Aaron Beck | |
|---|---|
 Beck in 1942 | |
| Born | Aaron Temkin Beck (1921-07-18)July 18, 1921 Providence, Rhode Island, U.S. |
| Died | November 1, 2021(2021-11-01) (aged 100) Philadelphia, Pennsylvania, U.S. |
| Alma mater | |
| Known for | Beck Depression Inventory |
| Spouse | |
| Children | 4, includingJudith |
| Awards | See list |
| Scientific career | |
| Fields | Psychiatry |
| Institutions | University of Pennsylvania Beck Institute for Cognitive Behavior Therapy |
| Doctoral students | Steven D. Hollon Jeffrey Young Gregg R. Henriques |
Aaron Temkin Beck (July 18, 1921 – November 1, 2021) was an American psychiatrist who was a professor in the department ofpsychiatry at theUniversity of Pennsylvania.[1][2] He is regarded as the father ofcognitive therapy[1][2][3] andcognitive behavioral therapy (CBT).[4] His pioneering methods are widely used in the treatment ofclinical depression and variousanxiety disorders. Beck also developedself-report measures fordepression andanxiety, notably theBeck Depression Inventory (BDI), which became one of the most widely used instruments for measuring the severity of depression.[5] In 1994 he and his daughter,psychologistJudith S. Beck, founded the nonprofitBeck Institute for Cognitive Behavior Therapy, which provides CBT treatment and training, as well as research.[6] Beck served as President Emeritus of the organization up until his death.
Beck was noted for his writings onpsychotherapy,psychopathology,suicide, andpsychometrics. He published more than 600 professional journal articles, and authored or co-authored 25 books.[7] He was named one of the "Americans in history who shaped the face of American psychiatry", and one of the "five most influential psychotherapists of all time" byThe American Psychologist in July 1989.[8]
Aaron Temkin Beck was born inProvidence,Rhode Island, on July 18, 1921. He was the youngest of four children born to Elizabeth Temkin and Harry Beck,Jewish immigrants fromUkraine.[9][10] Harry worked as a printer and Elizabeth's family found financial success in tobacco wholesaling; the family belonged to the upwardly-mobile vanguard of Providence's Eastern European-Jewish immigrant community. At the time of Aaron's birth, the Temkin-Becks lived a "comfortable, lower-middle class lifestyle" and were in the process of putting down roots onProvidence's East Side. In 1923, when Aaron was two years old, the family purchased a house at 43/41 Sessions Street in the city'sBlackstone neighborhood.[11]
Beck attended John Howland Grammar School, Nathan Bishop Junior High, andHope Street High School, where he graduated as valedictorian in 1938. As an adolescent, Beck dreamed of becoming a journalist.[11] Beck matriculated atBrown University, where he graduatedmagna cum laude in 1942.[12] At Brown, he was elected a member ofPhi Beta Kappa society, was an associate editor ofThe Brown Daily Herald, and received the Francis Wayland Scholarship, William Gaston Prize for Excellence in Oratory, and Philo Sherman Bennett Essay Award.[13] Beck attendedYale Medical School, planning to become aninternist and work in private practice in Providence. He graduated from Yale with aDoctor of Medicine in 1946.[14]
After receiving his M.D., Beck completed a six-month junior residency inpathology atRhode Island Hospital and a three-year residency inneurology at Cushing Veterans Administration Hospital inFramingham, Massachusetts. During this time, Beck began to specialize in neurology, reportedly liking the precision of its procedures.[14] However, due to a shortage of psychiatryresidents, he was instructed to do a six-month rotation in that field, and he became absorbed inpsychoanalysis, despite initial wariness.[14]
After completing his medicalinternships andresidencies from 1946 to 1950, Beck became afellow in psychiatry at theAusten Riggs Center, a private mental hospital in the mountains ofStockbridge, Massachusetts, until 1952.[15] At that time, it was a center ofego psychology with an unusual degree of collaboration between psychiatrists and psychologists, includingDavid Rapaport.[16]
Beck then completed military service as assistant chief of neuropsychiatry atValley Forge Army Hospital in theUnited States Military.[17]
Beck then joined the Department of Psychiatry at theUniversity of Pennsylvania in 1954.[18][19] The department chair was Kenneth Ellmaker Appel,[20] a psychoanalyst who was president of theAmerican Psychiatric Association,[21] whose efforts to expand the presence and relatedness of psychiatry had a big influence on Beck's career. At the same time, Beck began formal training in psychoanalysis at the Philadelphia Institute of theAmerican Psychoanalytic Association.[19][22]
Beck's closest colleague was Marvin Stein, a friend since their army hospital days to whom Beck looked up to for his scientific rigor inpsychoneuroimmunology.[23] Beck's first research was with Leon J. Saul, a psychoanalyst known for unusual methods such as therapy by telephone or setting homework, who had developed inventory questionnaires to quantify ego processes in themanifest content of dreams (that which can be directly reported by the dreamer). Beck and a graduate student developed a new inventory they used to assess "masochistic" hostility in manifest dreams, published in 1959.[24] This study found themes of loss and rejection related to depression, rather than inverted hostility as predicted by psychoanalysis.[23] Developing the work with funding from theNational Institute of Mental Health, Beck came up with what he would call theBeck Depression Inventory, which he published in 1961 and soon started to market, unsupported by Appel.[23] In another experiment, he found that depressed patients sought encouragement or improvement following disapproval, rather than seeking out suffering and failure as predicted by the Freudian anger-turned-inwards theory.[14]
Through the 1950s, Beck adhered to the department's psychoanalytic theories while pursuing experimentation and harboring private doubts.[23] In 1961, however, controversy over whom to appoint the new chair of psychiatry—specifically, fierce psychoanalytic opposition to the favored choice of biomedical researcherEli Robins—brought matters to a head, an early skirmish in a power shift away from psychoanalysis nationally.[23] Beck tried to remain neutral and, withAlbert J. Stunkard, opposed a petition to block Robins.[23] Stunkard, abehaviorist who specialized inobesity and who had dropped out of psychoanalytic training, was eventually appointed department head in the face of sustained opposition which again Beck would not engage in, putting him at bitter odds with his friend Stein.[23]
On top of this, despite having graduated from his Philadelphia training, the American Psychoanalytic Institute rejected Beck's membership application in 1960, skeptical of his claims of success from relatively brief therapy and advising he conduct further supervised therapy on the more advanced or termination phases of a case, and again in 1961 when he had not done so but outlined his clinical and research work.[14] Such deferments were a tactic used by the institute to maintain the orthodoxy in teaching, but Beck did not know this at the time and has described the decision as stupid and dumb.[14][23]
Beck usually explained his increasing belief in his cognitive model by reference to a patient he had been listening to for a year at the Penn clinic.[14] When he suggested she was anxious due to her ego being confronted by her sexual impulses, and asked her whether she believed this when she did not seem convinced, she said she was actually worried that she was being boring, and that she thought this often and with everyone.[14][25]
In 1962, Beck requested asabbatical and would go into private practice for five years.[23] In that same year, he was already making notes about patterns of thoughts in depression, emphasizing what can be observed and tested by anyone and treated in the present.[26] He was engaged byGeorge Kelly'spersonal construct theory andJean Piaget'sschemas.[27] Beck's first articles on the cognitive theory of depression, in 1963 and 1964 in theArchives of General Psychiatry, maintained the psychiatric context ofego psychology but then turned to concepts of realistic and scientific thinking in the terms of the new cognitive psychology, extended to become a therapeutic need.[23]
Beck's notebooks were also filled with self-analysis, where at least twice a day for several years he wrote out his own "negative" (later "automatic") thoughts, rated with apercentile belief score, classified and restructured.[23]
The psychologist who would become most important for Beck wasAlbert Ellis, whose own faith in psychoanalysis had crumbled by the 1950s.[27] He had begun presenting his "rational therapy" by the mid-1950s.[28] Beck recalled that Ellis contacted him in the mid-1960s after his two articles in theArchives of General Psychiatry, and therefore he discovered Ellis had developed a rich theory and pragmatic therapy that he was able to use to some extent as a framework blended with his own, though he disliked Ellis's technique of telling patients what he thought was going on rather than helping the client to learn for themselvesempirically.[29] Psychoanalyst Gerald E. Kochansky remarked in 1975 in a review of one of Beck's books that he could no longer tell if Beck was a psychoanalyst or a devotee of Ellis.[23] Beck highlighted the classical philosophicalSocratic method as an inspiration, while Ellis highlighteddisputation which he stated was not anti-empirical and taught people how to dispute internally.[30] Both Beck and Ellis cited aspects of the ancient philosophical system ofStoicism as a forerunner of their ideas. Beck cited Epictetus as an influence from Stoicism.[31]
In 1967, becoming active again atUniversity of Pennsylvania, Beck still described himself and his new therapy (as he always would quietly) asneo-Freudian in the ego psychology school, albeit focused on interactions with the environment rather than internal drives.[23][32] He offered cognitive therapy work as a relatively "neutral" space and a bridge to psychology.[23] With a monograph on depression that Beck published in 1967, according to historian Rachael Rosner: "Cognitive Therapy entered the marketplace as a corrective experimentalist psychological framework both for himself and his patients and for his fellow psychiatrists."[23]
Working with depressed patients, Beck found that they experienced streams of negative thoughts that seemed to arise spontaneously.[33] He termed these cognitions "automatic thoughts", and discovered that their content fell into three categories: negative ideas about oneself, the world, and the future. He stated that such cognitions were interrelated as thecognitive triad.[33] Limited time spent reflecting on automatic thoughts would lead patients to treat them as valid.[34]
Beck began helping patients identify and evaluate these thoughts and found that by doing so, patients were able to think more realistically, which led them to feel better emotionally and behave more functionally.[34] He developed key ideas in CBT, explaining that differentdisorders were associated with different types of distorted thinking.[34] Distorted thinking has a negative effect on a person's behavior no matter what type of disorder they had, he found.[34] Beck explained that successful interventions will educate a person to understand and become aware of their distorted thinking, and how to challenge its effects.[34] He discovered that frequent negative automatic thoughts reveal a person's core beliefs. He explained that core beliefs are formed over lifelong experiences; we "feel" these beliefs to be true.[34]
Since that time, Beck and his colleagues worldwide have researched the efficacy of this form of psychotherapy in treating a wide variety of disorders including depression,bipolar disorder,eating disorders,drug abuse,anxiety disorders,personality disorders, and many other medical conditions with psychological components.[34] Cognitive therapy has also been applied with success to individuals withschizophrenia.[35] He also focused on cognitive therapy for schizophrenia,borderline personality disorder, and for patients who have had recurrent suicide attempts.[36]
Beck's recent research on the treatment of schizophrenia has suggested that patients once believed to be non-responsive to treatment are amenable to positive change.[37] Even the most severe presentations of the illness, such as those involving long periods of hospitalization, bizarre behavior, poor personal hygiene, self-injury, and aggressiveness, can respond positively to a modified version of cognitive behavioral treatment.[38][39]
Although Beck's approach has sometimes been criticized as too mechanistic, modern CBT stresses the importance of a warm and encouraging therapeutic relationship and tailoring treatment to the specific challenges of each individual.[40] Beck's work was presented as a far more scientific and experimentally-based development than psychoanalysis (while being less reductive than behaviorism), Beck's key principles were not necessarily based on the general findings and models of cognitive psychology orneuroscience developing at that time but were derived from personal clinical observations and interpretations in his therapy office.[26] And although there have been many cognitive models developed for different mental disorders and hundreds of outcome studies on the effectiveness of CBT—relatively easy because of the narrow, time-limited and manual-based nature of the treatment—there has been much less focus on experimentally proving the supposedly active mechanisms; in some cases the predictedcausal relationships have not been found, such as between dysfunctional attitudes and outcomes.[41]
Beck was involved in research studies at the University of Pennsylvania, and conducted biweekly Case Conferences at Beck Institute for area psychiatric residents, graduate students, and mental health professionals.[42] He met every two weeks with conference participants and generally did two to three role plays. He was elected a Fellow of theAmerican Academy of Arts and Sciences in 2007.[43]
Beck was the founder and President Emeritus of the non-profitBeck Institute for Cognitive Behavior Therapy, and the director of the Aaron T. Beck Psychopathology Research Center, which was the parent organization of the Center for the Treatment and Prevention of Suicide, which is now known as the Penn Center for the Prevention of Suicide.[7] In 1986, he was a visiting scientist atOxford University.[1]
He was a professor emeritus at Penn since 1992,[7] and an adjunct professor at bothTemple University andUniversity of Medicine and Dentistry of New Jersey.[1] During his time at Penn, he pioneered the development of Recovery-Oriented Cognitive Therapy.[44] While the Center for CT-R was created at Penn, it was later absorbed by Beck Institute.[45]
Beck was married in 1950 to Honorable Phyllis W. Beck (ret.), and they had four children together: Roy, Judy, Dan, and Alice.[13] Phyllis was the first woman judge on the appellate court of theCommonwealth of Pennsylvania.[46] Her youngest daughter, Alice Beck Dubow, is a judge on the same court,[47] while the older daughterJudith is a prominent CBT educator and clinician, who wrote the basic text in the field[48] and is a co-founder of the non-profitBeck Institute.[48] Heturned 100 on July 18, 2021, and died later in the year on November 1 in his sleep at his home in Philadelphia.[49][50][51][52][53]
Along with the Beck Depression Inventory (BDI), Beck developed theBeck Hopelessness Scale,[54] Beck Scale for Suicidal Ideation (BSS),Beck Anxiety Inventory (BAI), Beck Youth Inventories,[55] Clark-Beck Obsessive-Compulsive Inventory (CBOCI),[56] Personality Belief Questionnaire (PBQ), Dysfunctional Attitude Scale (DAS), Suicide Intent Scale (SIS), Sociotropy-Autonomy Scale (SAS), Cognitive Therapy Rating Scale (CTRS), Beck Cognitive Insight Scale (BCIS), Satisfaction with Therapy Questionnaire (STQ) and BDI–Fast Screen for Medical Patients.[57]
Beck collaborated with psychologistMaria Kovacs in the development of theChildren's Depression Inventory, which used the BDI as a template.[58][59]
Beck received honorary degrees fromYale University, University of Pennsylvania, Brown University,Assumption College, andPhiladelphia College of Osteopathic Medicine.[13][62][63]
In 2017,Medscape named Beck the fourth most influential physician in the past century.[64]
{{cite book}}:|work= ignored (help){{cite web}}: CS1 maint: archived copy as title (link)
