American Psychological Association

122nd Annual Convention
Washington, D.C., August 7-10 2014

Aaron T. Beck at 93

Aaron T. Beck at 93

Aaron T. Beck - 8 August 2014 - Via Skype

Today we had the privilege of hearing and speaking with the legendary Aaron T(im) Beck, revered as the 'father of cognitive therapy', and widely known for his work with (and scales for) depression, and in recent years expanding the boundaries in which his principles were being successfully applied. Aaron T. Beck, now age 93, joined us via Skype. Moderating the event, as he has on many prior historic gatherings of psychologists - including conversations with Phil Zimbardo and Albert Ellis - is past-APA President, Dr. Frank Farley.

Dr. Farley began the discussion by asking Dr. Beck what he has been up to in his thinking and interests. Beck replied that first of all he's been energized by some of the work being done with treatment of schizophrenia. For him he's felt the need to shift from thinking about 'treating symptoms' to understanding what underlies some of what meets the eye, in particular the impact exerted by feelings of being disempowered, and of aloneness. What he (Beck) has been embracing as a tool is to address the healthy part by conversation about a 'psychosis-free topic'. You may find that if you "get him onto a psychosis-free topic, he can be just as lucid as the next person." Beck offered a case study of a patient (male) with a fixed idea that he was pregnant. In exploring (through safe topics and building a relationship) Beck found a 'hook' in that the patient became deeply moved as he discussed an important element in his life, his puppy. In brief, the outcome was successful and the man found employment - at an animal shelter!

[The following day Temple Grandin spoke at length about the power of work, of always being busy 'doing things', and taking advantage of whatever there is which both engages and taps your strengths. Echoing Malcolm Gladwell, Grandin spoke of seizing opportunity, and timing, and work, work, work which leads to big successes. Ellis often spoke of this too, while John Beard's 'clubhouse model' and therapeutic communities harness the power of activities and community. The point: 'doing things' you love, and moving forward - a recipe for happier life.]

Beck said that his cognitive and humanistic approach, along with others, are powerful tools. People, he said, are always asking him about ACT, DBT.... He believes that there are many 'brands' out there but across those that are effective, "there is one big theory". For him the key is dysfunctional beliefs, as beliefs guide behavior and our lives. Beck has observed over the years that "for each disorder, there are definite perceptual biases and dysfunctional beliefs" (An example of a perceptual bias seen in paranoia, Beck explained, might be seen in one's reaction to eyes and faces.) So, how to proceed? Beck acknowledged that some of the various techniques which are widely embraced include:

Emphasizing the importance of both the (human) connection and the matching of strategy to situation, Beck described another case in which his daughter (Dr. Judith Beck) had a patient who resisted her. Why? It turns out, when the patient was asked, the reason was "I don't like charts" like the ones he associated with his first therapist (J. Beck). So the solution was to send in a new therapist, and no charts. "Suddenly the patient loves CBT."

Beck used this example to underscore the importance of both sound techniques and therapeutic relationship [as in 'working alliance']. He does not find it productive to have total allegiance to only one school or another. In being an effective therapist, said Beck, "One of the drawbacks is the belief in one approach at the exclusion of others."

Dr. Farley asked if Dr. Beck has been focused at all on PTSD.

Yes, he has, particularly in the aftermath of the Boston Marathon bombing, with huge press coverage and questions raised about the impact on children. Beck described some research on children's brains pre and post trauma. From a medical/brain perspective, Beck said there has been some investigation of brain structure and function in response to trauma. In particular the before/after research separated out those who had hyperactive amygdalas (pre-trauma) and those who did not. 'Guess who was the most impaired?' Beck asked. "Those with hyperactive amygdala were most likely to have PTSD."

Another type of predictor has been postulated, that being the absence or presence of 'catastrophizing'. In one experiment, Subjects had been given brain scans, and also took tests which tapped tendency to catastrophize. It turns out that the level of catastrophizing was a better predictor than MRI's as to whom would be most affected by PTSD. "PTSD and Catastrophizing. The intervention is simple: train individuals to restructure events so the effect is not catastrophic."

[Beck asks for audience questions]

Question: What would you say has been your greatest accomplishment?
Beck: "Well, it depends on which phase of my career you ask that question, and I think if you ask me this question two years from now I'm going to say I think my greatest accomplishment has been this 'paradigm shift' in the treatment of patients with schizophrenia... individuals with schizophrenia. I think if it holds it's going to be the most enduring accomplishment that I've made."

Question: Any regrets?

Beck (smiling, joking here at first): "I was reading a book about George Bush... [Laughter] 'Can I get back to you later on that?'. [Seriously, "I'd like to answer that!"] I've made many mistakes, but...I think I've been able to capitalize on them. After I'd gone down a blind alley or gone off on a tangent, I found that these mistakes that I made actually were information for me. So... as many people know, I was in psychoanalysis for a long time and I thought that many of the things that I learned, or thought that I'd learned in psychoanalysis, turned out to be wrong. So that, then, stimulated me to think of things that were right. Things were actually the opposite of what I had thought. So, even the time that I spent in psychoanalysis, I think, was not wasted, because it's a learning experience for me.

Question: "Another question from the audience that's pretty relevant to what's going on in the world today... You have written on the topic of hate, have a book on hate, and have written extensively in that area. What are your reflections on 'promoting peace'?"

Beck: "Well, I think in order to promote peace, you have to understand what causes hate. And one of the regrets that I have is that the book that I wrote called Prisoners of Hate has probably been one of the least-read books that I've written, and yet I think in a way this could be the most important aspect. The problem that I see in terms of inter-group hostility is that you see the same type of biases between groups and between individuals that you see in people with psychiatric or psychological disorders. And so there's a tendency to see the other person - to see the other group - in very negative terms. The image that one has of the other person - and I keep thinking a 'person' because I got the idea in working with couples... [Beck pauses and jokes with Farley about the movement of the web cam] OK, so the big problem is the image of 'the enemy'. And this occurs whether you're talking about a marriage situation or you're talking about two ethnic groups that hate each other. Each ethnic group has the identical image of the opposite person. They see the other group as malicious, as un-trustworthy, as evil, as manipulative and so on. And the tendency next is to dehumanize, distance themselves from them. And since they see them as evil they get the idea that these other people have to be extinguished; they have to be exterminated. That then, is the essence, to me, of group warfare....

There are people actually, working in Europe, who are trying to ameliorate these kind of group conflicts, to try to get these individuals to see each other as more human... We once did a study of judges and plaintiff lawyers.... It turns out [they] hate each other. The plaintiff lawyers claim that the judges are always trying to give them a hard time and over-ruling them, and the judges feel that the lawyers are being discourteous and so on. And so what we did is, we did a reverse role-play... We had the judges play the role of plaintiff lawyers and vice versa. Afterwards, they would say, you know, the real judge can understand how the plaintiff feels, and the plaintiff lawyer would say 'now I see how the judge feels'.

This kind of role playing was also used successfully by one of my mentees in Northern Ireland, where they were able to get the Catholics and the Protestants to do this kind of reverse role playing. And when they did that they saw the other person in more human terms. So while we do have [hostility towards 'enemies'] we also have a way of correcting these notions. And so what I see in the future is some kind of mechanism will be set up so that people will be educated, or a mechanism will be set up to try to ameliorate this kind of negative casting of the other group. "

Question: What are your thoughts on 'psychology' vs. 'psychiatry'?
Beck: "There's generally NO difference because I talk about 'therapy'."

But historically, "you can go back to the 40's and 50's. For psychology it was just testing. Then came therapy, and psychiatrists moved away. To drugs. Now psychologists want to prescribe." [Fair enough, as it reflects two sometimes-rival groups. Meanwhile, psychoanalysis preceded psychiatry but is now offered or sought by a relative few...] The next shift in the turf wars, Beck speculated, might involve nurse practitioners, and prescribing ... But for Beck, in addition to the specific tools or orientation, the human skills are critically important. More than the specific school or degree. [Dr. Beck is, for anyone who may not know, a psychiatrist with stellar psychological credentials also, but as he just repeated, he most values and identifies with the work of 'therapy'.]

Dr. Farley asked Beck how he manages to keep up his productivity and stamina at his age, seemingly sharper and more active than some 30-year-olds. Beck replied that he enjoyed playing tennis regularly, up until around 3 or 4 years ago. Now he maintains relationships with his former co-players and enjoys getting together just to talk. He discovered new things, such as his co-players' families, illustrating how he has himself re-structured his activities with positive effect. Dr. Farley marveled at how Beck managed to actively play tennis until nearly age 90. With his big smile, Beck replied, "Well, it was doubles..."

Question (Audience) : How have you seen your approach adopted in other parts of the world?

Beck: "Cognitive Therapy can be adapted." He has been working with psychologists in developing countries. "In most places there is a history of psychoanalysis and CT is new." But the history is different, for example, in Moslem countries, where there was no prior history of psychoanalysis.

Question (Farley) : So how are you feeling?
Beck: "I feel good!" It's hot where he is (with family in Tampa, Florida; we can see the ceiling fan overhead) but it is quite comfortable indoors.
Farley: Any thoughts, going forward? [Referring to cognitive therapy strategies]
Beck: No... CT, ACT, it's one thing, called psychotherapy. There are techniques, and we depend on efficacy.

Question: Any additional thoughts on 'therapeutic alliance'?

Beck: "With schizophrenia the important thing is engagement. Engagement is crucial. 'Feeling crazy', 'feeling alone', and secondary: feeling disempowered..... Computer-based therapies seem to work. I do wonder if some patients like the relationship - with the computer. The important thing is action, working together."

Question: Going forward, are there any changes so you would like to see in the BDI? [Beck Depression Inventory]
Beck: That may be difficult in terms of the diagnostic aspects, because of the changes in DSM. With DSM-5 there is "a retrogression in the criteria for depression".

Question: What advice would you offer for new professionals? There are so many journals, for example...

Beck: "If you're going into psychotherapy you don't need to subscribe to everything. Go to events, like APA, and get a 'smorgasbord' of insights." Beck sees many beginning practitioners engage in "technique hopping", "or they grind a technique to death." without variation or specificity to the problem. "CT requires cognitive restructuring", but there are many techniques.

"I think I learn from every patient I treat, everyone I supervise, and even from questions at APA meetings!"

Question: Any last thoughts on treatment, perhaps with schizophrenia?

Beck: "I never liked the 'snake pit' [system which considers] people crazy through and through. We need a more humanistic approach. Schizophrenics can form relationships, they're just like the rest of us, and they can get better!"

And with that, today's session came to an end, after being treated to this shared event, one in which Beck and everyone present agrees, we all learn from each other, including from events such as this.

Aaron T. Beck, at age 93. What a unique and accomplished man, brilliant and grounded in humanism, compassion, and the power of belief.

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[New]Phil Zimbardo, on Evil and Heroic Good

2010 Convention Highlights:
Online Support Groups & Applications | Evidence & Ethical Practice | Opening Ceremony | Sir Michael Rutter: Resilience
Group Memory | Psychology in the Digital Age | Steven Hayes: What Psychotherapists Have that the World Needs Now

2011 Convention Highlights:
2011: eHealth Odyssey | Googling, Twittering, Poking | Zimbardo: Reflections + Enduring Lessons from 40 Years Ago: Stanford Prison Experiment
Opening | Avatar-based Therapy | Canine Cognition: Chaser | Aaron T. Beck @90 | Cavanagh: Computerized CBT | Seligman: Flourish
PsychTech: Virtual & Augmented Reality | Relationships 3.0 | POKE ME: Social Networks & Kids | Telehealth & Telepsychology Licensure - Barriers and Possible Solutions

2012 Convention Highlights:
Transmedia Storytelling | Opening | 2012: Virtual Reality Goes to War | DSM5: Q&A | Drew Westen: Dysfunctional Democracy
Howard Gardner: Multiple Intelligences | Zimbardo: Anatomy of a TED Event

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