Beck in Action: Grawemeyer-Winning Psychiatrist Influential in Psychology

As an undergraduate at Brown University, Aaron “Tim” Beck took his first – and last – class in psychology. “It all had to do with brain anatomy and physiology and so on,” he said. “I was disappointed.”

More than 50 years later, APS Fellow Beck’s influence on psychology has made him the recipient of numerous awards and honors, most recently the University of Louisville Grawemeyer Award for Psychology. The $200,000 award for outstanding ideas in psychology recognizes Beck’s work in the development of cognitive therapy.

Aaron Beck

“In terms of the field of psychotherapy, he’s the most widely known, and probably now most widely cited person in the world,” said Ed Craighead, professor of psychology at the University of Colorado, Boulder.

“Most people think that I’m a psychologist, and I feel very proud to be mis-identified as a psychologist,” said Beck, who earned an MD from Yale and later completed residencies in both pathology and neurology.

As a neurology resident, he was required to complete a rotation in psychiatry. “Even though I fought it, I finally had to do it,” said Beck, who had become disillusioned with the “nihilistic” approach to psychiatry he had originally encountered as a medical student.

“Once I got into it, I really was confused,” he admitted. “I had six months of psychiatry and I couldn’t really quite make it out. So, I decided to stay with it for a while to try to figure it out, and eventually I got into psychoanalysis.”

Beck’s interest in research led him to test psychoanalytic hypotheses with the depressed patients he was treating. At that time, it was thought that the dreams of people suffering from depression would show evidence of hostility. Instead, Beck and his colleagues found that depressed patients actually showed less evidence of hostility than did non-depressed patients.

“What I did see in the dreams of depressed patients was certain themes in which they perceived themselves as losers. It turned out that, far from having a lot of hostility, the patients actually had a very negative self-image,” he said.

He also observed that patients would often provide negative interpretations of their experiences and that they were subject to particular cognitive distortions in their thinking. Beck began guiding his patients to review these negative thoughts and assessments and to consider alternative explanations.

The results were encouraging. “Treatment that ordinarily would take a year or two years … would now be about 10 or 12 sessions,” Beck said. “So I made a transition then from the psychoanalytic theory to a cognitive theory. This was just the beginning of the cognitive revolution, which had a really strong impact on my developing a totally different type of formulation of mental illness and treatment from what I’d been exposed to.”

At first, this new approach to treatment was trivialized by others in the field. “The thought was ‘well the therapy’s like mood music,’ ” he said. Today, of course, cognitive therapy is a major force in psychotherapy. “It has become one of the first-choice treatments for major depression, and more recently, variants of his program of cognitive therapy have been developed for use with several other psychiatric disorders,” Craighead said.

Marjorie Weishaar, clinical professor of psychiatry and human behavior at Brown Medical School, completed a post-doctoral fellowship with Beck after completing her PhD in psychology. She is also author of the biography Aaron T. Beck, part of the “Key Figures in Counselling and Psychotherapy” series.

Weishaar explained that one of Beck’s major contributions to psychology is the research he has conducted with patients in clinical settings. “He provided all the clinical studies to support the cognitive revolution in psychology. The psychologists were basing their research on college students and he used clinical populations,” she said. “So, although he was not the sole inventor of cognitive theory, certainly … he’s the one who provided all the research and continued to do so … for the last 40 years.”

Currently, Beck is professor emeritus at the University of Pennsylvania School of Medicine and director of the Beck Institute for Cognitive Therapy and Research in Philadelphia. He is the author of more than 450 publications.

His most recent book is Prisoner’s of Hate: The Cognitive Basis of Anger, Hostility and Violence. In the book, he explores how disordered thinking affects larger societal problems such as domestic violence, war and genocide.

“Individuals are individuals. They’re still people whether they’re participating alone or in a group. So group psychology, the way I see it, is an offshoot of individual psychology,” he said. Beck added that members of warring groups show cognitive distortions similar to those seen in individuals treated with cognitive therapy.

Beck is now writing a new book on schizophrenia and exploring the use of cognitive therapy for the treatment of schizophrenics. He noted that work done in the United Kingdom has shown that cognitive therapy can be effective for the treatment of schizophrenia. However, he added, many American psychologists are not aware of this research. “There seems to be a kind of negative belief about whether it can work in the United States,” he said.

Another aspect of Beck’s current work continues research on suicide prevention he began during the late 1960s. “In order to be able to bring these ideas to fruition, it has taken over 30 years,” he explained. The development of this research began with the construction of a classifying system to measure whether patients were suicide ideators, suicide attempters and/or suicide completers. Next, it was necessary to develop scales for measuring suicidal intent and hopelessness. Current research based on these measures is focusing on intervention to prevent suicide attempts in at-risk patients.

In addition to his full workload, the 82 year old Beck enjoys spending time with his family, which includes eight grandchildren, and playing tennis three times a week.

“His tennis game is unbelievable” said Rob DeRubeis, professor and chair of the psychology department at the University of Pennsylvania. DeRubeis added that, despite his many professional accomplishments, Beck remains grounded.

“When I sit with him, if I think about it, I know I’m sitting with perhaps the most influential psychiatrist of his time, if not ever. And at the same time, I’m aware that he is as plain-spoken and down-to-earth as anybody I know,” he said.

“That incongruity always impresses me, and it’s how I like my famous people. I like them humble and with a sense of humor about themselves, and Tim certainly is that.”