Perhaps relatively few people undergoing cognitive therapy will have given much thought to its roots or development. It’s perfectly understandable as every medicine, clinical procedure and therapy has its own story, and we can’t know them all. The thing I find interesting about cognitive therapy is the way, in a comparatively short length of time, it has developed and been accepted as a mainstream therapy for depression. I still remember being taught the basics it as if they were hot off the press, although in many ways they were. So I thought in this post I’d take a little time to look back over how the whole thing started and share some of the basic ideas behind the model.
The psychiatrist Aaron Beck is widely regarded as the father of cognitive therapy. During his many consultations Beck was struck by the number of times his patients used self-criticism and assumed personal blame for their feelings. They would frequently view others as having purpose, meaning and happiness in their lives, and this often served to exaggerate their own perceived misfortunes, helplessness and futility. What Beck did next was to suggest a model of depression that has stimulated research for the past 40 years.
Beck suggested that the core of depression consisted of three key elements. The first of these was the so-called ‘cognitive triad’ made up of negative issues around the self, the world and the future. Beck suggested that people with depression have distorted thinking and tend to focus on negative aspects rather than the whole picture. This form of distortion is often exaggerated and magnified, a feature he described as ‘faulty information processing’ and which comprised the second of the key elements.
The ‘negative self-schema’ is the third element suggested by Beck. The word schema simply means shape, so a self-schema refers to the cluster of ideas and beliefs we have of ourselves. We may, for example, view ourselves as quiet and thoughtful, or stupid and thick, or loud and outgoing. Our schema inevitably incorporates our health status where we might view ourselves as robust, or sickly, and so on. According to Beck, people with depression have a negative self-schema which was probably acquired during childhood, most likely from critical, demanding or rejecting parents.
Beck’s model of depression effectively provided a platform for a new form of therapy in which the therapist works with a patient in order to identify and change patterns of thinking, behavior and emotions that may not only lead to depression but help to maintain it. Since the mid 1960s and 70s when the model first became prominent, it has been revised and adapted. The Beck Depression Inventory is still one of the most commonly used ways for measuring the severity of depression. Meanwhile, the Beck Institute continues to thrive under the Presidency of Aaron Beck’s daughter, Dr. Judith Beck.