Case Conference with Aaron T. Beck, M.D.

Judith_Aaron BeckEarlier this week, students, faculty and professionals from local universities and mental health organizations visited the Beck Institute for Cognitive Therapy and Research to watch a live patient session, conducted by Dr. Aaron Beck, followed by a case conference. Although we cannot disclose the particulars of the case, below are some of the general points that came up, from participants in attendance, in a Q & A session with Dr. Beck:

Aaron Beck

That patients often need to test their automatic thoughts and beliefs by doing behavioral experiments in order to fully change their ideas. Dr. Beck also emphasized the importance of the therapeutic alliance in facilitating patient progress. Dr. Beck observed where anxiety is concerned there are often images and thought patterns. Dr. Beck explained how he discovered images and their application to the Cognitive Model (see video clip here). He explained why it’s critical to build a patient’s confidence so that he or she can take some control over his or her symptoms, including anxious images. Thanks to all the professors, students and professionals who came to visit the Beck Institute!

Advanced Cognitive Behavior Therapy Experiential Workshop at Beck Institute: November 8 – 10, 2010

Aaron T. Beck, M.D.NOVEMBER 2010: (Left) Dr. Aaron Beck answers questions after conducting a live patient session that was viewed (via closed-circuit television) by participants in the Advanced Experiential Cognitive Behavior Therapy Workshop. The workshop was attended by psychiatrists, psychologists, social workers, counselors and other professionals who traveled from Australia, Brazil, Canada, Mexico, Saudi Arabia, Singapore, United Kingdom, and ten U.S. states. (Right) Dr. Judith Beck conducts a roleplay with Saima Salman, MSc, a psychotherapist from Singapore. The Advanced Workshop was designed for professionals at intermediate and advanced levels of trainingJudith S. Beck, Ph.D. and experience who wanted to enhance their ability to deliver cognitive behavior therapy efficiently and effectively to clients who pose a challenge in treatment. Participants presented cases from their practices. Beck Institute faculty (Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D.) taught the group advanced conceptualization techniques and treatment planning, then demonstrated cognitive behavior therapy interventions through demonstration roleplays and supervised participants in dyadic roleplays. Many topics were covered, including anger, early trauma, self harm behavior, binge eating, substance abuse, anxiety, chronic depression, hopelessness and suicidalitiy. Developing the therapeutic relationship and engaging reluctant patients in treatment were emphasized. 123456

Combination of Exercise and CBT Improves Outcomes in Depressed Patients with Heart Failure

newstudy-graphic-66x60.jpg A recent study appearing in the Journal of Psychosomatic Research aimed to examine the effectiveness of exercise combined with Cognitive Behavioral Therapy (CBT) as a treatment for heart failure. Participants were divided into four groups: 18 patients were assigned to complete a 12-week home-based exercise program in addition to 12 weeks of CBT, 19 patients were assigned to complete 12 weeks of CBT alone, 20 patients were assigned to complete only a 12-week home-based exercise program, and 17 patients were assigned to receive usual care. All of the participants were stable New York Heart Association Class II (mild) to III (moderate) heart failure patients that had been diagnosed with depression.  Patients with Class II heart failure experience fatigue, palpitations or dyspnea when undergoing ordinary physical activity.  Patients with Class III heart failure experience those same symptoms when undergoing less than ordinary physical activity. The patients were evaluated before treatment, after 12 weeks of treatment, and 3 months after the end of treatment. To evaluate the participants, the researchers used the Hamilton Rating Scale for Depression (HAM-D) to determine depressive symptom severity, a 6-minute walk test (6MWT) to determine physical function, and the Minnesota Living with Heart Failure Questionnaire to determine health-related quality of life (HRQOL). The combination group showed the greatest decrease in HAM-D scores (-10.4), while the usual care group showed the least decrease (-6.2), though none of the groups showed a statistically significant decrease. The combination group also showed a large improvement in the 6MWT at the three-month follow-up. Within the cross-section of moderately-to-severely depressed participants across all groups, only those in the combination group sustained lower HAM-D scores, showed significant improvement in the 6MWT, and showed the greatest increase in HRQOL.

Extramural Training Workshop at Beck Institute: October 25-26, 2010

Aaron T. Beck, M.D.

OCTOBER/2010: (Left) Dr. Aaron Beck conducts a case discussion with Extramural Workshop participants. The workshop was attended by psychiatrists, psychologists, social workers, professors, physicians, counselors and other mental health professionals. Participants traveled from Canada, Mexico, Sweden the United Kingdom, and nine U.S. states.

Certification in CBT

The Beck Institute Supervision Program provides intensive, one-on-one CBT supervision to professionals seeking to enhance their clinical skills and work towards certification in Cognitive Behavior Therapy. Click here to learn more about receiving supervision in CBT from Beck Institute.

Professional training in Cognitive Behavior Therapy for depression was provided by Beck Institute faculty members Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., Norman Cotterell, Ph.D., and Cory F. Newman, Ph.D.

Extramural Participants ~ October 2010 Cory Newman, Ph.D. SOKOLNorman Cotterell, Ph.D. Case ConferencePatrick Link, M.D., MPH

Cognitive Behavior Therapy Workshop for Professionals at Beck Institute: September 27 – 29, 2010

Aaron T. Beck, M.D.SEPTEMBER 2010: Psychologists, psychiatrists, social workers, professors, school counselors, nurse practitioners, and other professionals from mental health, medical, and related fields traveled from 18 states and 10 countries, including Australia, Brazil, Canada, Germany, Hong Kong, Jamaica, Japan, Netherlands, Pakistan and United Kingdom. Pictured above-left, Aaron T. Beck, M.D. answers questions after conducting a live patient session that was viewed (via closed-circuit television) by participants in the Cognitive Behavior Therapy workshop at Beck Institute.

Aaron T Beck, M.D., also met with scholarship winners Ellen Driessen, MSc, Jordana Muroff, Ph.D., LICSW, and Scott Ries, MSW, who were all granted full tuition scholarships to attend one of our 3-Day workshops.  They represent three out of ten winners from our Scholarship Competition held in March 2010, which received over 880 entries from around the world!

Participants received professional training in Cognitive Behavior Therapy from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, and observed demonstration roleplays among other activities. More event highlights:

Beck Institute Participants (1)Beck Institute Participants (2)Judith S. Beck, Ph.D. and Aaron T. Beck, M.D.Leslie Sokol, Ph.D.Norman Cotterell, Ph.D.Judith S. Beck, Ph.D.

The Effectiveness of Evidence-Based Treatment in Combating Multiple Anxiety Disorders

researchlogo72x65bl-new.jpgA recent study published in The Journal of the American Medical Association compared the effectiveness of Evidence-Based Treatment against usual care for multiple types of anxiety disorders.  The participants consisted of 1004 patients with varying anxiety disorders including panic, generalized anxiety, social anxiety, and post-traumatic stress disorder in 17 primary care clinics in 4 US cities.The researchers used a Brief Symptom Inventory (BSI) to measure both anxiety and somatic symptoms.  These initial scores were compared with follow-up measurements taken after 6, 12 and 18 months of either Coordinated Anxiety Learning and Management (CALM) or usual care.

The CALM model allowed participants in the intervention group to choose between Cognitive Behavior Therapy (CBT), medication alone, or CBT combined with medication. Real-time web-based outcomes monitoring was also incorporated to optimize treatment decisions, as well as a computer-assisted program to optimize the delivery of CBT.

Results showed that CALM techniques were significantly more effective than usual care in reducing global anxiety symptoms.  Patients undergoing CALM treatment had significantly reduced scores on the Brief Symptom Inventory.  These patients also had higher response and remission rates.   Response was defined as at least a 50% reduction on the BSI or meeting the definition of remission.  Remission was defined as an anxiety score between none and mild.

The results of this trial illustrate the effectiveness of Evidence-Based Treatment, specifically Coordinated Anxiety Learning and Management in real-world practice settings. CALM proved to be more effective than usual care for multiple types of anxiety disorders.  This trial indicated that Evidence-Based Treatment may be of greater help to patients with anxiety disorders than those measures currently being used.

Roy-Byrne, P., Craske, M. G., Sullivan, G., Rose, R. D., Edlund, M. J., Lang, A. J., Bystritsky, A., Welch, S. S., Chavira, D. A., Golinelli, D., Campbell-Sills, L., Sherbourne, C. D., & Stein, M. B.  (2010).  Delivery of evidence-based treatment for multiple anxiety disorders in primary care.  The Journal of the American Medical Association, 303, 1921-1928.

The Relationship between Interpersonal Self-Concept and Paranoia in Patients with Schizophrenia

newstudy-graphic-66x60.jpgA recent study published in Behavior Therapy examined the relationship between interpersonal self-concept and global self-worth, and psychotic and depressive symptoms in patients with psychosis. The participants consisted of 83 patients, all of whom had diagnoses on the schizophrenia spectrum, and 33 healthy individuals. The researchers measured each participant’s global self-worth, interpersonal self-concept, dysfunctional beliefs, positive and negative symptoms, delusions, paranoia, and depressive symptoms.

Results showed that (1) Global self-worth is related more to depression than it is to paranoia, (2) the perception of not being accepted by others is more related to psychotic symptoms, (3) individuals who believe that others evaluate them positively have lower levels of paranoia, regardless of their dysfunctional beliefs levels, and (4) negative self-concept (i.e., not being respected , trusted, loved, and accepted by others) is most closely related to positive symptoms, paranoia, and psychosis.

The significant correlation between dysfunctional interpersonal self-concept, dysfunctional attitudes, and paranoia reinforces the formulation-based cognitive approach to delusions and the importance of eliminating dysfunctional self-concepts. The results of this study suggest that cognitive therapy may be successful in treating persecutory delusions and paranoia by focusing on interpersonal and threat-related self-concepts.

Lincoln, T.M., Mehl, S., Ziegler, M. Kesting, M.L., Exner, C., & Rief, W. (2010). Is fear of others linked to an uncertain sense of self? The relevance of self-worth, interpersonal self-concepts, and dysfunctional beliefs to paranoia. Behavior Therapy, 41, 187-197.

Special Cognitive Behavior Therapy Workshop for Students and Post-Doctoral Fellows: August 9 – 11, 2010

Aaron T. Beck, M.D. AUGUST 2010: Post-doctoral fellows, psychiatry residents, social work interns, nurses, and other graduate students from mental health, medical, and related fields traveled from 20 states and 8 countries, including Brazil, Canada, Denmark, Hong Kong, Ireland, Lebanon, Mexico, Turkey, and United Kingdom. Pictured above-left, Aaron T. Beck, M.D. answers questions from students in the Cognitive Behavior Therapy workshop hosted by Beck Institute. (Below/Right) Torrey Creed, Ph.D., conducts a roleplay demonstrating techniques in Cognitive Behavior Therapy for children and adolescents. Participants received professional training in Cognitive Behavior Therapy from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Torrey Creed, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, and observed demonstration roleplays among other activities. More event highlights: Aaron T. Beck, M.D. and Judith S. Beck, Ph.D.Judith S. Beck, PhDLeslie Sokol, Ph.D.Leslie Sokol, Ph.D. (lecture)Judith S. Beck, Ph.D.

Dr. Aaron Beck with his Great-Grandson, Robin – July 2010

 Aaron T. Beck is pictured below with his great-grandson, Robin. Dr. Beck also has a great-granddaughter, Alma.

 ATB with Robin 2

The Effects of Therapist Competence in Assigning Homework in Cognitive Therapy With Cluster C Personality Disorders

newstudy-graphic-66x60.jpgThis study examined the effects of therapist competence in assigning homework on the outcome of CT (cognitive therapy) in patients with Cluster C personality disorders. 25 participants underwent 40 weekly, 50 minute, CT sessions that followed the Beck and Freeman treatment manual for personality disorders. The six treating therapists employed three primary techniques: guided imagery, homework assignments that led the patients to try new adaptive responses, and cognitive, behavioral, and emotion-focused techniques to develop new, more adaptive beliefs to replace the pathological beliefs.

The researchers used the Global Severity Index of the Symptom Checklist 90 Revised to measure symptom distress, the mean scores of the 127-item version of the Inventory of Interpersonal Problems to evaluate interpersonal problems, and the Millon Clinical Multi-axial Inventory to measure personality pathology, as prescribed by the personality disorder scales of avoidant, dependent-submissive, compulsive-conforming, and passive-aggressive. Additionally, they tracked initial symptom improvement after the fourth session using the Helping Alliance Questionnaire. The researchers measured therapist competence in assigning, monitoring, and reviewing homework with the homework assignment subscale of the Cognitive Therapy Scale. This rating is based on the extent to which the therapist reviewed previous homework and summarized progress and conclusions, provided rationale for the assignment and the intended goals, tailored the assignment to the patient’s specific needs, and asked for reactions and feedback from the patient. The researchers also measured therapist competence in agenda setting.

Higher ratings of therapist competence in assigning homework were related to statistically significant improved outcomes on all measures at mid and post-treatment. Therapist competence in agenda setting, however, did not predict treatment outcome at either time. This study is the first to examine the relationship between therapist competence in assigning homework and treatment outcome in patients with Cluster C personality disorders, and the first to find that higher ratings of therapist competence in assigning homework predict greater positive change in symptoms, interpersonal problems, and Cluster C personality pathology.