Aaron T. Beck - Cognitive Therapy and the Emotional Disorders

Aaron T. Beck, M.D.

To Phyllis
and
Alice, Daniel, Judy, and Roy

MERIDIAN

Published by the Penguin Group

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First published by Meridian, an imprint of Dutton Signet, a division of Penguin Books USA Inc. This is an authorized reprint of a hardcover edition published by International Universities Press, Inc.

First Printing, October, 1979

ISBN: 978-1-101-65988-5

Copyright 1976, Aaron T. Beck, M.D.

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In recent years, emotional disorders have attracted an enormous amount of attention and publicity. This intense interest is readily evident in the best-seller list of books sold to the public and in the contents of popular magazines. College courses in abnormal psychology have achieved a spectacular growth in popularity, and the number of psychiatrists, clinical psychologists, and other professionals in the mental health field has escalated. Bountiful outlays of public funds, as well as private contributions, have been poured into an enormous expansion of community mental health centers and other psychiatric facilities.

Paradoxically, the popularization of emotional disorders and the prodigious efforts to mass-produce professional services have occurred in the context of increasingly sharp disagreements among authorities regarding the nature and appropriate treatment of these disorders. With intriguing regularity, new theories and therapies have captured the imagination of both the layman and the professional and have then gradually drifted into oblivion. Moreover, the most durable schools devoted to the study and treatment of emotional disturbancestraditional neuropsychiatry, psychoanalysis, and behavior therapystill retain their original differences in theoretical framework and experimental and clinical approaches.

Despite the striking differences among these dominant schools, they share one basic assumption: The emotionally disturbed person is victimized by concealed forces over which he has no control. Emerging from the nineteenth-century doctrine of physicalism, traditional neuropsychiatry searches for biological causes such as chemical or neurological abnormalities, and applies drugs and other physical measures to relieve the emotional disorder. Psychoanalysis, whose philosophical underpinnings also were formed in the nineteenth century, attributes an individuals neurosis to unconscious psychological factors: The unconscious elements are sealed off by psychological barriers that can only be penetrated by psychoanalytic interpretations. Behavior therapy, whose philosophical roots can be traced to the eighteenth century, regards the emotional disturbance in terms of involuntary reflexes based on accidental conditionings that occurred previously in the patients life. Since, according to behavioral theory, the patient cannot modify these conditioned reflexes simply by knowing about them and trying to will them away, he requires the application of counterconditioning by a competent behavior therapist.

Because these three leading schools maintain that the source of the patients disturbance lies beyond his awareness, they gloss over his conscious conceptions, his specific thoughts and fantasies.

Suppose, however, that these schools are on the wrong track. Let us conjecture, for the moment, that a persons consciousness contains elements that are responsible for the emotional upsets and blurred thinking that lead him to seek help. Moreover, let us suppose that the patient has at his disposal various rational techniques he can use, with proper instruction, to deal with these disturbing elements in his consciousness. If these suppositions are correct, then emotional disorders may be approached from an entirely different route: Man has the key to understanding and solving his psychological disturbance within the scope of his own awareness. He can correct the misconceptions producing his emotional disturbance with the same problem-solving apparatus that he has been accustomed to using at various stages in his development.

These assumptions converge on a relatively new approach to emotional disorders. Nevertheless, the philosophical underpinnings of this approach go back thousands of years, certainly to the time of the Stoics, who considered mans conceptions (or misconceptions) of events rather than the events themselves as the key to his emotional upsets. This new approachcognitive therapysuggests that the individuals problems are derived largely from certain distortions of reality based on erroneous premises and assumptions. These incorrect conceptions originated in defective learning during the persons cognitive development. Regardless of their origin, it is relatively simple to state the formula for treatment: The therapist helps a patient to unravel his distortions in thinking and to learn alternative, more realistic ways to formulate his experiences.

The cognitive approach brings the understanding and treatment of the emotional disorders closer to a patients everyday experiences. The patient can regard his disturbance as related to the kinds of misunderstandings he has experienced numerous times during his life. Moreover, he has undoubtedly had previous successes in correcting misinterpretations, either through acquiring more adequate information or by recognizing the logical fallacy of his misunderstandings. The cognitive approach makes sense to a patient because it is somehow related to his previous learning experiences and can stimulate confidence in his capacity to learn how to deal effectively with present misconceptions that are producing painful symptoms. Furthermore, by bringing emotional disorders within the purview of everyday experience and applying familiar problem-solving techniques, the therapist can immediately form a bridge to the patient.

Of course, a question can be raised as to the validity of cognitive psychology and cognitive therapy. Fortunately, since the cognitive phenomena are readily observable by the patient through introspection, their nature and relationships can be tested in a wide variety of systematic experimentsunlike the more abstract constructs postulated by psychoanalysis. A growing number of systematic studies have given continuous support to the foundations of cognitive psychology, and therapeutic trials have demonstrated the efficacy of cognitive therapy.