Aaron Beck psychology

1. Presenter : Dr. Amrutha G
Moderator: Dr. Y Sai Sudheer (SR)
Chairperson : Dr. T V Pavan Kumar
(Professor and HOD)
AARON BECK
The Father of Cognitive Behavioral Therapy

2. Early Life and Career
Aaron Temkin Beck was born July 18th 1921 in USA, and was the youngest child
of four siblings to Russian Jewish immigrants.
Aaron Beck’s early life was marked by loss. Two siblings passed away before his
birth, an older brother died who during childhood and an older sister who died
in the influenza pandemic.
Partially due to this sequence of tragedies, Beck’s mother became chronically
depressed, which may have had a marked influence on his future profession.

3. Early Life and Career
• At age 8, after surgery for a broken arm, he developed a serious infection and
had to spend a whole month in a hospital, where he developed a fear of
injury and blood, and learned to manage his phobias by focusing his mind
elsewhere.
• He earned a medical degree from the University School of Medicine in New
Haven, Connecticut in 1946, and started his neurology residency training.

4. Early Life and Career
• However, while doing a six-month rotation in the
psychiatric ward, Beck became fascinated with
psychoanalysis.
• He went onto become a fellow in Psychiatry at the
Austen Riggs Center until 1952, and completed
military service as assistant chief of
neuropsychiatry at Valley Forge Army Hospital.

5. Development of Cognitive Therapy
• Throughout the 1950s, Beck adhered to the Department of
Psychiatry’s then commonly used psychoanalytic theories.
• As he pursued clinical research and had steadily growing doubts
about psychoanalysis, which he shared only with his wife and
intellectual partner, Phyllis Whitman Beck.

6. • Initially, he was totally committed to the theory and
therapy of psychoanalysis.
• He felt that for psychoanalysis to be accepted by
the larger scientific community, it would require a
solid base of evidence.
• So he decided to test out the central
psychoanalytic proposition that depression was
caused by inverted hostility.
Development of Cognitive Therapy

7. Inverted Hostility : If the patient experienced unacceptable anger
toward a close person but repressed this unacceptable anger, it would
come out in the form of self-criticism, negative expectancy, suicidal
wishes, and depressed mood.

8. • He teamed up with Marvin Hurvich, a psychology graduate student at
the University of Pennsylvania.
• He prepared a scoring manual for hostility in dreams, and Marvin
blindly scored a sample of dreams from patients with depression as
well as a control group of patients who were not depressed.
Development of Cognitive Therapy

9. To their surprise, the patients with depression showed less hostility in
their dreams than did the nondepressed individuals.
This negative finding made it seem that there is an absence of manifest
hostility in dreams, which had been characterized by Freudian theories.
Development of Cognitive Therapy

10. • However, after examining the content of dreams for a second time,
they found that the dreams of the patients with depression
consistently portrayed the dreamer or the action in the dream in a
negative way consistent with the conscious negative self-image.
• This consistent finding was not evident in the dreams of the
nondepressed patients.
Development of Cognitive Therapy

11. • He realized that depression was related to underlying feelings of loss
and rejection rather than “inverted hostility,” as predicated by Freudian
psychoanalytic theory.
• Eventually, he came to understand that these underlying beliefs were
consistent with a person’s automatic thoughts and cognitive
distortions and that these could be evoked and examined during
therapy sessions.
Development of Cognitive Therapy

12. • By helping patients identify and correct negative information
processing biases, Beck found that they felt better and engaged in
more adaptive behaviors.
• He named this radically new therapeutic approach “cognitive
therapy.”
• He also developed scales and questionnaires to assess these beliefs,
such as the Beck Depression Inventory.
Development of Cognitive Therapy

13. Expanding the Applications of CBT
• Beck’s theories were first tested in 1977, when a major clinical trial
compared cognitive therapy to antidepressant medication.(Rush et al.,
1977).
• This study concluded that cognitive therapy was more efficacious than
antidepressants for depression, and these results were replicated a few
years later.(Blackburn et al., 1981)

14. Expanding the Applications of CBT
• By 1979 he and his colleagues had codified the treatment in a detailed
manual.
• Beck and his colleagues soon started applying cognitive therapy to other
mental disorders, such as anxiety states, personality disorders,
substance abuse, and suicidality.

15. Expanding the Applications of CBT
• Eventually, cognitive therapy became the most commonly practiced and
extensively researched form of psychotherapy in the world.
• It also has been demonstrated to be effective as an adjunctive
treatment to medication for serious mental disorders such as bipolar
disorder and schizophrenia.
• During the 1980s and 1990s, cognitive and behavioral techniques were
merged into cognitive behavioral therapy.

16. Expanding the Applications of CBT
• Since then, CBT has been adapted and studied for children, adolescents,
adults, couples, and families.
• Its efficacy also has been established in the treatment of non-
psychiatric disorders such as irritable bowel syndrome, chronic fatigue
syndrome, fibromyalgia, insomnia, migraines, and other chronic pain
conditions.

17. Founding of the Beck Institute
• Two years after retiring from the University of
Pennsylvania and becoming an emeritus
professor (1992), Beck and his daughter, Dr.
Judith Beck, founded the nonprofit Beck
Institute for Cognitive Behavior Therapy and
started training hundreds and thousands of
others in CBT.

18. Death
• On November 1, 2021, Dr. Aaron T. Beck passed away peacefully at
the age of 100 in his home in Pennsylvania, surrounded by his family.

19. Beck's Self Report Measures
• Beck also developed self-report measures of depression and anxiety
including the following:
• Beck Depression Inventory (BDI)
• Beck Hopelessness Scale
• Beck Scale for Suicidal Ideation (BSS)
• Beck Anxiety Inventory (BAI)
• Beck Youth Inventories.

21. INTERPRETING THE BECK DEPRESSION INVENTORY
• Add up the score for
each of the 21
questions.
• The highest possible
total for the whole test
would be 63.
• 1-10____________________These ups and downs
are considered normal
• 11-16___________________ Mild mood disturbance
• 17-20___________________Borderline clinical
depression
• 21-30___________________Moderate depression
• 31-40___________________Severe depression
• over 40__________________Extreme depression

22. Cognitive Behavioural Therapy
• It is based on the cognitive theory which states that in
psychopathology, there are faulty thoughts which come
automatically to our mind (called automatic thoughts) following
certain situations which reinstate the psychopathology.

23. Cognitive Behavioural Therapy
• For example , if a colleague does not acknowledge a depressed
person, he or she may feel it is because the colleague does not like
him.
• This thought will contribute to a depressed mood and the person
may start avoiding conversing with colleagues. This behaviour may
eventually result in the person feeling worse.

25. Cognitive Behavioural Therapy
Emphasis on a warm, empathic client-therapist relationship.
Focus of therapy is identifying maladaptive and cognitive distortions,
and actively changing those thoughts to more healthy ones
Characteristics: Active, directive, collaborative, time-limited,
present-centered, problem focused, and structured.

26. Cognitive Behavioural Therapy
o Principle 1: Based on an ever-evolving formulation of the client and
his or her problems in cognitive terms
o Principle 2: Requires a sound therapeutic alliance (rapport)
o Principle 3: Emphasizes collaboration and active participation
o Principle 4: Goal oriented and problem focused
o Principle 5: Initially emphasizes the present

27. Cognitive Behavioural Therapy
 Principle 6: Educative, teaches the client how to be his or her own therapist
and emphasizes relapse prevention.
 Principle 7: Time limited
 Principle 8: Sessions are structured
 Principle 9: Teaches clients to identify, evaluate, and respond to their
dysfunctional beliefs.
 Principle 10: Uses a variety of techniques to change thinking, mood, and
behavior

28. Cognitive Behavioural Therapy
Beck (1976) outlined three levels of
cognition:
1. Core beliefs
2. Dysfunctional assumptions
3. Negative automatic thoughts

29. Cognitive Behavioural Therapy
Core beliefs, are deeply held beliefs about self, others and the world.
Core beliefs are generally learned early in life and are influenced by childhood
experiences and seen as absolute.
‘I cannot trust anyone’
‘I am not worthy of love’
‘Nothing I do is ever good enough’

31. Schemas
• The ways of organizing and interpreting
experiences of self and the world is
called Schema.
• We tend to filter incoming information
to accept information that fits the core
belief, while discounting anything that
contradicts our belief to form Schemas.

32. Schema

33. Cognitive Behavioural Therapy
The way that core beliefs influence our perception, interpretation, and
response to a situation is through what is called "intermediate beliefs."
This category includes our attitudes, assumptions, and rules.
These intermediate beliefs arise from core beliefs, either as logical extensions
of, or as attempts to cope with a painful core belief

34. Cognitive Behavioural Therapy
Dysfunctional assumptions are rigid, conditional ‘rules for living’ that people
adopt. ‘should’ and ‘must’ sentences.
These may be unrealistic and therefore maladaptive.
‘It’s better not to try than to risk failing’.
‘It’s better to avoid everyone in order to never get betrayed’
‘I am unlovable, so I should expect rejection.’

35. Cognitive Behavioural Therapy
Automatic Thoughts = “pre-surface thinking”
All people experience automatic thoughts.
But we often lack awareness of such thoughts.
Generally not of concern until people experience negative automatic thoughts
that start to contribute to distress and inhibit daily function

36. Cognitive Behavioural Therapy
Negative automatic thoughts (NATs) are thoughts that are involuntarily
activated in certain situations and cause dysfunction.
In depression, NATs typically centre on themes of negativity, low self-esteem
and uselessness.
‘I'm going to mess this up and everyone will judge me for it’
‘I deserve to be punished because I am not a good person’

37. Cognitive Behavioural Therapy
J. S. Beck (2011) states that negative automatic thoughts generally fall into
three categories based on their validity and utility -
(1) no validity and no utility
(2) valid with misdirected/maladaptive utility (Conclusion/meaning derived
from thought is distorted)
(3) valid with no utility

39. Cognitive Behavioural Therapy
People’s emotions and behaviors are influenced by their perception of
events and not situations directly.
CBT focuses more on the present rather than the past.

41. Core belief
Intermediate belief
Situation Automatic thought Emotion
COGNITIVE CONCEPTUALIZATION DIAGRAM

42. Cognitive Behavioural Therapy
 CBT assumes that disorders come
from illogical, irrational cognitions
and that changing the thinking
patterns to more rational, logical
ones will relieve the symptoms of
the disorder, making it an action
therapy.

43. Cognitive Triad
• Beck also developed the notion of the
cognitive triad to describe how depressed
adults tend to think about the world.
• The triad refers to thoughts about self, world,
and future.
• In all the three, depressed individuals tend to
have negative views.

44. Cognitive Triad
• Thus, a depressed individual would tend to
think
1. Self: 'I am a bad person'
2. World: 'The world is a terrible place'
3. Future: 'My life will never get better'

45. Errors of Thought/Cognitive Distortions
• Beck's work also led to the identification of
particular patterns of habitual and maladaptive
thinking that he called errors of thought.
• These included the following:
Arbitrary Inference
Selective Abstraction
Overgeneralization
Magnification and minimization

46. Errors of Thought/Cognitive Distortions
• Arbitrary inference is drawing a conclusion based on too little evidence
or no evidence at all.
• Selective abstraction is drawing a conclusion by concentrating on one
detailed aspect of a situation.
• Overgeneralization: unjustified generalizing from limited evidence
• Magnification and minimization : exaggerating or limiting the
significance of information.

48. Cognitive Behavioural Therapy
• To deal with the maladaptive thoughts and behaviours, CBT utilises
techniques which can either be
Cognitive (dealing with automatic thoughts) or
Behavioural (dealing with maladaptive behaviour)
• Both techniques go hand-in-hand, behavioural techniques are often
used first as a severely depressed patient may be unable to identify and
work with their automatic thoughts.

49. Cognitive Behavioural Therapy
• Among the behavioral techniques in cognitive therapy are scheduling
activities, mastery and pleasure, graded task assignments, cognitive
rehearsal, self-reliance training, role-playing, imagery, thought
stopping and diversion techniques.

50. Strategies and Techniques
 Relevant childhood data related to core belief.
 Core beliefs
 Conditional and Dysfunctional assumptions/beliefs/rules.
 Compensatory strategies: Coping strategies
 Cognitive Techniques. The therapy’s cognitive approach includes four processes:
eliciting automatic thoughts, testing automatic thoughts, identifying maladaptive
underlying assumptions, and testing the validity of maladaptive assumptions.

54. Automatic Thought Record
• A great intervention to integrate into identifying, evaluating, and
modifying negative automatic thoughts
• Effective use of thought records facilitates distress regulation,
changes maladaptive behavioral patterns, and helps assess outcomes
• Thought records also provide a great opportunity to track and log
therapeutic progress over time

56. References
• Sadock B. Kaplan and Sadock's comprehensive textbook of psychiatry. 10th ed. Wolters Kluwer; 2017.
• Morgan, C. T., King, R. A., Weisz, J. R. & Schopler, J. (1986). Introduction to Psychology (7th edition). New Delhi: Tata
McGraw-Hill
• Mendlowicz MV, Levitan MN, Nardi AE, Shorter E. The notable humanist and scientist Aaron Beck (1921-2021), the
revolutionary founder of cognitive therapy. Braz J Psychiatry. 2022;44:221-222. http://dx.doi.org/10.1590/1516-
4446-2021-2409
• Beck T Aaron. Perspectives on Psychological Science 2019, Vol. 14(1) 16–20 DOI: 10.1177/1745691618804187
• www.beckinstitute.org/