Aaron Temkin Beck (July 18, 1921 – November 1, 2021) was an American psychiatrist who was a professor in the department of psychiatry at the University of Pennsylvania. He is regarded as the father of cognitive therapy and cognitive behavioral therapy (CBT). His pioneering methods are widely used in the treatment of clinical depression and various anxiety disorders. Beck also developed self-report measures for depression and anxiety, notably the Beck Depression Inventory (BDI), which became one of the most widely used instruments for measuring the severity of depression. In 1994 he and his daughter, psychologist Judith S. Beck, founded the nonprofit Beck Institute for Cognitive Behavior Therapy, which provides CBT treatment and training, as well as research. Beck served as President Emeritus of the organization up until his death.
Beck was noted for his writings on psychotherapy, psychopathology, suicide, and psychometrics. He published more than 600 professional journal articles, and authored or co-authored 25 books. He was named one of the "Americans in history who shaped the face of American psychiatry", and one of the "five most influential psychotherapists of all time" by The American Psychologist in July 1989.
Aaron Temkin Beck was born in Providence, Rhode Island, on July 18, 1921. He was the youngest of four children born to Elizabeth Temkin and Harry Beck, Jewish immigrants from Ukraine. Harry worked as a printer and Elizabeth's family found financial success in tobacco wholesaling; the family belonged to the upwardly-mobile vanguard of Providence's Eastern European-Jewish immigrant community. At the time of Aaron's birth, the Temkin-Becks lived a "comfortable, lower-middle class lifestyle" and were in the process of putting down roots on Providence's East Side. In 1923, when Aaron was two years old, the family purchased a house at 43/41 Sessions Street in the city's Blackstone neighborhood.
Beck attended John Howland Grammar School, Nathan Bishop Junior High, and Hope Street High School, where he graduated as valedictorian in 1938. As an adolescent, Beck dreamed of becoming a journalist. Beck matriculated at Brown University, where he graduated magna cum laude in 1942. At Brown, he was elected a member of Phi Beta Kappa society, was an associate editor of The Brown Daily Herald, and received the Francis Wayland Scholarship, William Gaston Prize for Excellence in Oratory, and Philo Sherman Bennett Essay Award. Beck attended Yale Medical School, planning to become an internist and work in private practice in Providence. He graduated from Yale with a Doctor of Medicine in 1946.
After receiving his M.D., Beck completed a six-month junior residency in pathology at Rhode Island Hospital and a three-year residency in neurology at Cushing Veterans Administration Hospital in Framingham, Massachusetts. During this time, Beck began to specialize in neurology, reportedly liking the precision of its procedures. However, due to a shortage of psychiatry residents, he was instructed to do a six-month rotation in that field, and he became absorbed in psychoanalysis, despite initial wariness.
After completing his medical internships and residencies from 1946 to 1950, Beck became a fellow in psychiatry at the Austen Riggs Center, a private mental hospital in the mountains of Stockbridge, Massachusetts, until 1952. At that time, it was a center of ego psychology with an unusual degree of collaboration between psychiatrists and psychologists, including David Rapaport.
Beck then completed military service as assistant chief of neuropsychiatry at Valley Forge Army Hospital in the United States Military.
Beck then joined the Department of Psychiatry at the University of Pennsylvania in 1954. The department chair was Kenneth Ellmaker Appel, a psychoanalyst who was president of the American Psychiatric Association, whose efforts to expand the presence and relatedness of psychiatry had a big influence on Beck's career. At the same time, Beck began formal training in psychoanalysis at the Philadelphia Institute of the American Psychoanalytic Association.
Beck's closest colleague was Marvin Stein, a friend since their army hospital days to whom Beck looked up to for his scientific rigor in psychoneuroimmunology. Beck's first research was with Leon J. Saul, a psychoanalyst known for unusual methods such as therapy by telephone or setting homework, who had developed inventory questionnaires to quantify ego processes in the manifest content of dreams (that which can be directly reported by the dreamer). Beck and a graduate student developed a new inventory they used to assess "masochistic" hostility in manifest dreams, published in 1959. This study found themes of loss and rejection related to depression, rather than inverted hostility as predicted by psychoanalysis. Developing the work with funding from the National Institute of Mental Health, Beck came up with what he would call the Beck Depression Inventory, which he published in 1961 and soon started to market, unsupported by Appel. In another experiment, he found that depressed patients sought encouragement or improvement following disapproval, rather than seeking out suffering and failure as predicted by the Freudian anger-turned-inwards theory.
Through the 1950s, Beck adhered to the department's psychoanalytic theories while pursuing experimentation and harboring private doubts. In 1961, however, controversy over whom to appoint the new chair of psychiatry—specifically, fierce psychoanalytic opposition to the favored choice of biomedical researcher Eli Robins—brought matters to a head, an early skirmish in a power shift away from psychoanalysis nationally. Beck tried to remain neutral and, with Albert J. Stunkard, opposed a petition to block Robins. Stunkard, a behaviorist who specialized in obesity and who had dropped out of psychoanalytic training, was eventually appointed department head in the face of sustained opposition which again Beck would not engage in, putting him at bitter odds with his friend Stein.
On top of this, despite having graduated from his Philadelphia training, the American Psychoanalytic Institute rejected Beck's membership application in 1960, skeptical of his claims of success from relatively brief therapy and advising he conduct further supervised therapy on the more advanced or termination phases of a case, and again in 1961 when he had not done so but outlined his clinical and research work. Such deferments were a tactic used by the institute to maintain the orthodoxy in teaching, but Beck did not know this at the time and has described the decision as stupid and dumb.
Beck usually explained his increasing belief in his cognitive model by reference to a patient he had been listening to for a year at the Penn clinic. When he suggested she was anxious due to her ego being confronted by her sexual impulses, and asked her whether she believed this when she did not seem convinced, she said she was actually worried that she was being boring, and that she thought this often and with everyone.
In 1962, Beck requested a sabbatical and would go into private practice for five years. In that same year, he was already making notes about patterns of thoughts in depression, emphasizing what can be observed and tested by anyone and treated in the present. He was engaged by George Kelly's personal construct theory and Jean Piaget's schemas. Beck's first articles on the cognitive theory of depression, in 1963 and 1964 in the Archives of General Psychiatry, maintained the psychiatric context of ego psychology but then turned to concepts of realistic and scientific thinking in the terms of the new cognitive psychology, extended to become a therapeutic need.
Beck's notebooks were also filled with self-analysis, where at least twice a day for several years he wrote out his own "negative" (later "automatic") thoughts, rated with a percentile belief score, classified and restructured.
The psychologist who would become most important for Beck was Albert Ellis, whose own faith in psychoanalysis had crumbled by the 1950s. He had begun presenting his "rational therapy" by the mid-1950s. Beck recalled that Ellis contacted him in the mid-1960s after his two articles in the Archives of General Psychiatry, and therefore he discovered Ellis had developed a rich theory and pragmatic therapy that he was able to use to some extent as a framework blended with his own, though he disliked Ellis's technique of telling patients what he thought was going on rather than helping the client to learn for themselves empirically. Psychoanalyst Gerald E. Kochansky remarked in 1975 in a review of one of Beck's books that he could no longer tell if Beck was a psychoanalyst or a devotee of Ellis. Beck highlighted the classical philosophical Socratic method as an inspiration, while Ellis highlighted disputation which he stated was not anti-empirical and taught people how to dispute internally. Both Beck and Ellis cited aspects of the ancient philosophical system of Stoicism as a forerunner of their ideas. Beck cited Epictetus as an influence from Stoicism.