Cognitive Behavioral Therapy Redefines Mental Health

How Aaron Beck and Albert Ellis Started a Psychotherapy Revolution

Mary Sykes Wylie

PNND-05[1]Cognitive behavioral therapy (CBT) is arguably the most successful therapy ever developed. In only about 40 years, it’s gone from the almost accidental innovations of two disenchanted psychoanalysts to the most widely practiced and promulgated approach in the world. For space aliens who’ve never heard of CBT, a quick and dirty definition may be in order. CBT—not a single model, but a constellation of short-term, pragmatic, goal-oriented clinical techniques, used in varying ways in different circumstances with people suffering from different conditions—is based on a simple axiom about human experience: how we think and perceive hugely influences how we feel. Independently coinvented by Aaron Beck and Albert Ellis, the clinical method rests on a kind of Socratic questioning (with lots of homework!), which helps clients identify and correct the inaccurate, defeatist assumptions and distorted thinking patterns that keep them stuck in a perpetual round of self-reinforcing unhappiness.

Taught in almost every clinical psychology and psychiatry program in the United States, CBT dominates the field in North America, much of Europe, and increasingly, Asia and Latin America. It’s essentially the “official” therapy of the healthcare arm of the US Department of Veterans Affairs, which has in place a national staff-training program for treating depression—the largest such program in the country. Managed care and insurance companies love CBT for obvious reasons: it’s brief, usually 16 sessions or fewer, thus much cheaper than that once-famous other brand, psychodynamic therapy. It’s also reassuringly protocol-driven, sticking to a plan without wandering all over the place for years at a time. But what really stands behind its extraordinary rise is, and always has been, its claim to be far and away the most empirically supported therapy out there.

The imprimatur of science, or Science, not only boosted CBT’s reputation as empirically “truer” than other therapies, it gave therapists a life raft in the rising sea of medicalized psychiatry. CBT therapists touted their research to demonstrate that, indeed, not only was their version of talk therapy as good as psychotropic drugs, it could, in various trials, show itself to be even better! Today, it’s considered the preeminent “evidence-based practice” or “empirically supported treatment,” and has become virtually synonymous with those terms.

Where did this streamlined, efficient, practical therapy come from that would prove such a good match for our fast-paced, high-tech civilization? CBT’s founders, Beck and Ellis, began their careers as true believers in the great 19th-century Church of Psychoanalysis, but they lost their faith and became radical dissenters. Both came to believe that whether the causes of emotional suffering did or didn’t lie in buried unconscious impulses and repressed motives was irrelevant. What sustained unhappiness and turned it into an unshakeable habit, they hypothesized, was a pattern of distorted thinking and false, self-defeating beliefs.

Beck and Ellis came to embrace the belief that by working hard at thinking about their own thinking, people could figuratively pull themselves up from despair by their own mental bootstraps. As Beck tells it, he more or less accidentally stumbled upon his own revolution. In a now-legendary story, he was analyzing a young woman who spent her sessions describing in lurid detail her action-packed sex life while Beck sat quietly behind her taking notes. At the end of the session, he asked her in good, neutral analytic style how she felt.

“Very anxious, Doctor,” she said.

Beck gave her the standard formula: she felt anxious because she believed her sex life was unacceptable and feared disapproval from him, the community, her family, and so forth.

“No, no, not really,” she replied.

Well then, what? As Beck probed, she finally admitted that she wasn’t anxious about her reputation, but about whether she was boring him; in fact, she worried continually about boring everybody in her life. It wasn’t the sexual material, but her mistaken thoughts about how tedious a person she was that stirred up her anxiety.

Once Beck began helping her examine the belief and the entire lack of evidence for it, her anxiety rapidly diminished. From this small acorn of revelation, a mighty forest began to sprout. He began asking other patients, while they sat up in front of him rather than lying down on the couch, about their thoughts, uncovering poisonous streams of transitory, barely conscious self-talk—negative, pessimistic, self-disparaging, distorted, even including blatant misinterpretations of what he had said to them—that lavishly fed their anxiety and depression. Borrowing some techniques from Ellis, he began systematically helping patients “explore, investigate, and evaluate,” and quite soon, resist these negative thinking patterns. Amazingly, his patients rapidly improved. People he’d been seeing for years would get drastically better after only 10 to 12 so-called cognitive sessions and leave analysis.

Ask the average therapist what he or she thinks about CBT and you’ll likely get several predictable responses. But for all the notions of CBT as “lab therapy” that doesn’t have much relevance to the heterogeneous clients therapists see every day, each with multiple diagnoses and a jumble of symptoms, CBT lent chilly behaviorism a certain human warmth, drawn from the psychodynamic tradition. Beck and Ellis, meanwhile, went on to become two of the most influential figures in modern psychotherapy.

This blog is excerpted from “The CBT Path Out of Depression” The full version is available in the Nov/Dec 2014 issue. To subscribe, click here. >>

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Topic: Anxiety/Depression | Aging

Tags: Aaron Beck | affairs | Albert Ellis | anxiety and depression | behavioral therapy | cbt | clinical psychology | cognitive behavior | cognitive behavioral | cognitive behavioral therapy | cognitive behavioral therapy cbt | depression | drugs | emotion | family | HEAL | Judith Beck | psychoanalyst | psychodynamic therapy | psychology | psychotherapy | science | sex | success | TED | therapist | therapists | therapy | treating depression | veterans

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