Beck's Therapy for Depression

Aaron Beck was the founder of the Beck Institute for Cognitive Therapy and Research at the University of Pennsylvania. His approach is widely described as a cognitive behavior therapy, although he preferred the term cognitive therapy.

Like Ellis, Beck was trained in traditional psychoanalysis, became disillusioned, and developed his own approach. Like Ellis, Beck's therapy is built upon eliminating irrational self-talk and encouraging realistic thinking.

In Beck's theory, trouble occurs when a person sees things both negatively and inaccurately. Beck found that depressed clients experienced "automatic" negative thoughts about (1) themselves, (2) the world, and (3) their future.

These negative thoughts pop up involuntarily, and patients seldom reflect on them critically. Instead, they are treated as a true description of reality.

Patients easily arrive at the conclusion that matters are hopeless, and there is no point in even trying. Negative thoughts became a self-fulfilling prophecy.

Looking back in a 1997 article, Beck wrote about a patient who helped him see the limitations of Freudian analysis and switch his emphasis to negative thinking:

What started me in the current direction was something that occurred when I was seeing a patient named Lucy. She was on the couch, and we were doing classical analysis. She was presumably following the 'fundamental rule' that the patient must report everything that comes into her mind. During this session, she was regaling me with descriptions of her various sexual adventures.

At the end of the session, I did what I usually do. I asked her, 'Now, how have you been feeling during this session?' She said, 'I've been feeling terribly anxious, doctor.'

...I said, 'It's very clear why you are feeling anxious. You have these sexual impulses which are threatening to burst forth. Since your sexual impulses are unacceptable, they cue off anxiety.' I said, 'Does that sound right?' She said, 'Oh, yes. You're right on target.' I said, 'Do you feel better now that you know this?' She responded, 'No, I feel worse.' I replied, 'Thank you for being so frank, but can you tell me a little bit more about this?'

She responded, 'Well, actually, I thought that maybe I was boring you, and now that you said that, I think I really was boring you.' I asked, 'What made you think that you were boring me?' She replied, 'I was thinking that all during the session.'

I said, 'You had a thought, 'I am boring Dr. Beck,' and you didn't say it?' She replied, 'No, I never thought to say that.' I said, 'You had that thought just this one time, right?' She responded, 'Oh, no, I always have that thought.' I said, 'Oh? That's really strange. How come you never reported this before?' She responded, 'It just never occurred to me that this would be the sort of thing that you'd be interested in.'

I asked, 'Did you have any feeling when you had this thought?'

She replied, 'Well, this is what has really made me anxious.' I asked, 'Do you ever get this thought when you're not in the session?' She said, 'Oh, I get it with everybody. I'm always very anxious because I think that I'm boring people.'

It occurred to me that perhaps I had misconstrued the case and that she had the basic problem of having to make an impression on people and being rejected by them... I became very much interested in unreported thoughts of this kind, and I started asking other patients about this when they were free associating

In what did Beck become "very much interested"?

Periodically I would ask, 'What other thoughts are you having right now?' They would come up with other thoughts that had to do with me, typical transference thoughts according to psychoanalysis, but not what the patients had been previously reporting. I thought, 'There is a whole level of mentation going on that isn't being tapped through our classical methods.' (Beck, 1997)

Beck had been using the "classical method" of free association, a technique invented by Jung. The rules of free association were simple: report absolutely everything that enters your mind.

However, the client was not reporting negative thoughts she had all along. Once she was asked about them, she could identify them easily (and said they were constant and occurred in most situations).

Beck began looking for such thoughts in his clients, and he found them. Clients did not report these thoughts unless asked directly. Beck compared it to doing a surgical biopsy (taking a tissue sample to diagnose a tumor):

People have automatic thoughts that they use to broadcast ideas to themselves, but these are not the kinds of ideas that they would mention to other people.

This kind of internal system has to do with self-evaluation, thinking about what other people think of you, self-monitoring, self-predictions, and so on. Unless one specifically made a 'biopsy,' bored in at that very moment of the thought, one would miss it. (Beck, 1997)

Beck identified 12 cognitive distortions that turn up in this internal self-evaluation system. They resemble and overlap the list of irrational ideas from Ellis.

All or nothing thinking or dichotomous thinking: Seeing the world as black and white opposed to a more complex point of view
Catastrophizing: Assuming things will go wrong rather than looking at situations objectively
Disqualifying or discounting the positive: Placing little value in positive events in the total scheme of things
Emotional reasoning: Even in light of opposing evidence, still assuming one's feelings are correct
Labeling: Instead viewing one's self in a complex way, self applying a label or type
Magnification/minimization: Minimizing the positive and exaggerating the negative
Mental filter: Instead of focusing on the whole, focusing on a single negative aspect
Mind reading: Without considering other possibilities, assuming what others think
Overgeneralization: From small events, making large generalizations
Personalization: Thinking one's self is the reason for others negative actions
Should and must statements: Feelings that others, or oneself should behave in certain ways
Tunnel vision: only viewing one side of the situation, typically the negative side (Aaron Beck Wiki for GTTC, 2017)

Fulford, Rosen, Johnson, and Carver (2012) found ample evidence of the overgeneralization problem. They described it as "a tendency to generalize from a single failure to one's entire self-worth" and described it as "an important correlate and predictor of depression."

Beck and Ellis knew each other and sometimes appeared together on stage at forums sponsored by the American Psychological Association. They gave each other respect.

Following is an excerpt from a treatment session by Beck (1976, p.250). It is strikingly similar to therapy transcripts from Albert Ellis; if this was reported as REBT, nobody familiar with Ellis would find it strange.

Client: I have to give a talk before my class tomorrow and I'm scared stiff.

Therapist: What are you afraid of?

Client: I think I'll make a fool of myself.

Therapist: Suppose you do... Why is that so bad?

Client: I'll never live it down.

Therapist: "Never" is a long time... Now look here, suppose they ridicule you. Do you die from it?

Client: Of course not.

Therapist: Suppose they decide you're the worst public speaker that ever lived... Will this ruin your future career?

Client: No... But it would be nice to be a good speaker.

Therapist: Sure it would be nice. But if you flubbed it, would your parents or your wife disown you?

Client: No.... They're very sympathetic.

Therapist: Well, what would be so awful about it?

Client: I would feel pretty bad.

Therapist: For how long?

Client: For about a day or two.

Therapist: And then what?

Client: Then I'd be Okay.

Therapist: So you're scaring yourself just as if your life hangs in the balance.

Having exposed the errors of the client's thinking, the cognitive behavior therapist would turn to confidence-building activities. These might include behavior rehearsal or plans for positive reinforcing events.

Negative thoughts and self-perceptions would be challenged as they arose. More realistic and positive perceptions would be suggested to replace them. The emphasis would not be on "happy talk" but on realism, just as in Ellis's therapy. For more about CBT (cognitive behavior therapy) see the page on stress reduction in Chapter 14 (Frontiers).

Learned Optimism

Martin E.P. Seligman drew on Beck's approach when he formulated his influential ideas about happiness and depression. These were first summarized in a best-selling book, Learned Optimism (1990).

As discussed in Chapter 9 (Motivation), Seligman discovered learned helplessness early in his career. When dogs learned they could not escape from electric shocks, they gave up and sat still, absorbing the punishment, even when the experimenter opened the cage door and the animal was free to leave.

Seligman thought something similar was happening in depressed people. They learned a pessimistic outlook that discouraged self-help. Seligman identified three aspects of self-talk that contributed to a downward spiral of depression:

People become fixated on something negative about themselves (like Beck's patient who constantly thought she was "boring").
The negative characteristic is thought to affect everything about life ("I will never be loved, or successful, because I am boring")
This personal characteristic is judged to be unchanging and permanent ("I will always be this way")

Given that triad, no wonder people become depressed. They are doomed, and there is no escape.

Rumination, a constant stream of self-talk (what Beck called automatic thoughts) keeps the negative thinking going. Eventually it becomes a self-fulfilling prophecy. Depression leads to lack of initiative or self-sabotage and failure.

Seligman found that people grew happier if they eliminated and replaced damaging forms of self-talk. Opposite (and more realistic) ideas could be encouraged instead. The result, Seligman wrote, should be learned optimism instead of learned helplessness.

A capsule summary of learned optimism can be obtained by turning the three negative patterns of self-talk (above) into their opposites:

Instead of fixating on negative things about oneself, identify strengths and goals, and plan for successes.
When negative things happen, compartmentalize them (think of them as temporary and situation-specific).
Think positively about your long-term traits and cultivate the ability to learn and change.

Seligman's ideas link up to many of those discussed by other therapists. Seligman's emphasis on positive psychology picks up a thread started by Maslow. Seligman urged people to engage in social helpful behaviors and notice how it benefitted their own feelings as well, just like Adler.

How did Seligman's ideas resemble those of other psychologists?

Seligmen's emphasis on cultivating the ability to learn and change sounds like Karen Horney. Seligman borrowed the three facets of negative self-talk from Beck.

Seligman even proposed his own variation of Ellis's A-B-C-D-E mnemonic, changing a few of the items (A = Adversity, B = Belief, C = Consequences, D = Disputation, E = Energization, in Seligman's version). One could conclude that Seligman was a sponge, but the underlying fact is that all these therapists had similar and compatible ideas.

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References:

"Aaron Beck Wiki for GTTC" (2017, February 7) Retrieved from: https://beck.wikidot.com/

Beck A. T. (1976). Cognitive therapy and the emotional disorders. New York: International University Press.

Beck, A. T. (1997) The past and future of cognitive therapy. Journal of Psychotherapy Practice, 6, 276-284.

Seligman, M. E. P. (1990) Learned Optimism: How to Change Your Mind and Your Life. New York: Random House Books.

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