Aaron T. Beck M.D.
A native of Providence, Rhode Island, Aaron T. Beck had an interest in the vagaries of human nature as far back as he can remember. However, he did not pursue this interest until later in his professional career. At Brown University, he was associate editor of the Brown Daily Herald and received a number of honors and awards, including Phi Beta Kappa, the Francis Wayland Scholarship, the Bennet Essay Award, and the Gaston Prize for Oratory. After graduating magna cum laude in 1942, he embarked on a career in medicine at Yale Medical School graduating in 1946. He served a rotating internship, followed by a residency in pathology at the Rhode Island Hospital. Although initially interested in psychiatry, he found the approaches at Medical School to be nihilistic and unrewarding and decided on a career in neurology, attracted by the high degree of precision that characterized this discipline. During his residency in neurology at the Cushing Veterans Administration Hospital in Framingham, MA, a required rotation in psychiatry intrigued him with some of the more recent developments in the field. He decided to explore further developments in psychotherapy. He spent two years as a fellow at Austin Riggs Center at Stockbridge where he acquired substantial experience in conducting long-term psychotherapy. The Korean War shifted Beck's area of work to the Valley Forge Army Hospital where he was Assistant Chief of Neuropsychiatry.
Beck joined the Department of Psychiatry of the University of Pennsylvania in 1954 and is currently University Professor Emeritus of Psychiatry. He initially conducted research into the psychoanalytic theories of depression, but when these hypotheses were disconfirmed, he developed a different theoretical-clinical approach that he labeled cognitive therapy. Since 1959 he has directed funded research investigations of the psychopathology of depression, suicide, anxiety disorders, panic disorders, alcoholism, drug abuse, and personality disorders and of cognitive therapy of these disorders. His work was supported by a 10-year M.E.R.I.T. Award from the National Institute of Mental Health and grants from the Centers for Disease Control for a study to determine the efficacy and effectiveness of a short-term cognitive therapy intervention for suicide attempters. His most recent work has focused on reducing suicide attempts among chronic suicide attempters and borderline personality disorder patients. He has also directed an international working group testing cognitive therapy of schizophrenia. He has published over 450 articles and authored or co-authored seventeen books.
Beck has been a member or consultant for several review panels of the National Institute of Mental Health, served on the editorial boards of many journals, and lectured throughout the world. He was a visiting scientist of the Medical Research Council at Oxford and is a visiting fellow of Wolfson College. He has also been a visiting Professor at Harvard, Yale, and Columbia, and is a member of The Institute of Medicine. He has received awards from numerous professional organizations and is the only person to have received research awards from both The American Psychiatric Association and The American Psychological Association. He is also the recipient of the Heinz Award for “The Human Condition” and The Sarnat Award from The Institute of Medicine. Beck has been awarded two honorary degrees, a Doctor of Medical Science from Brown University and a Doctor of Humane Letters from Assumption College. He has been listed as one of the “10 individuals who shaped the face of American Psychiatry” and one of the 5 most influential psychotherapists of all time.
Beck has been married for 53 years and has four children and eight grandchildren.
The following are Dr. Beck’s research areas of interest:
Dr. Beck’s groundbreaking systematic research established for the first time the efficacy of any psychotherapy for the treatment of depression. He not only developed and tested an effective short-term treatment (cognitive therapy) for depression, but he and his former students have successfully adapted cognitive therapy to a wide range of other psychiatric disorders as well.
Beck’s outcome trials with the cognitive therapy of panic disorder demonstrated a significant and lasting reduction in the number of panic attacks. His work has also stimulated numerous controlled clinical trials that have now demonstrated that cognitive therapy is effective in a variety of other psychiatric conditions, including bulimia nervosa, hypochondriasis, social phobia, obsessive-compulsive disorder, substance abuse, body dysmorphic disorder, and post-traumatic stress disorder. His former students have also established the efficacy of cognitive therapy in medical conditions including chronic fatigue syndrome, hypertension, gastrointestinal disorders, and chronic pain. There is also accumulating evidence, based on Beck’s early work, that cognitive therapy can be effective in combination with pharmacotherapy in treating the most severe psychiatric disorders such as bipolar disorder and schizophrenia. Cognitive therapy also has played an important part in the prevention of suicide, as described below.
Beck discovered that by increasing patients’ objectivity regarding their misinterpretations of situations or subjective sensations or feelings (cognitive distortions) and their negative expectancies, they experienced a substantial shift in their thinking and subsequently in their affect and behavior. This approach consists of a combination of strategies and techniques designed to modify the cognitive distortions and thus enable the patients to cope more effectively with their psychological and interpersonal problems. An important principle emanating from his work was that patients can assume an active role in normalizing their dysfunctional thinking and thus gain relief from, and subsequently remission of, their psychiatric conditions. Of particular note is the finding that the therapy is more effective than drug treatment alone in reducing relapse in depression, bipolar disorder, panic disorder and schizophrenia. This work demonstrates the capacity of psychiatrically ill patients to compensate for their biological and psychological vulnerabilities.
Beck’s work has provided a new way of understanding psychiatric disorders. At the time that Beck began his investigations in the late 1950’s, the dominant psychological theory regarded depression as due to “introjected hostility.” In contrast to the prevailing dogma, Beck‘s studies showed that depressed patients have a systematic negative bias against themselves and in their predictions of their own future. He then demonstrated in a number of laboratory experiments that, after a successful experience, depressed patients had a positive shift in mood, increased optimism, and increased motivation. Thus, concrete feedback that disconfirmed their negative view of themselves and their expectations had an immediate ameliorative effect on their feelings and behavior.
Beck and his colleagues have subsequently elaborated the cognitive theory of generalized anxiety disorders, phobias, panic disorder, substance abuse, personality disorders, delusions and hallucinations, and negative symptoms (schizophrenia). These formulations have been supported by substantial research conducted elsewhere as well as in his own unit. Further, the theoretical framework emanating from these studies has provided the basis for treatment manuals and subsequent empirical studies of cognitive therapy of a wide range of psychiatric disorders.
3. Studies of Suicide:
Beck’s early work provided a rational basis for the classification and measurement of suicidal behaviors and made it possible to identify high-risk individuals. Of particular importance has been his utilization of psychological variables to predict future suicides. His prospective study of 9,000 patients has led to the formulation of an algorithm for predicting future suicide that has been shown to have high predictive power, particularly for those at the highest indices on the algorithm.
Beck stands alone in his work on identifying the suicide-prone individuals and applying an effective psychotherapy to reduce suicidal risk. He discovered that hopelessness is the key psychological factor driving people to suicide. He and his colleagues showed that the hopelessness, and consequently suicidal ideation, can be readily quantified in depressed patients and substantially reduced by cognitive interventions.
Beck’s ongoing work with recent suicide attempters has demonstrated that a short-term cognitive intervention can significantly reduce subsequent suicide attempts when compared to a control group.
4. Development of Assessment Techniques:
Beck’s fourth major contribution was the development of a strategy for assessing the severity of specific psychiatric syndromes. Up until the time of Beck’s work, psychiatric research was hampered by a dearth of techniques for operationalizing the various disorders and measuring their severity. The various instruments, including his Depression Inventory, Anxiety Inventory, Hopelessness Scale, and Suicide Intent Scale have helped to chart a new course of research in psychopathology and generated hundreds of research studies. The Beck Depression Inventory is one of the most widely used instruments in clinical practice as well as research. Other scales have helped to pinpoint the specific characteristics and mechanisms in a variety of disorders. They include: Cognitive checklist (for anxiety and depression); Cognitive checklist for mania; the Self Esteem Scales; the Panic Belief Questionnaire; the Dysfunctional Attitude Scale (with Arlene Weissman); the Substance Abuse Cognitions Scale; Marital Cognitions Scale; Sociotropy-Autonomy Scale; Beck Cognitive Insight Scale; Beck-Young Scales (with Judith Beck); and the Obsessive-Compulsive Cognitions Scale (with David A. Clark). The availability of these measures also facilitated rigorous basic research in the biology and psychology of mental disorders as well as in clinical outcome trials.
Recognition of Beck’s work includes the following citations:
TRANSLATED EXCERPT FROM
Dix Personnalité Qui Ont Changé le Visage de la Psychiatric Américaine
(Ten Personalities who have changed the face of American Psychiatry)* “These ten persons are landmarks in the construction and development of North American psychiatry”: B. Rush, D. Dix, J.M. Galt, S.W. Mitchell, C.W. Beers, T. Salmon, A. Meyer, L. Stein, A. Beck, E. Kandell
8. Aaron Beck (1921-_ “The Father of Cognitive Behavior Therapy”
In the United States, in the Fifties and Sixties, the dominant theoretical point of view was still psychoanalysis. His research in the effectiveness of cognitive therapy on personality disorders, depression and suicide, alcoholism and drug addiction and anxiety and panic took a completely different direction for American Psychiatry. Contrary to psychoanalysis and many other of the short therapies, he based his treatment on his research. He wrote a manual, established an institute for the training in cognitive therapy for various professionals, and he made his conclusions accessible to the public. That appears normal now, but in the 1950’s and 1960’s in the United States, it was revolutionary.
What is his heritage? He is the father of the most popular effective and teachable new psychotherapy in the United States.
*Talbott, J.A. (2002). Dix Personalité Qui Ont Changé le Visage de la Psychiatric Américaine. L’Information Psychiatrique, 78(7), 667-675.
Institute of Medicine – National Academy of Sciences – 1997 (Senior Member)
“You have almost single-handedly restored the relevance of psychotherapy. Your cognitive therapy is the fastest growing form of psychotherapy and has influenced the treatment of psychiatric disorders throughout the world.”
Kenneth I Shine, M.D.
Institute of Medicine
National Academy of Sciences