Aaron T. Beck Writes In: Early Response to CT, and Current Success

The following is a direct email excerpt from Dr. Beck’s conversation with an interviewer. [In response to a question about meeting resistance in publishing articles about Cognitive Therapy (CT) when Dr. Beck was first developing CT.] Dr. Beck: I did not have any resistance at all in publishing articles in psychiatric journals at the very beginning of my description of the theory and therapy. My first two articles in 1963 and 1964 were published in the prestigious Archives of General Psychiatry. The second article was also the subject of an editorial in the Journal of the American Medical Association. Having said that, the major phenomenon that I noticed (until there was a critical mass of empirical studies supporting cognitive therapy) was more or less disregard. That is, articles on depression in the mainstream professional journals occasionally mentioned cognitive therapy, although they generally emphasized psychodynamic therapy as well as the biological studies and pharmacological treatment. Cognitive therapy was totally ignored in the psychoanalytic journals; it was not perceived until fairly recently as a competitor of psychodynamic therapy. Certain individuals from the psychoanalytic field, however, ranged from skepticism to hostility in comments that they made to other people, which were brought to my attention. One psychoanalyst said that cognitive therapy was dangerous because it treated the symptoms instead of the causes, and eventually the patient would get worse because the causes were not addressed. Other criticisms were that it was superficial; it was like treating meningitis with mood music. Even today, a prominent British psychoanalyst said that cognitive therapy is like aspirin rather than an antibiotic. Also, the guidelines for depression published by the American Psychiatric Association tended to emphasize drug therapy and psychodynamic therapy, and cognitive therapy was addressed in a secondary way. The problem still exists today in that most of the training programs in psychiatry have a much larger load of training in psychodynamic therapy than in cognitive therapy and the other empirically based therapies largely (I suppose) because the instructors have been trained only in psychoanalytic therapy. This has become a self-perpetuating phenomenon. [In response to a question about why Cognitive Therapy (CT) has been successful.] Dr. Beck: I believe that success of cognitive therapy has been based on the following: a. With each disorder, the investigators (including myself) first made a careful phenomenological study of the disorder and created a cognitive model that fit the disorder. There is a generic cognitive model which needs to be adapted to each disorder. Thus, there are significant variations in the formulation of the specific disorder and also in the treatment. Based on the formulation, the treatment for obsessive-compulsive disorder is totally different from the treatment for panic disorder, which is totally different from the treatment for depression. b. The investigators validated the theory through research and then developed treatment manuals based on the formulations. c. I also believe the success has been based not only on the careful understanding of each disorder using the generic cognitive model, but on the strategies of cognitive therapy itself, which involves a number of features such as “guided discovery” and “collaborative empiricism.” The technique includes skills training, a reasonable degree of structure in the interviews (agenda setting), and homework assignments. d. The therapy has been validated in hundreds of clinical trials of numerous disorders.