Aaron T. Beck and Cognitive Therapy for Depression

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 the approach has demonstrated efficacy on the same level as pharmacological interventions for mild to moderate cases (Hoffman & Nazario, 2015). To gain 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 Aaron T. Beck

Born in Providence, Rhode Island, in 1921, Aaron Temkin Beck was the youngest of 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 his career, an early childhood experience was clearly a formative influence on his life. 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, Beck reported that "he believed himself to be a replacement child for his sister" and that "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, yet he still accumulated numerous awards and honors for his early work, including graduating first in his high school class (Spicher, 2008) and building a distinguished record in journalism and academia, as well as active duty military service during the Korean War (Beck biography, 2015). During his time at Brown University, he served as associate editor of the university newspaper, which earned him several honors, including the Francis Wayland Scholarship, the Phi Beta Kappa distinction, the Bennett Essay Award, and the Gaston Prize for Oratory (Beck biography, 2015).

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).

Despite this remarkable academic record, Beck remained uncertain about the future direction of his career. 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 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. 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, Spicher cites Beck's autobiography, wherein Beck says, "I thought it was nonsense. I could not really see what it fitted" (2008, para. 4).

During a two-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 in 1954" (Beck biography, 2015). During his tenure at Philadelphia's university, 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). 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).

Beck's career at this institution had some serendipitous qualities that would ultimately have a profound influence on the direction of his work. After accepting a position in the psychiatric department in 1954, Beck implemented a depression research clinic and began more thoroughly developing his cognitive approach to treating the condition (Spicher, 2008). Following his appointment as an associate professor in 1967, Beck was allowed a one-year extension on his depression research only, and this position required him to give up his on-campus office and work from home — an outcome that would have important implications for his research. 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, and he received full professor status in 1971 (Spicher, 2008).

Beck's gradual development of psychoanalytic approaches to helping people overcome cognitive disorders required years of painstaking empirical observation and research. 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 several decades, Beck has overseen a number of sponsored studies concerning the psychopathology of various conditions, including depression, 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 in how to conduct cognitive therapy in their own communities (Beck biography, 2015).

Beck is also actively researching the efficacy of cognitive therapy treatment for schizophrenia (Beck biography, 2015). Enormously prolific, he has authored or co-authored more than 540 articles and 22 books to date (Beck biography, 2015). These publications span the full range of cognitive disorders beyond depression. For example, "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). Spicher (2008) likewise 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 the application of cognitive theory of emotional disorders to this condition (Freeman, 1999). These seminal works continue to describe the fundamental tenets of Beck's theories concerning psychological problems (Freeman, 1999).

Beck has also served as a consultant or member of numerous review panels for the National Institute of Mental Health, as well as on the editorial boards of peer-reviewed journals, and is currently a member of The Institute of Medicine (Beck biography, 2015). He is internationally renowned, having lectured around the world and served 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).

Over the years, Beck has received four honorary degrees — from Brown University, his home university, Assumption College, and Philadelphia College of Osteopathic Medicine (Beck biography, 2015). This lifetime of professional service has garnered him the distinction of being included among the "ten individuals who shaped the face of American psychiatry" and recognition as the most influential American psychotherapist (Beck biography, 2015, para. 3). Beck continues to serve as President of the Beck Institute for Cognitive Therapy (Beck & Freeman, 2004) and as University 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 (née Whitman), and together they have four children, eight grandchildren, and two great-grandchildren (Beck biography, 2015). 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). His wife served as a Pennsylvania Superior Court judge, and their daughter Alice also serves as a judge in Pennsylvania, making them the only mother-daughter pair of judges in Pennsylvania history (Spicher, 2008).

Given this remarkable life and career, Beck could easily be forgiven for retiring, yet a lifetime of commitment to helping others keeps him going strong. 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). Padesky adds: "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.

Development of Cognitive Therapy and the Beck Depression Inventory

After accepting a position in the psychiatric department in 1954, Beck implemented a depression research clinic and began more thoroughly developing 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, administrators at the university were initially unresponsive to this innovation (Spicher, 2008). As Beck puts it, there was "an underwhelming interest in the project" (cited in Spicher, 2008, para. 6).

As noted above, the cornerstone of Beck's approach to treating severe psychological conditions, including depression, has been cognitive therapy. Beck proudly states that "cognitive therapy has grown from its humble beginnings to become the fastest growing psychotherapy in the world" (2004, p. 16). This assertion has the support of numerous therapists who agree that Beck's cognitive therapy represented a major advance in psychotherapy. 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. 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). A number of studies have also shown that behavioral therapy provides superior results compared to psychotherapy in terms of overall patient adjustment and work and social outcomes in some cases (Reisner, 2005). In fact, some researchers have determined that cognitive therapy can provide superior clinical outcomes compared to pharmacological interventions (Hoffman & Nazario, 2015).

Conclusion

Born in 1921 and raised in Rhode Island, Aaron T. Beck is currently the University Professor Emeritus of Psychiatry and a member of The Institute of Medicine, but these positions represent only a tiny fraction of his contributions to the field of psychotherapy. With hundreds of articles and dozens of books to his credit, Beck has proven to be a prolific author whose interests include depression, suicide, anxiety, and other psychiatric conditions. Uniformly lauded by his biographers, friends, and colleagues, the research shows that Beck and his family have been major forces in their respective fields, and Beck continues his valuable work in these areas today.

References

Beck, J. (2012). Cognitive therapy for a client with depression [streaming video]. Retrieved from PsycTHERAPY database.

Beck, A. T., & Freeman, A. (2004). Cognitive therapy of personality disorders (2nd ed.). New York: Guilford Press.

Beck biography. (2015). Aaron T. Beck official site. Retrieved from

Freeman, H. (1999). A century of psychiatry. London: Mosby.

Hersen, M., & Ammerman, R. T. (2000). Advanced abnormal child psychology. Mahwah, NJ: Lawrence Erlbaum Associates.

Hoffman, M., & Nazario, B. (2015). Cognitive therapy for depression. Medscape. Retrieved from http://www.webmd.com/depression/features/cognitive-therapy.

Jones, J. V., Jr., & Lyddon, W. J. (2000, November 3). Cognitive therapy and empirically validated treatments. Journal of Cognitive Psychotherapy, 14(3), 337–345.

Macrodimitris, S. D., & Hamilton, K. E. (2010, July 1). CBT basics: A group approach to teaching fundamental cognitive-behavioral skills. Journal of Cognitive Psychotherapy, 24(2), 132–135.

Nelson, M. L. (2002, Fall). An assessment-based model for counseling strategy selection. Journal of Counseling and Development, 80(4), 416–420.

Padesky, C. A. (2013, July 24). Aaron T. Beck: A man of curiosity. The National Psychologist. Retrieved from

Reisner, A. D. (2005). The common factors, empirically validated treatments, and recovery models of therapeutic change. The Psychological Record, 55, 377–399.

Rosner, R. I. (2011). Aaron T. Beck's drawings and the psychoanalytic origin story of cognitive therapy. History of Psychology, 15(1), 1–18.

Sasso, K. E., Strunk, D. R., Braun, J. D., & DeRubeis, R. J. (2015). Identifying moderators of the adherence-outcome relation in cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 83(5), 976–981.

Shurlati, E. S., Schniering, C. A., Lynchham, H. J., & Rapee, R. M. (2011). A model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders. Clinical Child and Family Psychology Review, 14, 89–109.

Spicher, A. R. (2008, Spring). Aaron Temkin Beck biography. Retrieved from

Stangier, U., Heidenreich, T., Peitz, M., Lauterbach, W., & Clark, D. M. (2003). Cognitive therapy for social phobia: Individual versus group treatment. Behaviour Research and Therapy, 41, 991–1007.