Q&A with Dr. Judith Beck

What do you think is important for a young CBT therapist or researcher to know about the history of CBT?

Aaron Beck has always started with clinical material first, working with clients and generating hypotheses about his observations. He tests his hypotheses, refines his theories, and bases treatment on these theories, continually testing and improving the validity of his theories and the efficacy of treatment.  He continues to do so to this day, in his work with individuals with schizophrenia. Researchers should follow his lead, always treating clients to inform their work. And they should learn to treat clients outside of their specialty area, for example, clients with different ages, cultures, genders, diagnoses, and so on, so they can maintain a broad perspective.

 

 

What is in your opinion most exciting about CBT today?

There are many different directions the field is going in today, but I’ll just choose one, something that we’re heavily involved in at the Beck Institute: developing online training programs for therapists. So many mental health professionals throughout the world can’t afford existing training programs or can’t travel to attend workshops or conferences. With today’s technology, we can train many more mental health and health professionals in evidence-based treatments. So many more people, with a range of problems, can be helped.

 

 

Any predictions for the future? Will there be a place for CBT in the future?

Yes—and the treatment for certain disorders may look somewhat different from how it looks today, based on advances in research and technology. And I hope more people will adopt a different view of CBT. Many professionals believe that CBT is defined by its use of cognitive and behavioral strategies. But that’s too narrow a definition. CBT should be seen as a system of psychotherapy that is based on the cognitive model, not based on its use of certain techniques. In fact, with clients with personality disorders, we often adapt techniques from a range of psychotherapeutic modalities, used in the context of the cognitive model, such as strategies more commonly associated with Acceptance and Commitment Therapy, Dialectical Behavior Therapy, Gestalt Therapy, Psychodynamic Psychotherapy, Interpersonal Psychotherapy, Positive Psychology, and a number of others. CBT will continue to be a major force in mental health treatment as long as research studies show equal or better outcomes for both treatment and relapse prevention.

Judith Beck

Drs. Beck and Evans Discuss Evidence-Based Practices

Within the span of a few decades Dr. Aaron T. Beck, widely regarded as the “Father of Cognitive Behavioral Therapy”, has changed the way we think about mental health treatment. In 2007 the city of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), and Dr. Aaron Beck joined in a collaboration unlike any other to bring Cognitive Behavioral Therapy out of academia and into Philadelphia’s behavioral health system.

This unique partnership is one of many strategies employed by DBHIDS to ensure that all Philadelphians have access to the most effective treatments. To capture this fascinating story Dr. Beck, and DBHIDS’ Commissioner Dr. Arthur C. Evans have joined to create this short video about their work.

CBT: Review of Randomized Trials

Written by Paulo Knapp, PhD

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A systematic review of the literature of all published papers in the year of 2014 describing randomized controlled trials (RCTs) that compared cognitive-behavioral interventions with a wait-list control group, or another form of psychosocial intervention or other medical treatment was conducted. Only RCTs that clearly specified a CBT theoretical orientation were included. Samples included all populations, undergoing any type of psychiatric or medical condition; subjects with no formal diagnosis (e.g., students in a school-based prevention program), and psychotherapy professionals in training condition were also included. As the objective of the review was to take an instant picture of the current clinical applications of CBT interventions in the whole spectrum of psychiatric and other medical disorders, variables such as fidelity of therapists to the proposed intervention, heterogeneity of the experimental samples, appropriateness of the control groups, and any other confounding variables were not analyzed.

The data extracted from 394 identified RCTs published in the year of 2014 revealed that around 58,000 individuals underwent CBT-based interventions conducted in 34 countries for the treatment of 22 different medical and psychiatric diagnoses. As could be expected, the most prevalent investigated diagnosis was depressive disorders in 20% of trials, while other medical conditions, as chronic pain and fatigue, and collateral symptoms of cancer treatments, e.g., insomnia, were treated with cognitive-behavioral interventions in 75 studies, 19% of total. Among other diagnosis, mixed anxiety-depression symptoms were addressed in 63 studies, and substance use disorders in 37 studies.

One hundred forty seven trials were conducted in the USA, and 15 in Canada, summing up 162 (41% of total) studies in North America. European countries showed a similar contribution with 167 (43% of total) studies, mostly from United Kingdom (43), The Netherlands (35), Germany (25), and Sweden (21), representing three quarters of the European trials. Outside North America and Europe, Australia published a fair amount of studies (35), and CBT-oriented trials were also reported with samples far apart in the globe as China (9) and Brazil (4), as well as in different countries like Israel, Pakistan, Iran, Congo, Indonesia, Turkey, Korea, India, and Greece, among others. However, almost all (95% of total) trials were conducted in high-income economy countries.

In accordance to our current times, 65 (16.5%) studies reported web-based cognitive-behavioral interventions, from Internet sites to phone apps. Four studies conducted in school settings aiming psychopathology prevention were published, as well as two trials comparing different formats and settings for professional training in CBT.

This systematic review shows that there has been a steady dissemination and adoption of the cognitive-behavioral therapies in practitioner’s clinical work in a wide array of psychiatric and medical conditions. The high number of randomized clinical trials conducted in a single year, with worldwide study samples, reporting an increasingly widespread use for different clinical conditions, demonstrates a definite consolidation of cognitive behavioral therapies in the contemporary therapeutic scene.