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Beck Depression Inventory (BDI)

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DOI: 10.1002/9781118625392.wbecp261

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Beck, Aaron T. (b. 1921)
Rachael I. Rosner
Independent Scholar, U.S.A.
Aaron T. (Temkin) Beck was born in Prov-
idence, Rhode Island, the youngest of three
sons of Jewish immigrant parents with socialist
and Zionist leanings. He graduated magna
cum laude from Brown University (1942) with
a double major in English and political sci-
ence. He completed his MD at Yale University
(1946) while serving as a private first class in
the U.S. Army. Beck completed residencies
in pathology and psychiatry followed by a
2-year fellowship in psychiatry at Austen Riggs
(1950–52), a private mental hospital in the
Berkshire Mountains of Massachusetts. He
married Phyllis Whitman Beck in 1950 (she is
now a retired appellate court judge). Their four
children were born between 1952 and 1959.
Beck returned to the army from 1952 to 1954
as assistant chief of neuropsychiatry at Valley
Forge Army Hospital in Pennsylvania.
Psychoanalytic Work
Like most psychiatrists of his generation, Beck
was trained in a psychoanalytically informed
(Freudian) psychiatry. Brief forms of psy-
choanalytic treatment had proven effective
on the battlefields of World War II. Many
North American psychiatrists in the postwar
years were optimistic about the promise of
psychoanalysis for treating a wide variety of
illnesses. In 1954, Beck joined the department
of psychiatry at the University of Pennsylvania.
He also began formal psychoanalytic training
in 1954 at the Philadelphia Psychoanalytic
Society. Beck graduated from the Philadelphia
Psychoanalytic in 1956.
Beck was particularly influenced at Penn
by a senior psychoanalyst named Leon Saul.
Saul introduced Beck to a rudimentary form of
social science research that tested the functions
The Encyclopedia of Clinical Psychology, First Edition. Edited by Robin L. Cautin and Scott O. Lilienfeld.
© 2015 John Wiley & Sons, Inc. Published 2015 by John Wiley & Sons, Inc.
DOI: 10.1002/9781118625392.wbecp522
of the ego in various forms of hostility-related
mental illnesses. Beck decided to test the psy-
choanalytic postulate that depression was a
form of inverted hostility (i.e., hostility turned
inward). In 1959, he won a grant from the
National Institute of Mental Health (NIMH)
for a larger psychoanalytic study of depression.
It was for this study that Beck created and
published in 1961 the Depression Inventory
(now known as the Beck Depression Inventory;
Beck, Ward, Mendelson, Mock, & Erbaugh,
1961), a 21-item paper-and-pencil test of the
depth of depression.
Creation of Cognitive Therapy
Beck broke from organized psychoanalysis
in 1962 out of frustration with the establish-
ment’s anti-experimentalist and authoritarian
attitudes. In the mid-1950s, Beck had begun
cultivating a theory that neuroses (mood
disorders) could be identified by the specific
thoughts and evaluations the patients were
making. Prior to 1962, he conceptualized this
idea in psychoanalytic terms; after 1962, he
pursued his cognitive hypothesis as something
distinctly different from classical psycho-
analysis. He concluded that there was no evi-
dence for the presence of unconscious drives
or wishes in depression (the core components
of the psychoanalytic theory of depression).
Rather, depression was the result of a bias in
how the patient evaluated the self, the world,
and the future. The key, he argued, was to iden-
tify in therapy the core biased thoughts, and
to pursue them collaboratively as any scientific
team would: to establish them as hypotheses,
to gather data, to consider alternatives, and to
revise them accordingly. Shifts in the thoughts
would result in an alleviation of the depressed
mood. Beck borrowed from an eclectic mix
of psychotherapies to create techniques for
CT, but he was particularly indebted to Albert
Ellis (1913–2007), founder of a school of
psychotherapy called rational-emotive ther-
2 BECK, AARON T. (B. 1921)
apy (later called rational-emotive behavior
therapy). Beck called his new approach cog-
nitive therapy (CT). Early versions of CT
appeared in two articles in 1963 and 1964 and
in his first book, Depression: Clinical, Exper-
imental and Theoretical Aspects (Beck, 1967,
1972).
Central to Beck’s work from 1962 on was
making the experimentalist ethos, particularly
that of the social sciences, the foundation
of both treatment and research. Following a
5-year sabbatical, Beck began teaching CT to
psychiatry residents in the late 1960s. He won
several grants from the NIMH in the 1970s
to study the cognitive dimensions of suici-
dal behavior. Beck also coalesced a group of
graduate students, residents, and postdoctoral
fellows to study the cognitive model of depres-
sion. They created the first “manual” for the
treatment of depression with CT, which was
used as part of the first randomized controlled
trial (RCT; NIMH sponsored) comparing
psychotherapy and drug treatment in depres-
sion (Beck, Rush, Shaw, & Emery, 1980). To
sustain a patient base for his research, Beck
established The Mood Clinic (now known as
the Center for Cognitive Therapy) at Penn.
Beck also cultivated in the 1970s relationships
with cognitively oriented behavior therapists.
He founded the first CT journal, Cognitive
Therapy and Research, in collaboration with
them in 1977. Clusters of cognitive behav-
ioral therapy communities began to appear
in the 1980s, many of whom trained or col-
laborated with Beck. They constitute what is
known as the cognitive behavioral therapy
movement.
Expansion and Proliferation of
Cognitive Therapy
In the mid-1980s, Beck began applying CT to
a wide range of disorders, including anxiety
and phobias (Beck & Emery, 1985), personality
disorders (Beck et al., 1990), substance abuse,
marital problems (Beck, 1988), and chronic
pain. In 1994, Beck established, with his daugh-
ter Judy Beck, the Beck Institute for Cognitive
Therapy and Research in suburban Philadel-
phia. The Beck Institute provides advanced
training and certification in CT for a wide
variety of practitioners. Beck also revised the
BDI in 1996 to be consistent with diagnostic
criteria for depression in the text revision of
the fourth edition of the DSM (DSM-IV). Beck
has created over 25 different assessment tools
for a wide variety of diagnoses. In recent years,
Beck’s group has worked with the Philadel-
phia public schools to bring CT into the high
schools, and they have developed a protocol
for the treatment of schizophrenia.
The wide dissemination of CT was also
the result of changes in both the study and
delivery of mental health care. The publication
in 1980 of the DSM-III resulted in changes
in federal funding policies for psychotherapy
treatment and research. By the mid-1980s,
psychotherapists were required to provide
to insurance companies quantitative data of
the efficacy of treatment, and psychotherapy
researchers seeking funding from the NIMH
were required to use the RCT design and
use DSM-III diagnostic criteria. The old psy-
choanalytic model was not well equipped to
respond to these changes; CT was particu-
larly well suited to them. Beck’s manualized
treatment protocol became the gold standard
in psychotherapy research. Short-term treat-
ments tailored to quantitative assessments of
their effectiveness, of which CT has been the
most prominent, have been the most success-
ful in the era of managed care reimburse-
ment.
Awards, Criticism, and Influence
Beck has authored or coauthored over 600
articles and 25 books. He has received 65
awards both nationally and internationally,
the most prominent of which is the Albert
Lasker Award for Clinical Medical Research
(2006), the American equivalent of the Nobel
Prize. Beck has received honorary doctorates
from six universities, including Brown, Penn,
and Babes-Bolyai University in Romania. His

daughter Judy, his son Daniel, and one of his
granddaughters are also practitioners of CT.
Cognitive therapy has been criticized for
treating surface-level symptoms rather than
addressing the underlying and chronic per-
sonality issues. Others have accused Beck of
practicing common sense, using simplistic
platitudes and positive psychology. Still, Beck
is widely acknowledged for having played
a major role in shifting the preferences of
psychotherapists away from interpretive and
experiential treatments, like psychoanalysis, to
more pragmatic, solution-focused, short-term,
and collaborative techniques. At the height of
his influence, Beck commanded audiences of
thousands at national conventions and was
frequently sought for autographs, newspaper
articles, and radio and television appearances.
Beck’s personality has likely also been a factor
in his rise to psychiatric “stardom.” He is
known for his gentle demeanor, his shock of
white hair, and a red bow tie. For many years,
he was an avid tennis player and, at age 93,
Beck remains an avid reader and an active
colleague at Penn.
SEE ALSO: Beck Depression Inventory (BDI);
Cognitive Therapies; Ellis, Albert (1913–2007);
Major Depressive Disorder; Psychoanalytic and
Psychodynamic Therapies: Long Term and Short
Term
References
Beck, A. T. (1967). Depression: Clinical,
experimental, and theoretical aspects. New York:
Harper and Row.
View publication stats
BECK, AARON T. (B. 1921) 3
Beck, A. T. (1972). Depression: Causes and
treatment. Philadelphia: University of
Pennsylvania Press. (Republished edition of
Beck, 1967).
Beck, A. T. (1988). Love is never enough. New York:
Harper and Row.
Beck, A. T., & Emery, G., with Greenberg, R. L.
(1985). Anxiety disorders and phobias: A cognitive
perspective. New York: Basic Books.
Beck, A. T., Freeman, A., Pretzer, J., Davis, D. D.,
Fleming, B., Ottavani, R., … & Associates.
(1990). Cognitive therapy of personality disorders.
New York: Guilford Press.
Beck, A. T., Rush, J. A., Shaw, B. F., & Emery, G.
(1980). Cognitive therapy of depression. New
York: Guilford Press.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J.,
& Erbaugh, J. (1961). An inventory for
measuring depression. Archives of General
Psychiatry, 4, 561–571.
Further Reading
Beck, A. T. (1976). Cognitive therapy and the
emotional disorders. New York: International
Universities Press.
Beck, A. T., Rector, N., Stolar, N., & Grant, P.
(2009). Schizophrenia: Cognitive theory, research,
and therapy. New York: Guilford Press.
Rosner, R. I. (2012). Aaron T. Beck’s drawings and
the psychoanalytic origin story of cognitive
therapy. History of Psychology, 15(1), 1–18.
doi:10.1037/a0023892
Weishaar, M. (1993). Aaron T. Beck. London: Sage.