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 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.
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.
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 Personality 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.
NRSA Postdoctoral Fellowship with Dr. Aaron T. Beck. Click here for information.