Cognitive Therapy

"Dr. Beck was a young psychiatrist trained in Freudian analysis when, in the late 1950s, he began prompting patients to focus on distortions in their day-to-day thinking, rather than on conflicts buried in childhood, as therapists typically did. He discovered that many people generated what he called “automatic thoughts,” unexamined assumptions like “I’m just unlucky in love” or “I’ve always been socially inept,” which can give rise to self-criticism, despair and self-defeating attempts to compensate, like promiscuity or heavy drinking.

 

Dr. Beck found that he could undermine those assumptions by prompting people to test them out in the world — say, by socializing without alcohol to observe what happens — and to gather countervailing evidence from their own experience, like memories of healthy relationships. Practicing these techniques, in therapy sessions and in homework exercises, fostered an internal dialogue that gradually improved people’s mood, he showed.

 

Dr. Beck’s work, along with that of Albert Ellis, a psychologist working independently, provided the architecture for what is known as cognitive behavior therapy, or C.B.T. Over the past several decades, C.B.T. has become by far the world’s most extensively studied form of psychotherapy. In England, it forms the basis for a nationwide treatment program offering a number of related talk therapies.

"The influence of cognitive therapy on the treatment of mental disorders is hard to exaggerate. Researchers have adapted the approach — originally developed for depression — to manage panic attacks, addictions, eating disorders, social anxiety, insomnia and obsessive-compulsive disorder. Therapists teach a variation to help parents manage children’s outbursts at home, and some have used it, in combination with medication, to manage the delusions and hallucinations of schizophrenia. Sports psychologists have made use of the principles for performance anxiety.

 

Dr. Beck came across as an affectionate paterfamilias. Smiling softly beneath a rich sweep of white hair, wearing a bright bow tie and tailored suit, he engaged patients gently, chipping away at self-defeating beliefs with Socratic questions: Would you agree it is against your interests to have this belief? Do you think it’s possible to ignore these thoughts?

 

In the first chapter of his classic 1967 book, “Depression: Causes and Treatment,” he observed: “There is an astonishing contrast between the depressed person’s image of himself and the objective facts. A wealthy man moans that he doesn’t have the financial resources to feed his children. A widely acclaimed beauty begs for plastic surgery in the belief that she is ugly. An eminent physicist berates himself ‘for being stupid.’”

 

In his last years Dr. Beck applied cognitive techniques to help largely forgotten groups of people, like destitute drug addicts and people with late-stage schizophrenia. “These people have some capacity to do better, but they have all these defeatist attitudes and expectations; they assume they’re going to fail,” he said in an interview with The Times in 2009 in Bala Cynwyd."