At 88, the University of Pennsylvania psychiatrist Aaron Beck has lived long enough to see the methods he has championed, which fall under the head Cognitive-Behavioral Therapy, win the day. He has outlasted early skepticism about his work to find himself "the most well-known psychotherapist alive."
Those are the words of the writer Daniel B. Smith, who profiles Beck in the latest issue of The American Scholar. Cognitive-Behavioral Therapy "is taught in nearly every clinical psychology and psychiatric residency program in America," Smith notes, "and it is the cornerstone of a new, $117 million program implemented by the U.S. Army to foster mental resiliency in soldiers." A major study, in 2005, found that CBT was as effective as Paxil in the treatment of depression in the short-term and more effective in the long-term (a relapse rate of 31 percent as opposed to 76 percent).
What, then, is CBT? Where traditional psychotherapy searches for the root causes of current neuroses in, say, childhood trauma, CBT zeroes in on the factual beliefs that underpin one's current problems. The therapist then encourages the patient to test whether those beliefs are rational. Often, the patient can be convinced that his or her beliefs do not, in fact, make sense. The effect of this can be liberating. For example, Smith writes,
If a patient reports that he felt a pang of anxiety when his wife failed to kiss him on her way out of the house, for example, the therapist might question the patient until he uncovers the precipitating thought, "Maybe she doesn't love me anymore. If the patient can be led to question the evidence for or against this thought, and perhaps identify a more logical explanation for the missed kiss ("She was just running late"), the anxiety should decrease.
A pattern of such self-depreciating thoughts might uncover the core belief "I am not worthy of being loved." The truth value of that factual claim can then be probed. Instead of years on the couch, patients who undergo this brand of therapy can find relief relatively quickly: "In run-of-the-mill cases of depression and anxiety, the complaints for which most people seek out therapy, patients usually report a lessening of their symptoms after only 12 to 16 sessions."
There are those who find Beck's focus on notions that are testable using reason to be too one-dimensional. (What of emotion, for example?) Still, his channeling of psychotherapy onto a more-empirical path has made the idea of incremental progress possible, in a field whose practitioners once boasted that what they were doing was too important, too artistic even, to be quantified.
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Leon Neyfakh is the staff writer for Ideas. Amanda Katz is the deputy Ideas editor. Stephen Heuser is the Ideas editor.
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Joshua Rothman is a graduate student and Teaching Fellow in the Harvard English department, and an Instructor in Public Policy at the Harvard Kennedy School of Government. He teaches novels and political writing.