Two images from Aaron T Beck´s private photo album. At 87, he fills his days with research and lectures. The images belong to Aaron T Beck.

Copyright text: Timothy Tore Hebb

By Timothy Tore Hebb

Imagine developing a theory of human emotions and the psyche that leads to millions of people around the world feeling much better. Much like Albert Einstein did, and revolutionizing fundamental knowledge and therefore explaining ourselves in a more fruitful way.

That was precisely what the doctor, professor emeritus and psycho-therapist Aaron T Beck did when he developed cognitive behavioral therapy, which broke with Sigmund Freud´s psychodynamic school.

In this exclusive interview Beck, who was born in 1921 and is still highly active in research, teaching and collects prestigious prizes around the world, explains cognitive behavioral therapy as he sees the therapy today, and where he thinks it is heading. He also tells us how he dreams of using it in the future.

It was in 1961 that Aaron T Beck suddenly got “a eureka moment” during a phone conversation.

- How automatic thoughts and destructive behavior are linked was understood through many clinical observations of automatic thoughts and cognitive distortions. I had also done research on depression and found that depressed patients essentially have a negative image of themselves and their future.

So negative automatic thoughts lead to individuals interpreting events incorrectly and distortedly - for example depression is associated automatic thoughts that lead to feelings of sadness, isolation and, in particular, suicidal thoughts.

- Cognitive behavioral therapy gives us a basic structure for understanding human nature, and particularly emotional disturbance. The focus is on the wrong meaning people give experiences, rather than on the experiences themselves. It is the wrong interpretations of the events that lead to psychiatric problems.

This is the reason that cognitive therapy can be used in so many and ever-expanding groups of problems - depressions, suicidal tendencies, phobias, obsessive compulsive disorders, and more. Beck says that the therapy in all cases is to define how people interpret events in the wrong way, and then to help rectify this wrong Modus Operandi.

- Depressed patients interpret their experiences so that they feel disappointment and helplessness, while patients with anxiety disorders regard their experiences on the basis of self-perceived threats and danger to their security.

People with obsessive compulsive disorders, on the other hand, perceive their thoughts as being dangerous or immoral. Aaron T Beck says that this is why cognitive behavioral therapy is so successful - when the core problem of a new specific mental disorder has been defined, he and his colleagues develop the technique to remedy or mitigate that particular condition.

- Psychiatric problems appear in many forms, but the same principle is the basis for the understanding and treatment of them.

According to Beck, it is important to identify the automatic thoughts of how we interpret events, those that lead to depression and obsessive compulsive disorder. But failing that cognitive behavioral therapy can still be helpful. In "Cognitive Therapy and the Emotional Disorders" (1976), he helped many different patients who relatively easily got help with their mental problems when their negative automatic thoughts about themselves and the world, those that led to their problematic feelings and behaviors, began to be in line with reality.

An example of a negative, predictive self-view is a student who each time before a class speech at university believes that the other students will laugh, and maybe even beat him down because he is so awful. This negative automatic thought can lead to tremendous anxiety, and possibly after a while he might be clinically depressed.

- Through various cognitive and behavioral strategies, the patient learns how to evaluate and test his erroneous conclusions and assumptions. Then he will learn how to make more realistic and constructive assumptions about himself and his future.

This is the therapy explained by the father of cognitive behavioral therapy, he who started The Beck Institute for Cognitive Therapy and Research. But an issue that is very dear to him today is developing new methods to help suicidal people. He is head of the Center for the Treatment and Prevention of Suicide at the University of Pennsylvania, which study how cognitive behavioral therapy can prevent suicide among borderline patients and elderly men, but also how cognitive behavioral therapy can be spread throughout society in a good and efficient way.

And the result? For example, Aaron T Beck has successfully managed to develop different scales to estimate the degree of depression, anxiety and suicidal tendencies in individuals.

- These scales are based on observations of patients describing symptoms, feelings, thoughts, desires and behavior. Self-estimates by patients are translated into weights, which may be specific numerical weights. The sum is then compared to the doctor or therapist's own estimate.

- Scales have proved very effective to assess how serious a person's disorder is.

However, the most commonly used scale to predict suicide is "Beck Hopelessness Scale," says Beck. In that test, the individual estimates how she regards her own personal future through hopelessness, loss of motivation, and expectations. A study that looked at a thirty-year material showed that the method, in a significant proportion of the cases, could predict suicide during this period.

He is proud of the new uses for his therapy, which have resulted in attempts where schizophrenia is treated with both medications and cognitive therapy - Britain is investing in this combination therapy. Recently, Beck finished a volume with research on cognitive behavioral therapy and schizophrenia, as well as a volume on cognitive behavioral therapy and suicide. The latter helps to formulate the patient's problems and how they contribute to her helplessness. These include depression, addictions, impulsiveness and environmental factors.

- Every problem is processed separately, and it leads to an improvement. We see that hopelessness and suicidal impulses fall sharply or completely disappear.

Cognitive behavioral therapy has taken the world by storm, but Aaron T Beck actually worked as a psychodynamic therapist in Freud´s fashion in the beginning, but he quit the method when he developed his own therapy school. When he gets the question if cognitive behavioral therapy works only on a superficial level, while not addressing "the real reason", which many psychodynamics mean, it sounds as if he has been asked it at least a few times before.

- Lots of studies have rejected that claim. For instance, it has been shown that the cognitive effect lasts longer than medication, and that must indicate that it affects the "causes" as it would not happen if only the symptoms changed.

He adds that it also proves that early intervention with cognitive behavioral therapy can prevent the onset of depression, and brain scans have showed that cognitive behavioral therapy alters the activity in the brain for the better in people with depressions, phobias and obsessive-compulsive disorders.

- Again, it shows that cognitive behavioral therapy is effective when it comes to these disorders.

So does Beck have a personal criticism when it comes to psychodynamic therapy? Well, Freud developed his therapy over a hundred years ago, and since then there have been many pioneering, scientific breakthroughs on the brain, in psychology and psychotherapy. Although he emphasizes that in the U.S., the two schools have increasingly moved closer to each other, as more and more psychodynamics use cognitive principles in their therapy, which include how interviews are structured, focusing on current problems, and being very active in the therapy.

Then Aaron T Beck explains the critique against his therapy further, that it is too uncomplicated and simplifying.

- Cognitive behavioral therapy is based on the understanding of human nature, which is really complicated. We have tried to extract the basic principles, which are possible to change, of human nature and psychopathology.

And the future? What does he see there? How can develop cognitive behavioral therapy be developed? He anticipates that more mental and physical illnesses can be treated in the near future, such as chronic fatigue syndrome and chronic pain in the back. Personally, he has a dream area, which would really take cognitive behavioral therapy to a new level – he wrote about it in "Prisoners of Hate."

The quest is to change destructive behaviors in humans, such as those that lead to conflicts and wars - between ethnic, national and religious groups.

- It would not involve cognitive processing in the normal way, this challenge requires deep understanding of the psychological reasons why we hurt people, wage wars and destroy each other.

It feels like Aaron T Beck bears the world's troubles on his shoulders, and that makes one wonder what it is that actually drives him to tirelessly work answer these complicated questions.

- I want to do what I can to help people. My work springs from an insatiable curiosity to understand human nature and what makes us act as we do.