacement child for his sister" and "he takes joy in the idea that, even at a young age, he was able to cure his mother's depression" (cited in Spicher, 2008, para. 2).

Notwithstanding this early incident, Beck's professional interest in psychiatric interventions did not develop fully for some time but he still racked up numerous awards and honors for his early work, including graduating first in his high school class (Spicher, 2008), a distinguished record in journalism and academia as well as active duty military service during the Korea War (Beck biography, 2015). For instance, during his attendance at Brown University, he served as associate editor of the university newspaper which earned him numerous awards and honors, including the Francis Wayland Scholarship, the Phi Beta Kappa, the Bennet Essay Award, and the Gaston Prize for Oratory (Beck biography, 2015).

As if all of this was not enough to exhaust an undergraduate, Beck's unquenchable thirst for knowledge kept him even busier while he was attending Brown University. For instance, Spicher reports that, "Although his majors were English and Political Science, Beck did not allow himself to be fenced in by course requirements and took classes in a plethora of subjects while at Brown" (2008, para. 4). Following his magna cum laude graduation from Brown University in 1942, Beck attended Yale Medical School where he graduated in 1946 (Beck biography, 2015).

By this point in his academic and professional career, it would seem reasonable to suggest that Beck would have been able to make up his mind about the future direction of his career with some finality, but he remained uncertain about his plans. In this regard, Spicher (2008) notes that, "Even after graduation Beck was still undecided on his specialty. After receiving input from his family, he decided to take an internship at the Rhode Island Hospital where he studied neurology as a specialty" (para. 4).

At Rhode Island Hospital, Beck served a series of rotating internships and a residency in pathology as well as a residency in neurology at the Framingham, Massachusetts Veterans Administration (now Department of Veterans Affairs) Medical Center where he first became actively interested in psychiatry (Beck biography, 2015). This was not Beck's first encounter with the psychiatric field, but his initial experiences were somewhat disillusioning, causing him to delay his active pursuit in the field until later in his career. In this regard, Spicher (2008) advises that, "Though he entered Yale with an interest in psychiatry, he soon lost that interest upon taking his first psychoanalytic class" (para. 4).

In support of this assertion, Spicher cites Beck's autobiography, Aaron T. Beck, wherein Beck says, "I thought it was nonsense. I could not really see what it fitted" (2008, para. 4). During a 2-year tenure as a fellow at Austin Riggs Center in Stockbridge, Massachusetts, Beck gained significant experience with long-term psychotherapeutic interventions (Beck biography, 2015). During the Korean War, Beck was assigned to the Valley Forge Army Hospital where he served as assistant chief of neuropsychiatry (Beck biography, 2015).

According to Beck's official biography, "Dr. Beck joined the Department of Psychiatry of the University of Pennsylvania in 1954 (Beck biography, 2015). During his tenure at Philadelphia's University of Pennsylvania, Beck became interested in psychoanalytic theories of depression and went on to create a theoretical-clinical approach that he termed "cognitive therapy" (Beck biography, 2015). In this regard, one biographer reports that, "At Philadelphia, Beck had originally trained as a psychoanalyst, because he believed it offered a way of viewing the whole range of human experiences and problems" (Freeman, 1999, p. 273).

In reality, Beck's tenure at the University of Pennsylvania had some serendipitous qualities to it that would ultimately have a profound influence on the direction of his professional career. After accepting a position at the University of Pennsylvania's psychiatric department in 1954, Beck implemented a depression research clinic and began to more thoroughly develop his cognitive approach to treating the condition (Spicher, 2008). Based on his research in this capacity, Beck developed the Beck Depression Inventory (BDI) in 1961 (Spicher, 2008). According to Spicher, "The BDI is one of the most widely used and referenced scales of depression. It is a 21 item scale that uses a Likert scale to determine the severity of depression symptoms" (2008, para. 6). Despite its widespread acceptance as a reliable and valid instrument for assessing depression disorders, the higher-ups at the University of Pennsylvania were unresponsive to this innovation (Spicher, 2008). As Beck puts it, there was "an underwhelming interest in the project" (cited in Spicher, 2008, para. 6).

Following his appointment as an associate professor at the University of Pennsylvania in 1967, Beck was allowed a 1-year extension on his depression research only, and this position required him to give up his on-campus office which required him to work at home, an outcome that would have important implications for Beck and his research into depression (Spicher, 2080). In this regard, Spicher (2008) emphasizes that, "Working from home turned out to be just what Beck needed, and he produced his first book, Depression: Clinical Experimental and Theoretical Aspects" (para. 7). This publication helped to solidify Beck's status at the University of Pennsylvania and he received full professor status in 1971 (Spicher, 2008).

To his credit, Beck's gradual development of psychoanalytic approaches to helping people overcome their cognitive disorders required years of painstaking empirical observations and research before he was satisfied that there was a relationship between individuals and their environment that must be taken into account. For instance, Freeman advises that, "Like Freud, [Beck] began by exploring the links between the environment, the individual, and their emotions and motivations, as well as how disturbances in the balance between and within these factors resulted in emotional problems and disorders" (1999, p. 273).

Over the past 55 years, Beck has overseen a number of sponsored studies concerning the psychopathology of various conditions, including most especially depression (Beck biography, 2015), but other conditions as well including suicide, anxiety disorders, panic disorders, alcoholism, drug abuse, personality disorders, and schizophrenia and how cognitive therapy can help sufferers of these conditions (Beck biography, 2015). At present, Beck's professional interest is focused on evaluating the effectiveness of cognitive therapy interventions in community-based settings. One of these initiatives, the eponymous "Beck Initiative," is a partnership with the City of Philadelphia's Department of Mental Health/Mental Retardation Services that trains therapists concerning how to conduct cognitive therapy in their own communities (Beck biography, 2015).

Beyond the foregoing, Beck is also actively researching the efficacy of cognitive therapy treatment for schizophrenia (Beck biography, 2015). Enormously prolific, Beck has also penned more than 540 articles and authored or co-authored 22 books to date (Beck biography, 2015). These publications have spanned the entire range of cognitive disorders besides depression. For example, according to one of his many texts, "Dr. Beck has worked extensively with personality disorders and has been an investigator on two studies using cognitive therapy with borderline personality disorder" (Beck & Freeman, 2004, p. 5). Likewise, Spicher (2008) reports that, "Beck has produced a multitude of publications on subjects ranging from depression, suicide, relationships, anxiety, and many other topics. Depression, his first research interest, has probably received most of his devotion" (para. 7).

During the period between 1960 and 1965, Beck authored his original articles on depression and how the cognitive theory of emotional disorders could be applied to this disorder (Freeman, 1999). These seminal works continue to describe the fundamental tenets of Beck's theories concerning psychological problems (Freeman, 1999).

Since that time, Beck has also served as a consultant or a member of numerous review panels for the National Institute of Mental Health, as well as numerous editorial boards of peer-reviewed journals and is currently a member of The Institute of Medicine (Beck biography, 2015). Moreover, Beck is internationally renowned having lectured around the world as well as serving as a visiting scientist at the Medical Research Council and a visiting fellow at Wolfson College (both at Oxford) as well as a visiting professor at Yale, Columbia and Harvard (Beck biography, 2015). Given his long-time contributions to the field, it is not surprising that Beck has been the recipient of numerous accolades.

In addition, over the years, Beck has also received four honorary degrees (Brown University, University of Pennsylvania, Assumption College, and Philadelphia College of Osteopathic Medicine) (Beck biography, 2015). This lifetime of professional service has also garnered Beck the distinction of being included among the "ten individuals who shaped the face of American Psychiatry" and the most influential American psychotherapist (Beck biography, 2015, para. 3). In addition, Beck continues to serve as President of the Beck Institute for Cognitive Therapy (Beck & Freeman, 2004) and University of Philadelphia Professor Emeritus of Psychiatry (Beck biography, 2015).

Although he married relatively late in life in 1950 (during his 30s), Beck is still married to Phyllis Beck (nee Whitman) with four children, eight grandchildren, and two great-grandchildren (Beck biography, 2015). Moreover, Beck's wife and progeny have made major contributions in their own rights. For example, Spicher (2008) reports that, "Phyllis proved to be a perfect match for her husband's strong work ethic and intelligence; she completed a law degree while raising their four children" (para. 6). In addition, his wife was a Pennsylvania superior court judge and their daughter, Alice, also serves as a judge in Pennsylvania, making them the only mother-daughter duo of judges in Pennsylvania history (Spicher, 2008).

Given this remarkable life and career, Beck could easily be forgiven for retiring and taking some time for himself, but a lifetime of commitment to helping others keeps him going strong today. For instance, according to one long-time colleague, "Now in his 90s, Beck's ongoing research pursues new knowledge about schizophrenia, depression and suicide. He still experiences a thrill when his team makes discoveries that can help people" (Padesky, 2013, para. 2). This lifetime commitment to helping others has not gone unnoticed by professional organizations, of course, but it has also been widely recognized by his peers and associates who regard him as a compassionate world-changer. In this regard, Padesky adds that, "When we last had lunch in Philadelphia, I smiled at his ongoing enthusiasm, still powered by genuine caring, and his unflagging curiosity. Beck has changed the world" (2013, para. 3). In recent years, Beck has also collaborated with his daughter, Judith Beck, in co-authoring cognitive therapy articles and scholarly texts.

As noted above, the cornerstone of Beck's approach to treating severe psychological conditions including depression has been cognitive therapy. Although humble in other ways, Beck proudly boasts that, "Cognitive therapy has grown from its humble beginnings to become the fastest growing psychotherapy in the world" (2004, p. 16). This assertion, though, has the support of numerous therapists who agree that Beck's cognitive therapy represented a major advance in psychotherapy. For instance, Rosner (2011) reports that, "[Beck's] new school of cognitive therapy brought the experimental ethos into every corner of psychological life, extending outward into the largest multisite randomized controlled studies of psychotherapy ever attempted and inward into the deepest recesses of our private worlds" (p. 1). Moreover, cognitive behavioral therapy (CBT) is based on Beck's cognitive theory of emotional disturbance (Macrodimitris & Hamilton, 2010) and has been verified as good evidence-based practice. For instance, Shurlati, Schniering, Lynchham and Rapee (2011) report that, "In the case of child and adolescent anxiety disorders, CBT is the most empirically supported treatment" (p. 91). Likewise, a number of studies have shown that behavioral therapy provides superior results compared to psychotherapy in terms of overall patient adjustment and work and social adjustments in some cases as well (Reisner, 2005). In fact, some researchers have determined that cognitive therapy can provide superior clinical outcomes compared to pharmacological interventions (Hoffman & Nazario, 2015).

In sum, Beck's cognitive therapy model is based on a so-called "continuity hypothesis" because it "suggests that psychiatric syndromes are exaggerated forms of normal emotional responses. It also sees emotional and behavioral responses to events or experiences as being largely determined by the cognitive appraisal that is made of them by the individual" (Freeman, 1999, p. 273). Since the latter half of the 20th century, Beck's cognitive therapy has been among the most prevalent theories advanced in an attempt to better understand the development and maintenance of depression (Possel, 2011). Ever since its introduction, Beck's cognitive therapy has been empirically evaluated and has become an increasingly popular approach for the treatment of depression (Possel, 2011). According to Possel, Beck's cognitive therapy model gained importance for a number of reasons, including most especially the following:

It helped to explain epidemiological data (e.g., gender difference in depression rates;

It provides a theoretical basis for mechanisms underlying the development and maintenance of depression;

It is supported by a variety of empirical studies; and,

Some of the most effective interventions for depression have been developed on the basis of this and other cognitive models (Possel, 2011, p. 618).

Not all clinicians are of a like mind when it comes to cognitive therapy, though, and the model has attracted some criticisms. For example, Jones and Lyddon (2000) report that, "Opponents of empirical research and manualized protocols argue that while behavioral and cognitive therapies value symptom reduction, other approaches such as psychodynamic therapies value insight and increased understanding" (p. 340). Notwithstanding these criticisms, though, a growing body of evidence supports the efficacy of cognitive therapy as an empirically validated treatment model. Taken together, it is clear that Dr. Aaron T. Beck is a major force in the world of psychiatry today, and his cognitive therapy is an empirically validated treatment with proven efficacy for the treatment of depression as discussed further below.

Application of Cognitive Therapy for Treating Depression

Besides the Beck Depression Inventory which has proven reliability and validity and can be used to accurately quantify individuals' current depressive status (Beck, 2012), two of Beck's empirically validated treatments include his cognitive therapy for the treatment of unipolar depression and token economy programs for the "chronically mentally ill." Although the cognitive therapy model is most frequently applied to cases of depression, a growing body of research indicates that Beck's token economy model can also be effective in treating depression. For example, Hersen and Ammerman (2000) note that, "The empirical research on token economies has suggested that this treatment program is effective with many different populations and behaviors" (p. 205). In support of this statement, Hersen and Ammerman (2000) cite the results of research that has demonstrated that the use of a token economy together with other procedures can be effective in treating clinically depressed children and adolescents by focusing on behaviors such as appropriate classroom behavior, academic performance, social skills, and improving peer relationships. The studies to date have shown that "patients showed statistically significant improvement on standardized measures such as the Hopelessness Scale for Children and the Beck Depression Inventory (Hersen & Ammerman, 2000).

Although more research is needed in this area, the results of a study by Stangier, Heidenreich, Peitz, Lauterbach and Clark (2003) indicate that the type of setting may have an impact on the efficacy of cognitive therapy. In this regard, Stangier et al. (2003) report that, "Individual cognitive therapy is a specific treatment for social phobia and that it's [sic] effectiveness may be diminished by delivery in a group format" (p. 991). In addition, the studies to date also indicate that the efficacy of cognitive therapy is directly related to how closely therapists adhere to the manual-specified techniques to conducting the therapy, which is termed "therapist adherence" (Sasso, Strunk, Braun & DeRubeis, 2015, p. 976). In this regard, Sasso and his associates (2015) report that, "Studies examining the effects of adherence in cognitive therapy for depression specifically have each found some evidence of a relation between therapist adherence and subsequent reductions in depressive symptoms" (Sasso et al., 2015, p. 976).