US pioneer of cognitive therapy, Dr Aaron T Beck, dies at 100

Brand of pragmatic psychotherapy became the centerpiece of a scientific transformation

Dr Aaron T Beck  transformed treatment of depression, anxiety and many related mental disorders. Photograph: Ryan Donnell/The New York Times

Dr Aaron T Beck transformed treatment of depression, anxiety and many related mental disorders. Photograph: Ryan Donnell/The New York Times

 

Dr Aaron T Beck, whose brand of pragmatic, thought-monitoring psychotherapy became the centerpiece of a scientific transformation in the treatment of depression, anxiety and many related mental disorders, died Monday at his home in Philadelphia. He was 100.

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.

Beck found that he could undermine those assumptions by prompting people to test them out in the world – say, by socialising 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.

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 CBT. Over the past several decades, CBT has become by far the world’s most extensively studied form of psychotherapy.

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.

Steven Hollon, a psychologist at Vanderbilt University, said of Beck: “He took a hundred years of dogma, found that it didn’t hold up, and invented something brief, lasting and effective to put in its place. He basically saved psychotherapy from itself.”

Aaron Temkin Beck, known to friends and colleagues as Tim, was born in Providence, Rhode Island, US on July 17th, 1921, the youngest of four children. After high school, he entered Brown University in Rhode Island, finishing summa cum laude in 1942. He went on to get a medical degree from Yale University in Connecticut and did his residency in psychiatry at the Cushing Veterans Administration Hospital in Framingham, Massachusetts.

He was still in training at the Philadelphia Psychoanalytic Institute (now the Psychoanalytic Center of Philadelphia) when he began to have doubts about the scientific basis of Freud’s open-ended talk therapy, which was then the gold standard of treatment in American psychiatry. Though Freudian analysts agreed that there were “deep factors at work” in many cases of mental distress, Beck told The New York Times in 2000, no one could agree on what they were.

After searching in vain to find some empirical basis for Freud’s ideas, he began to focus on patients’ thinking in the here and now. For years he worked in relative obscurity, unsure of his footing and supported primarily by his wife, Phyllis, whom he called his “reality tester.” (He and Phyllis Whitman married in 1950.) Judge Phyllis W Beck, who is now retired and survives him, was the first woman to serve on the Pennsylvania Superior Court.

In addition to her and his daughter Judith, Beck is survived by another daughter, Alice Beck Dubow, a judge in the Pennsylvania courts; two sons, Roy and Daniel; 10 grandchildren; and 10 great-grandchildren. This article originally appeared in The New York Times