Aaron Beck obituary

“Naming to tame” the core self-belief and starting to challenge such self-criticism by urging patients to look at the evidence became the basis of cognitive behavioural therapy (CBT), which would become the world’s most popular treatment for depression.

The problem initially was that Beck’s ideas, influenced by ancient Greek Stoicism, also seemed to challenge the prevailing Freudian approach to psychoanalysis, which encouraged patients to identify internal conflicts that had become ingrained in the subconscious during childhood. In early 20th century Vienna, Sigmund Freud had asserted that depression was the result of anger turned inward and that people with depression were undergoing a psychodrama based on the idea that they needed to suffer.

Beck’s approach was to construct a model that would challenge what he called “automatic thoughts”, people’s core beliefs about themselves, such as “I’ll always be a failure” or “I’m unloveable” that were constantly triggered by events, causing despair and self-destructive behaviour. Rather than focus on exploring childhood experiences, which seemed to be an open-ended and imprecise form of therapy that did not lead to outcomes, treatment should focus on challenging core beliefs on a day-to-day basis and slowly reframing this low self-worth to improve mood and ease anxiety.

Taking a sabbatical from the University of Pennsylvania, Beck spent much of the Sixties in private practice developing his proto-CBT, encouraging patients to identify the triggering event that had made them feel bad and the automatic self-belief that was behind it. Patients would find a neat figure whose immaculate attire would be finished off with a natty bow-tie and who would gently chip away at their suppositions, without crossing the line into hectoring.

They would be asked to challenge thoughts by rationally recording the evidence, such as people’s responses to something they had said. After challenging the thought, they were asked to record the degree to which their mood had improved. “There is an astonishing contrast between the depressed person’s image of himself and the objective facts,” he wrote in his 1967 book, Depression: Causes and Treatment. “A wealthy man moans that he doesn’t have the resources to feed his children. A widely acclaimed beauty begs for plastic surgery in the belief that she is ugly. An eminent physicist berates himself ‘for being stupid’. ”

Beck, who twice a day wrote down his own “automatic” thoughts (rated with a belief score and then challenged), cited the Socratic method of asking questions as an inspiration to challenging these beliefs. To this end he developed the Beck Depression Inventory in 1971, to rate a person’s mood through multiple-choice questions.

After several years of private practice he claimed that many of his patients felt able to leave therapy after 12 weeks (psychoanalysis typically lasted two to three years) and face their demons with the tools that Beck had given them.

He would need to draw on his own reserves of mental health to face the backlash that came from adherents of the prevailing Freudian approach, as well as from pharmaceutical companies suspicious that he seemed to be presenting an alternative to the antidepressant medication that was already earning them vast revenues.

Some psychologists dismissed CBT as superficial and the benefits as short-term. Beck’s model was criticised for being a simplistic “one size fits all” approach. Beck, who did not revel in spats with his fellow professionals, simply pointed to the data that he had painstakingly compiled and published over years of treating patients; much of it appeared in his own journal, Cognitive Therapy and Research. He pointed to the lasting benefits of CBT and said that, far from being an alternative, his approach was neo-Freudian and did not discount the childhood experiences that had shaped people’s automatic negative thoughts. CBT could complement deeper psychoanalysis.

Acceptance grew. He served as visiting scientist at the Medical Research Council in Oxford from 1986, and by the 1990s CBT had become mainstream. In 2008 the Labour government in Britain started to make CBT available on the NHS. Many GPs began to suggest that patients try CBT before starting antidepressants, and would refer patients to group CBT sessions or online courses such as SilverCloud.

Aaron Temkin Beck was born in Providence, Rhode Island, in 1921 to Russian Jewish immigrants Harry, a printer who wrote poetry, and Elizabeth Beck. His babyhood was framed by tragedy; an older brother and sister had died during the flu epidemic. Deeply depressed and grief-stricken, his mother was fiercely protective of Aaron but the bird-happy child took no notice, loving sports and paying little attention to schoolwork. While horseplaying with his friends aged seven he broke his arm. During an operation to reset the limb he contracted septicaemia. Doctors gave him a 5 per cent chance of survival. Over several weeks of recuperation, he discovered a love of reading.

He returned home with a phobia of surgery and chronic squeamishness about blood, but had started an intellectual pursuit that would lead to his graduation with honours from Brown University in 1942. Having majored in English at Brown, he would go on to Yale Medical School, where he overcame his medical phobias by repeated exposure to procedures.

Beck specialised in neurology, but was pushed down the path of psychoanalysis because of a shortage of practitioners. After completing the six months he was ordered to do, he had found his metier.

In 1950 he became a fellow in psychiatry at the Austen Riggs Center, a private mental hospital in Stockbridge, Massachusetts. The same year he married Phyllis, who as Phyllis W Beck would become the first woman judge on the appellate court of the Commonwealth of Pennsylvania. She survives him along with their children, Alice Beck Dubow, also a judge, Roy, Dan, and Judith, a CBT educator and practitioner.

Beck joined the department of psychiatry at the University of Pennsylvania in 1954, where he started his life’s work researching psychoanalytic theories of depression. In the early 1960s he entered private practice.

All the while he began to publish his findings in journals and found an ally in the then more eminent Penn University psychologist Albert Ellis, who had been developing his own “rational theory” for treatment of depression since the mid-1950s and is regarded by many as a co-father of CBT. Together they challenged accepted wisdom on treatment, although they differed on clinical practice as Beck favoured a more empirical approach that encouraged and enabled patients to go on their own voyages of discovery.

In 1967, Beck returned to the University of Pennsylvania as a professor in the department of psychiatry, where he remained until retirement. In all he wrote or co-wrote 17 books. Later works began to tailor the use of CBT to treat specific problems, such as suicidal thoughts, personality disorders, schizophrenia, bipolar disorder and drug addiction.

“One by one, he took each condition in psychiatry and laid out his thinking about how it should be addressed — and others followed up,” said David Clark, a professor of psychology at Oxford University who was instrumental in setting up the NHS programme based on CBT. “I’m not sure that that’s ever been done, in quite that way.”

Beck was a visiting fellow of Wolfson College, Cambridge and a visiting professor at Harvard, Yale and Columbia universities.

In 1994 he co-founded the not-for-profit Beck Institute for Cognitive Behavior Therapy in Philadelphia with his daughter Judith, who will continue his work. Beck himself remained active as a therapist, conducting workshops at the institute into his nineties.

He won the Lasker Award in 2006 for contribution to medical science, and a year later was considered for the Nobel prize. Few of the millions of people he had helped would have begrudged him had he won it.

Beck always believed that he could help people to become better human beings to face life’s difficulties that would always be there. He wrote in 1979: “To be human is to deal with problems.”

Aaron Beck, psychiatrist, was born on July 18, 1921. He died on November 1, 2021, aged 100