By Judith S. Beck, PhD, Beck Institute President and Sarah Fleming, BA, Public Relations Specialist
The following blog post is the first part of an article published in the German journal Verhaltenstherapie und Psychosoziale Praxis (Behavior Therapy and Psychosocial Practice). Read part two here; part three coming soon. Download the full article in German here.
Introduction
Beck Institute (BI) is a nonprofit organization in Philadelphia, Pennsylvania, USA, with a mission to improve lives worldwide through excellence and innovation in cognitive behavior therapy (CBT) training, practice and research. My father, Dr. Aaron T. Beck, and I founded the Institute in 1994. Since that time, we have trained thousands of health and mental health professionals in 130 countries through a wide variety of programs.
Dr. Aaron Beck is globally recognized as the father of cognitive therapy, after developing the revolutionary treatment at the University of Pennsylvania in the 1960s and 1970s, where he is currently Emeritus Professor of Psychiatry. A prolific and productive researcher and author, with a career spanning more than 70 years, he has published over 600 articles and authored or co-authored 25 books. At the time of Beck Institute’s founding, I had been working at the University of Pennsylvania for nearly two decades, and I continue my work there to this day, as Clinical Professor of Psychology in Psychiatry at the Perelman School of Medicine. During my career, I have written over 100 articles and chapters on different aspects of cognitive therapy, and authored the primary text in the field, Cognitive Behavior Therapy: Basics and Beyond, now in its third edition, along with six other CBT books for professionals and consumers.
Despite our success in research, clinical care, and training within the framework of academia, we saw a need for a free-standing institute that would provide state-of-the-art psychotherapy to clients and comprehensive training programs for health and mental health professionals. From the beginning, we established a tradition of offering low-fee treatment (when needed) and scholarships to clinicians and organizations in lower-resourced countries and communities. Over the past 26 years, Beck Institute has grown from a small treatment-focused setting with a staff of eight, to an international hub for CBT training and resources, employing 50 staff and 45 adjunct faculty.
The Early Years
In the 1990s, interest in CBT was growing both in the United States and internationally. Dr. Aaron Beck and his team of researchers at the University of Pennsylvania, as well as researchers around the world, had spent many years studying the theoretical constructs of CBT, and investigating its efficacy and effectiveness in clinical practice; they then used the results of this research, and research in related fields, to refine theory and practice. The approach was increasingly gaining traction in mental health, medicine, and in the media. More and more individuals who suffered from depression, anxiety, substance use disorder, chronic pain and other conditions were seeking therapists who practiced this form of psychotherapy. When we opened in 1994, our vision was to become an international center for CBT training and research. Initially, clinical services comprised about 80% of our activities. By 1998, BI’s 11 clinicians had conducted over 4,800 patient evaluation and treatment sessions annually.
The other 20% of Beck Institute’s activities during this time involved funding and participating in research and conducting training programs for professionals. Our aim was to increase the number of competent CBT therapists, faculty, and supervisors–making effective CBT more widely available across the United States and in other countries. BI held eight designated “Visitors Weeks” each year. A small group of participants, selected through an application process, studied at Beck Institute, completing coursework in depression, anxiety, and personality disorders. They also viewed live and recorded therapy sessions, discussed clients in case conferences, and engaged in supervised, independent study.
Viewing live therapy sessions was a critical component of training, and an important piece of Beck Institute’s history and legacy. Every week since BI’s inception, Dr. Aaron Beck conducted a live therapy session with a psychiatric patient who was being treated by a clinician in our clinic, followed by discussions which I moderated. The patients who participated in these sessions had been diagnosed with depression, anxiety, bipolar disorder, substance use, relationship difficulties, eating disorders, and other conditions. The sessions were recorded and livestreamed to BI clinicians, trainees, post-doctoral fellows, medical students, and colleagues. These sessions provided an important learning opportunity, allowing medical and mental health professionals and graduate students to see cognitive therapy in action, as practiced by its developer. These weekly sessions continued for over fifteen years, and eventually evolved, with trainees roleplaying their patients.
Another important facet of training was the Extramural Program, an intensive training opportunity which we designed to increase participants’ competence in CBT. The Extramural Program, which we had started at the University of Pennsylvania, began with 19 participants from around the world. They participated in three CBT workshops in the core diagnoses of depression, anxiety, and personality disorders. They also received a year of weekly or bi-weekly one-on-one telephone supervision sessions, based on their supervisors’ prior review of recordings of their therapy sessions. (Extramural fellows who treated clients in a language other than English translated transcripts of sessions for their supervisors who then provided feedback through email and/or phone.)
Another training opportunity we brought over from the University of Pennsylvania was the Beck Institute Scholars Program. Beck Scholars were individuals who had made or were likely to make significant contributions to the field of cognitive therapy. We offered these stellar individuals a full scholarship to the Extramural Program. By participating in workshops and supervision, Scholars improved their theoretical understanding, refined their research, and enhanced their teaching, supervision, and clinical skills. Many of the most prominent researchers and academics in the field today were part of the Beck Scholars program, including Keith Dobson, Zindel Segal, Steven Hollon, Stefan Hofmann, Robert Friedberg, Allison Harvey, Martin Antony, Marcus Huibers, Tania Lincoln, Greg Siegel, and Sabine Wilhelm.
Despite our small footprint, our training programs had a big impact. Researchers, eager to add to the growing evidence base for CBT, often drew upon Beck-trained therapists for their studies. Between 1996 and 2000, Beck Institute provided therapist training and oversight for a study of late mortality in patients experiencing depression after a heart attack (Carney et al, 2004). Patients were provided with either six months of cognitive therapy, anti-depressant medication, or treatment as usual. The study found that patients who were refractory to treatment were at high risk for late mortality. BI also provided training for a study comparing telephone-administered CBT to telephone-administered supportive emotion-focused therapy in patients with depression and multiple sclerosis (Mohr, et al., 2005). This study concluded that the telephone-administered CBT produced improvements in depression and positive affect above and beyond those seen in the telephone-administered supportive emotion-focused therapy group.
BI partnered with the National Nurses Center Consortium to develop a cognitive therapy training model for advanced practice nurses working in nurse-managed community-based primary care health centers (Reilly & McDanel, 2005). We trained nurses in the fundamentals of cognitive therapy, as well as applications of CBT to specific diagnoses. Another important study that drew upon Beck-trained therapists showed that CBT worked as well as a commonly prescribed anti-depressant for moderate to severe depression (DeRubeis, et al., 2005). The effects of cognitive therapy were also shown to be more enduring than the effects of the medication Hollon, et al., 2005). In addition, the researchers found, unsurprisingly, that better trained therapists had better outcomes (Strunk, et al., 2010). This finding in particular, highlighted the importance of excellent and accessible CBT training.
In addition to training protocol therapists, Beck Institute also helped advance CBT research by providing funding for researchers. In 2004, we funded a study of cognitive therapy for borderline personality disorder (Brown, 2004), and convened a meeting of researchers to discuss the Cognitive Therapy Rating Scale (CTRS). The Institute also collaborated on a study that found that the number of CBT sessions could be reduced by incorporating a computer program into treatment, making therapy much more cost-effective and accessible (Wright, et al., 2005). In 2006, Dr. Aaron Beck and colleagues at the Beck Institute and the University of Pennsylvania published a review of meta-analyses, summarizing the literature on treatment outcomes of CBT with a wide range of disorders and quality-of-life issues, ranging from depression and anxiety to marital distress, anger, bulimia nervosa, and chronic pain (Butler, et al., 2006). It was an important contribution to the literature, providing support for CBT’s efficacy and durability as compared to other treatments.
In the early 2000s, Beck Institute began to fulfill a growing need for CBT training within health and mental health organizations. In 2000, we trained staff at hospital units in New York, New Jersey, and Pennsylvania. In 2002, we partnered with the University of Louisville to train community mental health therapists in seven counties. In 2002, we trained and supervised 32 therapists from a hospital system in Detroit.
This was also a period of growing renown for Dr. Aaron Beck. In 2005, he participated in a series of historical meetings with His Holiness the 14th Dalai Lama in Goteborg, Sweden. During their hour-and-a-half public conversation, they discussed the similarities between cognitive theory and Buddhism, particularly the overarching theme of both systems of thought: that only the mind can cure the mind. Dr. Beck concluded that Buddhism is the philosophy closest to the underlying theory of cognitive therapy. The two maintained a rich correspondence for years following their meeting.
Dr. Beck was also honored with numerous prestigious awards during these years. In 2001, he received the Heinz Award for the Human Condition. In 2006, he was voted the Greatest Mind in Psychiatry at the Royal Institute in London; and received the Lifetime Achievement Award from the American Foundation for Suicide Prevention. In 2007, he received the Albert Lasker Award for Clinical Medical Research. The Lasker awards, often likened to Nobel Prizes, are given in recognition of “stunning” achievements in medical research. The chairman of the jury committee who selected Dr. Beck for the award stated that the development of cognitive therapy was “one of the most important advances – if not the most important advance” in the treatment of depression and anxiety in the last 50 years. The same year, Dr. Beck also received the Gustav O. Lienhard Award for Advancement of Health Care from the National Academy of Medicine, in recognition of his outstanding achievement in improving health care services in the United States.
It was around this time that Beck Institute started to diversify its training programs to include a broader range of offerings. The didactic and supervision elements of the Extramural and Visitor’s programs were uncoupled, offering trainees the option to take workshops with or without engaging in supervision. In 2010, we also established an annual workshop to teach the fundamentals of CBT for depression and suicide prevention to health and mental health graduate students, interns, post-doctoral students, and early career professionals. We have provided ten scholarships to this workshop every year and have attracted young trainees from all over the world. This has been an important investment in the future of the field.
Citation
Beck, J. S., & Fleming, S. (2021). Die Geschichte des Beck Institute for Cognitive Behavior Therapy. Verhaltenstherapie Und Psychosoziale Praxis, 53(3), 469–479.