New Breakthroughs in Cognitive Therapy: Applications to the Severely Mentally Ill (Part 1)
Aaron T. Beck, MD
Note: This article summarizes Aaron Beck’s interview with Judith Beck at the Evolution of Psychotherapy Conference in Anaheim, CA, December 16, 2017, for which he received a standing ovation from over 7,000 conference participants.
Origins and Development of the Treatment
Early in my career, I treated a delusional patient who believed he was being followed by government agents. This individual recovered, and I was enthusiastic about using psychotherapy to treat individuals suffering from delusions. Many decades later, I supervised a resident who was treating an individual with delusions at one of the hospitals. This individual believed that all the other individuals in the unit were members of the Camden police force. At my urging, the resident suggested she get to know each of the people on the unit closely, and be able to describe them. Over the course of time, the number of supposed police gradually diminished to zero. At the time, I attributed her improvement to increased focus. Later, I realized that forming social relationships with the other members of her unit also played a key role.
Sometime later, I discovered that several British groups were successfully treating individuals with schizophrenia using CBT. They adapted various CBT strategies to address the unique needs of this patient population. This inspired me to see if we could develop a treatment based on the principles of cognitive therapy that could address the negative symptoms of schizophrenia. Paul Grant and I (Grant & Beck, 2009) developed several questionnaires and determined that the negative symptoms, namely isolation, were related to defeatist beliefs such as, “If I try something, I will only fail” and asocial beliefs such as, “If I reach out to people, I will only be rejected.” We found that this formulation correlated significantly with the negative symptoms of schizophrenia and indeed our findings were replicated by almost a dozen other investigators. Following our discovery, we conducted a randomized control trial in which we adapted CT to this patient population (Grant et al, 2017).
Paul M. Grant, Aaron T. Beck; Defeatist Beliefs as a Mediator of Cognitive Impairment, Negative Symptoms, and Functioning in Schizophrenia, Schizophrenia Bulletin, Volume 35, Issue 4, 1 July 2009, Pages 798–806, https://doi.org/10.1093/schbul/sbn008
Six-Month Follow-Up of Recovery-Oriented Cognitive Therapy for Low-Functioning Individuals with Schizophrenia. Paul M. Grant, Keith Bredemeier, and Aaron T. Beck. Psychiatric Services 2017, 68:10, 997-1002