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Cognitive Therapy of Substance Abuse. New York: Guilford Press, 1993.
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Veterans Administration Hospital in Framingham, Massachusetts, he became interested in some of the recent developments in the treatment of mental illness. Beck then decided to become a psychotherapist.
Beck was originally trained in the theories and techniques of classical psychoanalysis. After finishing his residency in Framingham, Beck accepted a two-year fellowship at the Austin Riggs Center, a small private psychiatric hospital in Stockbridge, Massachusetts, which had been founded in 1919. The Center provided Beck with extensive experience in treating patients who needed long-term psychotherapy. When the Korean War broke out in 1951, Beck moved to Pennsylvania and accepted the position of assistant chief of neuropsychiatry at the Valley Forge Army Hospital. There he treated soldiers suffering from what is now termed post-traumatic stress disorder, or PTSD. Beck received his board certification in psychiatry in 1953, joined the Department of Psychiatry of the University of Pennsylvania in 1954, and completed his graduate training in psychoanalysis at the Philadelphia Psychoanalytic Institute (which changed its name to the Psychoanalytic Center of Philadelphia in 2001) in 1958. Beck remained at Penn until he retired from active teaching in 1992, when he was appointed University Professor Emeritus of Psychiatry. In addition to his teaching at Penn, he served as an adjunct professor at Temple University and the University of Medicine and Dentistry of New Jersey. He was also a visiting professor at Oxford University in 1986.
Beck has published over 465 books and articles as of early 2004. He has received funding for his various research projects from the University of Pennsylvania, the National Institute of Mental Health (NIMH), and the Centers for Disease Control and Prevention (CDC).
Early depression studies Beck developed cognitive therapy almost by accident in the course of his growing discontent with Freudian psychoanalysis. As a practicing therapist, Beck was aware that academic psychologists whose work he respected questioned Freud's account of depression because of the lack of supportive evidence from well-conducted studies. In addition, Beck had had difficulty with much of Freudian theory since medical school. His dislike was reinforced by a rebellious streak in his character and a self-acknowledged need for control. Beck told an interviewer in 1990, "I thought [psychoanalysis] was nonsense. I could not see that it really fitted there was a rebellious aspect [in me] I just couldn't control. .. . Being the youngest son probably had something to do with it." Beck initially dealt with his distrust of mainstream Freudianism by moving in the direction of the so-called neo-Freudians, a group that included Alfred Adler (1870-1937), Karen Horney (1885-1952), Harry Stack Sullivan (1892-1949), and Erik Erikson (1902-1994), who had been one of Beck's supervisors at Riggs. In general, the neo-Freudians placed a greater emphasis on social, interpersonal, and cultural influences in human development, and downplayed the significance of innate biological drives.
Freud had posited in Mourning and Melancholia (1917) that depression results from anger turned inward against the self, emerging outwardly as the patient's "need to suffer." Beck decided to set up a series of studies involving depressed patients, partly to collect data to convince psychologists of the soundness of Freud's hypothesis, and partly to design a brief form of psychotherapy that would target the core symptoms of depression. He received a research grant from Penn in 1959, and consulted two colleagues in the psychology department, Seymour Feshbach and Marvin Hurvich, for research methodology and statistical analysis. Beck then analyzed the dreams of 12 patients diagnosed with depression. The patients' dreams did in fact contain such themes as losing something of value, being prevented from achieving a goal, or appearing ugly, damaged, or diseased.
When Beck gave the depressed patients verbal conditioning and card-sorting tests, however, they reacted positively to successful outcomes, gaining self-esteem and performing better on subsequent tests. If Freud's theory of a "need to suffer" had been correct, the patients should have been upset by their successes. This discrepancy between psychoanalytic theory and research findings led Beck to reappraise his theoretical position. He went back to his dream study and began to compare the material in his patients' dreams with the verbal content of their interviews. In Beck's view, the comparison refuted Freud's notion of dreams as representing unconscious motivations and wish fulfillment. He recalled,
... it became clear to me as I went into it that the dream themes were consistent with the waking themes. It seemed to me a simpler notion about the dreams was that they simply incorporated the person's self-concept. Well, if it is just a question of the person's self-concept, you don't have to invoke the notion of the dreams being motivated. ... If you take motivation and wish fulfillment out of the dream, this undermines the whole motivational model of psychoanalysis.
Following this reevaluation, Beck then constructed his first cognitive model of depression, which incorporated three specific concepts: the so-called cognitive triad; schemas, or stable patterns of thinking; and cognitive errors, or faulty information processing. According to Beck, the cognitive triad encompasses a depressed person's view of himself, his ongoing experiences, and his future, causing him (or her) to regard present experiences or interactions with others as defeats or failures, and to think of the future as one of "unremitting hardship, frustration, and deprivation." This triad of negative cognitive patterns then generates the emotional disturbances and loss of energy or motivation associated with depression. Next, Beck devised an approach to therapy intended to identify a patient's thought distortions, test them against the rules of logic and external reality, and help the patient correct the distorted patterns of thinking.
Extension of cognitive therapy Beck was cautious in extending his cognitive model of depression to other mental disorders; he has always been a methodical researcher, careful to restrict his claims to demonstrable results. For example, his first book on the treatment of depression recommended limiting cognitive therapy to nonpsychotic patients with unipolar depression who had not responded to or refused to take antidepressant medication. After the 1970s, however, the cognitive model was successfully applied by Beck's followers to a wide range of problems, including anxiety disorders, substance abuse, marital conflict, eating disorders, and anger management. One study reported that the interest in cognitive therapy among mental health care professionals increased 600% in the 16 years between 1973 and 1989. In the 1990s, cognitive therapists published outcome studies that reported success in treating psychotic disturbances and personality disor-ders—historically regarded as the most difficult mental disorders to treat.
Recent research interests Since the early 1990s, Beck has expanded his research interests to include such topics as human evolutionary biology and the movement toward psychotherapy integration. With regard to evolution, Beck has studied the works of anthropologists and experts in the biology of nonhuman primates in order to investigate the possible evolutionary roots of depression, anxiety, and personality disorders in humans. Beck's book on anger and aggression, Prisoners of Hate (1999), opens with an analysis of chimpanzees and hunter-gatherer societies for an evolutionary basis for empathy and social cooperation among humans. Similarly, the second edition of Cognitive Therapy of Personality Disorders (2004) contains a section on the relationship between affective or personality disorders and evolutionary survival "strategies."
The integrative movement in psychotherapy began in the late 1970s as the result of three factors: general dissatisfaction among mental health professionals with single schools of therapy; the failure of any one school to dominate outcome studies for all mental disorders; and demands for greater accountability from health insurers. Some of Beck's students had already begun to use techniques derived from Gestalt therapy in treating depressed patients, and Beck himself had started to acknowledge the importance of unconscious factors as well as the therapeutic relationship in conducting cognitive therapy. Since the early 1990s, Beck has maintained in his publications that cognitive therapy is the therapy that can integrate all the others, partly because its emphasis on cognition offers common ground with a range of other approaches, and partly because Beck's research has sought to demonstrate the capacity of cognitive therapy to successfully incorporate techniques from these approaches.
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