American Psychological Association

126th Annual Convention
San Francisco, California, August 9-12 2018




Note: This is my 20th year of presenting these reports, originally in near real-time in daily 'list' posts which were widely subscribed, but increasingly web-based as list-servs gave way to instant texts, interest/Pinterest groups, and whatever flashes across the screen - in this age where attention span, focus, and reasoning are said to rival that of a goldfish. That said, if you are still reading: Enjoy, reflect, discuss, and share. ('Giving psychology away!')


Aaron T. Beck at 97

 

Aaron T Beck at 97 - APA 2018

Conversation with Dr. Aaron T. Beck: 9 Aug 2018, APA Convention (San Francisco)


Today at the Moscone Center, a huge ballroom was once again standing room only, as psychologists, students and others gathered to see and hear the legendary Aaron T. Beck.


Context/Background

Dr. Beck is regarded as one of the most powerful influences in psychiatry/psychology and is is widely seen as the 'father of cognitive behavioral therapy' (CBT). Famed for his trail-blazing work in the assessment and treatment of depression, recently he has extended his treatment to some of the most difficult-to-treat disorders, adopting and modifying treatment techniques which have proven successful in the treatment of depression and anxiety orders to his most recent focus on schizophrenia. For those unfamiliar with Beck's work, a key factor is that his research and practice led Beck towards illuminating and treating 'negative beliefs' which underly and drive dysfunctional thinking and behaving.

[ For a look at how this resembles and differs from the approach of another pioneer in cognitive therapy, Albert Ellis, please see this report of an historic discussion between the two legends in 2002: A Conversation on Mind and Psychology with Aaron T. Beck and Albert Ellis. ]

By the early 2010's, Beck had become interested in tackling the treatment of schizophrenia using the findings of research into negative symptoms - flattened affect, lethargy, etc.- seen also in depression. In 2014 Beck presented his initial research and clinical experience working with schizophrenia. He offered some case studies, in which he outlined how underlying negative beliefs can sustain negative behavior, and showed how active intervention addressing beliefs, combined with concrete actions to engage, empathize, and motivate improvement produced some dramatic life improvements. The audience at that (2014) conference were spellbound by how the 'cognitive therapy' father was sounding now like a 'humanist'. (This was well received, it should be noted!) Beck also used a variety of tools and techniques, ranging from finding ways to engage the withdrawn, through music in one example, to helping a patient fill a deep need through engaging him with animals from a local pet shelter. He emphasized how he sees value in many 'brands' of cognitively-based treatments, such as DBT and ACT, and encourages the use of an expanded tool kit of techniques.

You can see a report on that here: Aaron T. Beck at 93 (2014) ]

Both a pragmatist and a dedicated scientist-practitioner, Beck continues to push into new frontiers and exudes excitement and optimism about each new advance or revelation. Still energized, and at 97 as lucid and charming as ever, here is today's discussion with Aaron T. Beck.

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Dr. Frank Farley said hello to the audience and as in the past, invited all to sing a 'Happy Birthday' wish for Dr. Beck, now celebrating his 97th. Given that this event was sponsored by the Society for Experimental Psychology and Cognitive Science (Div. 3), Farley dubbed the audience the 'Cognitive Science Singers'.

Beck was gracious, expressing the hope that he could live up to the introduction, and playfully suggested that maybe 'with enough cognitive distortion' - which seems on many levels to be the rule of the day - he'd manage. (laughter)

Aaron T. Beck: Applying CT Principles to Treatment of Schizophrenia

Beck asked Farley and audience, "Have you ever wondered how I got onto doing research in schizophrenia since all my work up until the 1990's, and the 2000's, have been in the non-psychotic area? [Farley: Yes, tell us about that if you will!]


Beginnings

Beck: "I first got started on depression research - and this was the way I would typically research, and then 'therapeutize' a particular syndrome....

First I would try to measure what is actually going on in the head of the individual. And then of course we'd validate the measures, and so on. Then we would do some clinical work and we would see how various defenses would work on the particular measure. And then we used our findings to develop a theory. And the theory has grown quite essential to our work - and actually does apply to our work in schizophrenia. Then from that framework we evolved therapy.

So when I first started, sorry to say, about 60 years ago .... [before most of the audience was born] I developed something that's well known, called the Beck Depression Inventory. And then we got going on suicide, and went through the same process of developing a treatment and then doing clinical trials of that treatment.

And then writing a book.

So, it started with depression, anxiety, suicide, going through the same phases in the book. And then ultimately we got to substance abuse and then finally, personality disorders.

I would be going on the trail, giving lectures on different disorders ... And one question always came up: 'What about schizophrenia?' You've talked about theory, the therapy, the clinical trials, everything - but you've been 'afraid of schizophrenia'....So, I hadn't worked with schizophrenia and I decided maybe that's the way to go.

About 15 years ago... I recruited one of the [students] at Penn, by the name of Paul Grant. And I got Paul to write a doctoral thesis on the cognitive aspects of schizophrenia. And he did come up with a very interesting finding. And that is that individuals with this disorder had the same type of negative beliefs that we found in depression: that is, they had a strong negative, personal negative bias against themselves. And they had beliefs [like] 'If I try something I'm only going to fail', 'if I try to approach somebody, the other person's going to reject me', and so on. So they had this negative cast... And this was particularly true for those with negative symptoms.

So the next thing we did was, we did a literature search and found that the big problem with schizophrenia is that these individuals had a deficit - in attention, memory, flexibility, and cognitive processing... And that this deficit was pervasive, certainly across all those people with negative symptoms. We also discovered - and we had clinical evidence of this - that these same individuals actually 'failed' practically any test we could give them. Not only that but we found that the same deficit was present in many other disorders, such as depression, OCD, and so on.

So here we are dealing with a pronounced cognitive deficit, and the question is: where does this deficit come from? Is it a lack of brain matter? ... This was and is a prevailing belief in the schizophrenia field; The idea currently is that these individuals have a 'primary deficit in attention' and so on.... It's a real puzzle. Because we observed clinically that individuals who'd be spending their time in bed all day long, and be non-responsive, did very poorly on these tests....

[Yet sometimes patients were able to do amazing things, like learning chess... or playing Charades.]

How could they do well in something like 'charades', which requires 'reading other people's minds', being able to tell their emotions, and so on?

Then we went back and looked at the research. We realized that perhaps a cognitive bias - the negative cognitive beliefs, such a 'I'm going to fail' - might be a factor.... And it turns out that the people who did very poorly on these tests actually had a very low motivation - for doing well on anything, even brushing their teeth... Their motivation was low. Well, this is somewhat different than prevailing theory, which is that the deficit is in attention and memory. But here we're finding a deficit in motivation."


Motivation Deficit and 'Negative Symptoms'

"And where does the deficit in motivation come from? Could we get a show of hands? Anybody know? [Big smile] I thought I told you! .... Well, let's go back to Paul Grant's research. These people believe they're going to fail and therefore they fail. Well, this was, to us, quite an amazing finding.

And so we did find that... We did an experiment, a cross-sectional experiment, that showed that if they have this cognitive bias against themselves, and they believe they're going to fail - and incidentally, everybody else believes they're going to fail, so this is a 'cultural thing in addition to everything else. They believe they're going to fail, so they don't try, and since they don't try, they fail.

So we had assistance from the Society for Experimental Psychology. [A card-sorting experiment was designed.] There were 6 trials and the individuals were asked to sort as many cards as they could in 45 seconds. Two groups, one a control group, one an Experimental group. The experimental group got lots of feedback - a lot of encouragement, empathy, understanding, and so on ... [The control group just got testing, with no feedback, and they remained the same. But for the experimental group...] With each successive trial, the individuals did better.

And so that gave us a great clue as to therapy. Which is that first of all....these people had a negative cognitive bias.

The second thing is that their performance is below average.

And the 3rd thing is that they don't expect to succeed and they're apathetic.

The therapy we developed was based on 3 cardinal features:
  1. Nothing succeeds like success
  2. Performance is regulated by increased motivation
  3. By increasing motivation you'll increase performance and you'll get the person better
Those are the 3 cardinal rules.

And with that, we finished our experimental work and went on to other treatment conditions.

So that's all that I have to say about the experiments.

Any questions?"

FARLEY: Are you saying it's less of a thinking deficit than a motivational deficit?

BECK: "It's a motivational deficit which is based on negative dysfunctional beliefs. If you have defeatist beliefs you're going be defeated, and your performance will be poor.

And so the question then is, how do you change around these dysfunctional beliefs so that performance will improve and then the symptoms will remit? The question is, how do you do that."

FARLEY: And how would you say it should be done?
BECK: " This is what we did, let's take an example...

The Case of John

There's a patient who sits in the corner all day, listening to hallucinations, with a blanket over his head... The staff had tried everything in the world to entice him, to get him involved, to get him engaged, and they failed totally.... So how many in the audience see patients like this?" [Many hands went up.] ...

The therapist tried an experimental approach - suggesting to John that he was being given a survey about his musical preferences: 'I'm going to play some music for you.' His task was to say which songs he likes. The therapist played a song on her cell phone ('be-bop') and all of a sudden John emerged to say, 'I like it but I like hip-hop more'. And so the therapist offers to play some hip-hop. He's engaged!

The therapist found an area of interest! Meanwhile, somebody was playing the piano, and people were singing. [The therapist complimented John on his knowledge of music and said 'let's go over and help out'.] And the next thing you know they're over at the piano, singing and dancing.... Of course, he goes back to his room and his bed"... and soon appears as regressed/withdrawn as usual.

"To reconstruct what our clinician did: First she found an item of interest to him, and that is often difficult. And the second thing: She was able to get him engaged in something that was meaningful to him, that he liked. And the third thing was, that once he was engaged he was actually 'normal' [for that period]. Then he goes back and he's not doing great again... but that's a first step. There are numerous steps [to go before] he gets back to the community, has a job, makes many friends..."

What we did was, we hit the sweet spot and we were able to exploit that... It's very important to set up aspiration."

[*Here the work of R.D. Laing and the 'Fountain House model' of supported work-home-community come to mind, along with perhaps, Maslow's hierarchy of needs. And the whole concept of 'the therapeutic relationship'.- MF]

Aspiration leads to motivation.

Beck offered a second example of 'hitting the sweet spot'. Here another individual, also withdrawn, became engaged once the clinician noticed his 'fancy shoes', and was able to pursue a 'sweet spot'. She asked if he was interested in fashion. 'Yes, I'm crazy about fashion!' "And all of a sudden his face lights up, his negative affect, his flat affect, goes away, and he gets animated. In the course of time they talk about what his aspirations are.... His aspiration is to be a fashion designer. [And this was a means of engagement...] What we found from the first experiment was that when they are successful they dote on their success, and they build up..." So here too, after a number of steps, the patient progressively came closer to reaching his aspiration.

Delusions

One of the symptoms seen with schizophrenia is the presence of delusions (beyond dysfunctional negative beliefs associated with anxiety or depression.) Beck had an example here to demonstrate an approach to deal with a full-blown ('fixed') delusion, focusing on both cognition/belief and aspiration/motivation:


The Case of the Pregnant Man

"It's not unusual that [we see] bizarre delusions....Here's a patient - we'll also call him 'John' - who walks around telling people he is pregnant. They even went to the extent of giving an MRI to demonstrate he's not pregnant. But of course you know from your own work with delusional patients, the more you try to convince them they're wrong, the more convinced they are that they are right." So... What is the meaning of the delusion?

Discussion with John centered on why it was important to him to be pregnant. How did that make him feel? What made him feel good? 'What is good about having babies? How would it make you feel?'
John replied how it would make him feel important, 'They'll always be there for you', 'I'd feel wanted', 'I'd feel like life really mattered', 'I'd have an objective'....

In further exploring the meaning and probing about life events, John was asked if he remembers any times when he did have good feelings like that. Yes, when he was a child he had no friends - except for his 'best friend' Rex!

Fast forward, and the staff brought in pictures of animals, and finding ways of further engaging him. "To make a long story short... the individual was later able to visit an animal hospital. And eventually he got a job working at an animal hospital, 'taking care of dogs and cats and other animals'. And the interesting thing is, he never again spoke about being pregnant. "

[Teaching tip/discussion point: Take a look at how Temple Grandin describes her own emergence from severe autism - in a sense also following a 'craving' to fulfill aspirations, motivated through tapping her interests and strengths.]

"And so that in a nutshell is what we do. We try to find out what it is that the patient really yearns for - and it takes work to do that... but underneath their veneer of isolation and rejection is a real human being who has just the same wants and wishes and fears that we all have.

But the problem is, how do you tap into that? And that's where the expertise comes in. Right now we have a training program and have been training people, in different states, and particularly in state hospitals, in how to use this method..."
"The method - the system, tries to engage the person first of all. Secondly, try to find out what their cravings are, and sometimes address the delusions, as I described... And the third thing is to set up a program so they're going to reach a destination, which is their aspiration."

[Note / Discussion Point: Much of the severe dysfunction described here is found in hosptal settings, which vary of course, but often they do have recreational, music, art, etc. therapies - with a shared purpose, of course, being to engage interests and motivation. Beck's approach seems perfectly suitable for a 'mindful' application of engagement and work towards aspirations. Or, as Temple Grandin and Beck - along with
Seligman, Zimbardo, Gardner, and all types of talented educators know, start at the earliest ages towards identifying motivations, tapping islands of strength, and aiming at aspirations.]

"Sometimes to make the aspiration real, they have to imagine what it would be like... Sometimes you get an answer like 'I want to be a famous musician'. But it's obvious that the person does not have the wherewithal... So you how do handle that? Well, you say, 'What is it like to become a famous musician?'

Patient says: It makes me feel dignified, people look up to me, I'm proud of myself...
Therapist: Right now what can you think of? That you could right now, which would capture that feeling?
Patient: 'Well, I'm pretty good at the piano, maybe I could teach other people how to play the piano.'

And so the objective gets down to the 'meaning', and the meaning is, 'when I teach somebody to play piano I feel important, I feel useful, I feel dignified, I feel proud of myself'.

And so the meaning of the objective was the objective itself.

Beck said he could go on and on, but rather than 'conducting a workshop' wanted to leave sufficient time for questions and discussion. Here is a sample.


Questions - Discussion - Thoughts on Psychology and Therapy Training

QU: What has been the most rewarding part of your long career?

Beck: I would say that this top of my career has been the most rewarding, because I feel that this is the toughest problem I've ever encountered. And I had to draw on all the other aspects of my career. I had to draw on all of my research experience, my clinical experience with all the other disorders, and all the behaviors to tackle. This problem ... What makes me proud and pleased is the work that our group has been doing. This has been a group effort - and what makes me so pleased with that is that we've been able to tackle a problem that really seemed insoluble - and where we feel that what we have to offer is going to be way above what is offered now.

QU: Did you have any idea how popular and worldwide CBT and CT would become?

Beck: "When I first started out I was on the faculty at Penn, and my main objective was to train the residents in CT. And that was as far as I went..." Then one day one of the residents said to Beck that he admired his work but that Beck really needed to do clinical trials. "If you don't do a clinical trial nobody's going to believe you." Beck was reluctant to take on such a big, time-consuming task, but was told, "'well Tim, if you prepare a manual for us, I'll do the research...' So I said O.K...

So he did conduct this clinical trial where we compared cognitive therapy with imipramine. And Cognitive therapy did very well. So that diverted me and my career. I've done about 20 trials since then.... Paul Grant did that and he had a follow up study last year. It turned out to do quite well... as a first step it's done well.

Qu: Slightly different topic [reflected in many questions] ... On the state of the world and the state of America... As someone who has studied the human mind, and cognitive psychology and its application...
Do you have any thoughts on where this world is going?

Beck: "Well first of all, when I'm with a group of friends they're always bemoaning the fact that the Presidency is going to the dogs..."

Farley: Can we quote you on that?
Beck: "That's what my friends say! What I say, I say 'you're over-reacting'.

I do think, what you see are exactly the same type of cognitive distortions that I have described in my work with patients. You see this in groups of people, you see it in in tribes, you see it in in warfare. You see it in conflict among nations... These individuals tend to do, first of all dichotomous thinking: There's the in-group and the out-group - and the in-group is all good and the out-group is all bad. And so there's conflict.... There is this tendency. And that's one of the problems in human relations. Once you start dichotomizing like that, and start seeing outsiders as foes, you fall into the catastrophizing, the misinterpretation, the emotional reasoning, all of the things I've described...

I've been working with somebody who is a researcher for the European Union... He works out of Brussels, and he negotiates between the various leaders of the European Union. And he has been able to show them, to some degree, where they are distorting what other people say... It's a long process.

I wrote a book on this subject, called Prisoners of Hate, and the essence of this book is that people become imprisoned by their hate. And it shows that we can undercut hate by undercutting all of the cognitive distortions."

[For an historic discussion of Evil and Hate, with Beck and also Phil Zimbardo, from a social psychology/systemic point of view, here is one of the most profound dialogues among two great psychological thinkers of our day: Beck and Zimbardo on Hate and Evil ]

"So anyhow, to answer your question, there's a huge cognitive distortion going on in the world today... Hopefully some of the knowledge of cognitive psychology will seep through and the various leaders of nations will come to acknowledge that they are distorting reality.... So that's my quick answer to a very profound question."

Farley: Yes. Thank you.
Do you see any way that we could 'scale up' some of these ideas, for literally 'societal intervention', as opposed to clinical intervention? Do you see anything there?

Beck: "I see patients, so... The education system... it starts when children are very young. I think it's very hard to get adults to change their minds unless they're suffering ...and they're motivated to change their mind. But I think, with the education, what I've been talking about can start in preschool and be tailored to the attainment level of the individuals. And then and in the course of time individuals will know more about what I'm talking about and will be able to apply that. That would be my particular contribution to the cultural change.

[Note/Discussion Point: For some fascinating perspective, to broaden this area of learning and motivation please see TEMPLE GRANDIN speaking about this need for engagement and aspiration, in her own life with autism, and HOWARD GARDNER, on tapping into learning styles ('multiple intelligences') and interests in the service of motivating learning and movement toward aspirations.]

Qu: If you were invited to have dinner with Donald Trump, what would you want to talk about? [Laughter]
Beck: "Well... I think we'd end up talking about what he wanted to talk about [laughter/applause].... That's a good question. I'd have to think about that."

Farley: OK, maybe we can do that next year... So, there are a number of students in the room.
What advice do you have for somebody coming into the field of psychology in 2018?

Beck: "So this is my feeling about psychology today. I think that individuals have to be as broad-based as possible. And so while the undergraduate courses do include things like humanism and so on, there's a very strong drift towards neuroscience. And I think that psychology today has become unbalanced.

A person starting today shoud be familiar with all of the humanistic people - like Abraham Maslow and Carl Rogers, Karen Horney - as well as the experimental people, the theoretical people - such as George Kelly - and then the neuro-science people.... So they should have a very broad base....

They should not be thinking simply in terms of cognition or in terms of brain pathways or in terms of the cultural elements and so on... But they should try to have a very broad view. That's what I would like to see."

Q: OK, one burning question is, You're 97 years old ... You are still writing prolifically... Last year ... you had the lead article in Clinical Psychological Science, the APS journal... Can you impart something to all of us about work habits? I mean, how you do all that you've accomplished?

Beck replied that he's been reading a book 'The Habits of Famous People'. The author interviewed or studied case histories of a wide variety of famous people, such as Matisse and other famous artists and writers. "He found out there was one common denominator in that they all worked very hard... Persistence and patience, along with the degree of creativity that they had. I guess the creativity had to be there - if you don't have the wherewithal it's going to take a lot of persistence, and common stick-to-itivenes to get to the aspiration.

FARLEY: Will you agree to join us again next year?
BECK: Yup! I plan to do it every year until I get to be 100, and then I'll reconsider.

[Huge applause]

Thank you, Tim.




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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

2014 Convention Highlights:
Opening Ceremony | Phil Zimbardo on Heroism vs. Evil | Aaron T. Beck at 93 | David Mohr: Technology for Better or Worse | Temple Grandin: All Kinds of Minds

2015 Convention Highlights:
Aaron T. Beck - On Humanism, Therapies, and Schizophrenia | Albert Bandura: Efficacy, Agency, & Moral Disengagement | Danny Wedding: Psychopathology & Psychotherapy in the Movies | Phil Zimbardo on 'The Stanford Prison Experiment'




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