Aaron Temkin Beck: psychiatrist who invented cognitive behavioural therapy

Psychoanalysis

But his interest grew and he joined the Department of Psychiatry at the University of Pennsylvania in 1954. There he was initially won over by psychoanalysis and went through two psychoanalyses himself.

The scientist in him wanted to prove the precepts of analysis, so he did a series of clinical experiments that he thought would validate the practice. One, for example, was a consideration of the dreams of depressed patients. His daughter explains, “He hypothesised that the dreams of depressed patients should show more signs of hostility because psychoanalysts believed that depression was really anger and hostility turned against the self.”

But he found the opposite—depressed patients had less hostility in their dreams than non-depressed people.

Other experiments with card sorting showed that depressed patients did not seem to have an innate need to suffer, and in fact enjoyed doing well.

This all suggested to Beck that a new approach might be in order, and in the 1960s he set out to develop a therapy that would be backed by science.

Science based therapy

“What he did,” says close friend and mentee Martin Seligman, “was take the basic Freudian premise about thought being driven by emotion and turn it on its head.” Seligman says that where Freudians thought of emotion as “the espresso or cappuccino” and cognition as the “froth on top,” Beck had it the other way. For example, it’s thoughts of danger that make people anxious, not anxiety causing people to think of danger.

“He was the greatest psychiatrist of the 20th century,” says Seligman, “and the most influential one since Freud. But, unlike Freud, he was right.”

Beck and his colleagues and students spent years developing, refining, and clinically testing an approach that involved helping patients understand how their thoughts could lead to psychological problems, and how to change their thinking patterns and set goals that will bring them out of their problems. A recent meta-analysis showed that CBT works well in group and telephone treatment, and through guided self-treatment. The NHS covers CBT for many mental health conditions. And for many years, the National Institute for Health and Care Excellence in the UK has recommended CBT for routine use in mild to moderate depression rather than drug therapy; it also lists it as an option for people with irritable bowel syndrome, chronic fatigue syndrome, and fibromyalgia. NICE also recommends CBT as a part of treatment for schizophrenia.

Displacing Freud had its price. “Beck was despised by the psychoanalysts for obvious reasons,” says Seligman, who adds that Beck was proud of that. The Beck Institute claims that more than 2000 studies have shown CBT to be effective in many different health and mental health conditions. It’s been applied repeatedly and successfully for depression, anxiety disorders, substance use, personality disorders, eating disorders, couples’ problems, anger issues, and psychosis.

Beck’s lifetime publication list runs to 57 pages and includes numerous journal articles, books, book chapters, and manuals. His first journal article was in 1948 on kidney problems, and his last was this year (2021), with daughter Judith and another colleague as co-authors, with a description of how psychiatric disorders stem from adaptive behaviour to serious mental illness.

Global mental health

Beck’s ideas, says Vikram Patel, professor of global health at Harvard University and a founder of the movement for global mental health, “are the foundation of global mental health psychotherapy today.” The therapy has proved effective across cultures because the therapies are brief—especially compared with psychoanalysis—and could be “manualised” and measurable, he says.

“This is as foundational a discovery as those of Galileo or Newton,” says Patel.

The University of Pennsylvania named Beck an emeritus professor in 1992. He and his daughter Judith founded the Beck Institute in 1994. The institute has now trained more than 28 000 clinicians from 130 countries in CBT and is beginning to train clinicians in R-CT.

In his later years, Beck continued to collaborate on research projects, meeting regularly with mentees. “He was a model for me for ageing,” says Seligman, who visited Beck monthly until the end. Daughter Judith says her father worked—with joy—until the day before he died.

In 2006, Beck won the Albert Lasker Award for Clinical Medical Research, the only psychiatrist so honoured, cementing the scientific reputation he prized.

Aaron Beck was born in the US to Russian immigrant parents. He leaves his wife of 71 years, Judge Phyllis Beck; three children in addition to Judith; 10 grandchildren; and 10 great grandchildren.