A pioneer in psychotherapy research:

Aaron Beck
Sidney Bloch

Australian and New Zealand Journal of Psychiatry 2004; 38:855–867

SB: I gather you grew up in a Jewish family, your Did you think this through or was it an unconsciously
parents having migrated to the United States from determined decision?
Russia. What was it like for you? Did that experience AB: Everything is retrospective. I tended to face and
influence you in choosing to study medicine? meet challenges throughout my childhood and adoles-
AB: I grew up with loving parents, which was a cence. The greatest learning experience I ever had
problem when I was in psychoanalysis; I could not recall probably though was as a Boy Scout. I had to learn
any unpleasant experiences in growing up. I was the things that were quite difficult for me – lifesaving,
youngest of three siblings. My parents actually lost two swimming half a mile, and things of that nature. I think
children before I was born. A sister died in the influenza that if there was any pattern in my life it was going out
epidemic of 1920, and in a way I was a replacement for and meeting challenges that lay before me. I think I was
her. If anything, my mother was very over-protective. conscious of that and I would galvanize myself. I had a
The most traumatic episode in my childhood was when I strong need to conquer whatever problems I faced.
broke my arm and developed septicaemia. At one point
they were thinking of amputating my arm, but then
thought that it wouldn’t work. I learnt years later that it
was a staphylococcus infection which had about 95%
mortality in those days. Obviously I recovered and still
retained my arm but the impact on me psychologically
was that I developed an intense fear of surgery and a
blood injury phobia. For many years if I saw anything
related to surgery or to injury, I would become faint and
occasionally I almost toppled over. One of my ambitions
was to overcome this fear. I did so eventually through
exposure and willpower. When I went to medical school
I often experienced feelings of faintness but I would go
to the operating room to desensitize myself. Eventually I
was able to overcome the problem. This may have been
one of the roots of my later thinking that it was possible
to overcome very disabling symptoms.
SB: You could have gone another route and concluded:
‘Medicine is not for me; I am one of the faint-hearted’.

Sidney Bloch, Editor and Professor

Australian and New Zealand Journal of Psychiatry. Department of
Psychiatry, University of Melbourne, St Vincent’s Hospital, Victoria,
Australia. Email: s.bloch@unimelb.edu.au
This interview was conducted in Philadelphia by Sidney Bloch on 3 May,
2004. My sincere thanks to Professor Beck for participating so willingly in
this interview. Aaron Beck
856 INTERVIEW WITH AARON BECK
There was also a family tradition of scholarship. For
example, both my brothers excelled in their particular
fields and had done very well in school. It was part of the
ethos of the family to push ahead and do whatever you
could do. Part of that probably was from my immigrant
parents who came to America looking for opportunities.
While they were not able to realize them themselves,
they could do so through their children.
SB: I understand your father was a committed social-
ist. Did this play any role in your thinking as an adoles-
cent and young adult?
AB: My father’s socialism projected the idea that one
could make a better world wherever one lived. While I
was not an activist myself, I did believe in democratic
values and this has been a major theme throughout my
life.
SB: Turning to your mother, I read somewhere that she
was a moody person. Given that you developed an inter-
est in depression, was there anything in your family life
that may have stimulated you in that way?
AB: My mother was moody but I actually got inter-
ested in depression for totally practical reasons. When I
first started clinical practice most of my patients were
depressed. If I was going to be interested in any area it
probably would have been anxiety and phobias because
of my personal experience of them.
SB: You chose psychiatry as a lifetime career. I am
curious why you went up this route given that you did a
residency in pathology. Was that a competing option?
AB: I actually went into psychiatry by accident.
When I was in medical school I was very much turned
off by the subject because I felt that it did not provide
answers for anything. Our Professor of Psychiatry,
Eugen Kahn, was a student of Kraepelin and believed
that there were only two basic diagnoses, schizophrenia
and psychopathic personality, and neither was treat-
able. At the time I was very much interested in organic
medicine and took a two-year internship in order
to cover every aspect of medicine, from paediatrics to
mental illness. I decided later that in order to achieve
a strong grounding in physical illness I should do a
residency in pathology. I also concluded that neurol-
ogy was the field in which I wanted to work. I spent a
year in it. Then, because there was a shortage of
psychiatry trainees, all neurology trainees had to spend
six months in psychiatry. I was actually pushed into
psychiatry against my will. Freudian psychiatry was
reaching its zenith at the time. The entire service was
involved in psychoanalytic theory and therapy. It
seemed to me that psychoanalysis did perhaps have the
answers to everything but that one could not get those
answers unless one had been analysed or, at least, had
become immersed in the subject. I toyed with the idea
of staying in psychiatry long enough to determine
whether psychoanalysis was a valid approach to under-
standing human behaviour. Although I kept on in
psychiatry, I am still enrolled as a neurology registrar
who has never completed his training program! Even-
tually I decided to find out for myself whether psycho-
analysis did have all the answers by obtaining training
as an analyst.
SB: It sounds to me like this was tantamount to taking
up a challenge and dealing with it directly. Would it not
have been easier to remain in neurology, even neuro-
psychiatry, since you did a stint in the army in that area?
AB: I began to think that neurology was too easy since
it was so precise, with everything well laid out. More-
over, there weren’t many successful treatments in those
days. I wanted to plough new fields, discover whether
psychoanalysis could yield answers, and then proceed to
test out the answers.
SB: After a period of training in what seems a fairly
conventional setting, a veteran’s administration hospital,
you moved to Austen Riggs, a distinctly unusual place.
What motivated you?
AB: When I was in psychiatric training, the psycho-
analytic structure that was imposed on us was extremely
orthodox. Trainees were never expected to respond to
patients’ questions. We would always respond to a ques-
tion by posing another question such as: ‘What do you
mean by that?’ The therapist was expected to be a blank
screen and not to disclose anything about themself. This
seemed to me unrealistic. I was attracted to Austen Riggs
because it embraced a much more liberal humanistic
attitude, maintaining a tradition Dr Riggs had originated
in the asylum. The exposure I had there was indeed at the
very liberal cusp of psychotherapy. Even though there
was a psychoanalytic thrust to the type of therapy done,
it was sensible and humanistic. I learned a great deal.
Many leading American therapists worked at Austen
Riggs at the time, among them Erik Erikson and Robert
Knight. I learned much from them and was able to weave
this knowledge into my therapy later.
SB: What was Erikson like?
AB: Erikson actually supervised me on one of my
cases. I learned particularly how childhood themes could
play themselves out in adulthood. Erikson had a very
easy manner and I think I adopted a thoughtful, reflec-
tive demeanour, which can be most helpful with some
patients.
SB: He seems a very popular figure, certainly among
Australian trainees. They see him as coherent and logical
in the way he describes the effect of social factors on
psychological development.
AB: What stood out for me was his aesthetic approach
to human problems. As you probably know, Erikson was
 S. BLOCH
an artist before he became a psychoanalyst. One could
see the artistic temperament and the related approach he
used. I found I could add my own repertoire of skills to
this.
SB: You decided to train in psychoanalysis and
enrolled in the Philadelphia Psychoanalytic Institute.
AB: I got my formal analytic education in Phila-
delphia. Austen Riggs was the background. I was
enthusiastic because it seemed to reveal whole worlds
about which I had no intimate knowledge. I found the
experience exciting and intriguing. I finished up fairly
rapidly. I had a few residual problems but felt these
would resolve in time. I was a strong believer during
and after my psychoanalysis that this approach was for
everyone, and I tried to persuade my friends to become
analysed.
SB: Were there any aspects you were unhappy with?
AB: I think one of the downsides was that I became too
preoccupied with myself, but this was something I only
became aware of later. I was looking introspectively for
all kinds of psychodynamics and probably was not as
good a spouse and father as I could have been.
SB: Did that create a tension in you?
AB: I looked forward to the introspection because it
was a voyage of discovery and I kept looking for more
and more things. However, I never did find the holy grail
that would reveal the answer, not only to my own human
nature but also to the human nature of everybody else.
I never succeeded in making the great psychoanalytic
discoveries – the primal scene, the Oedipus complex,
psychosexual development – and so felt unsuccessful.
I did however, keep trying until my psychoanalysis was
completed.
SB: You then got interested in depression. You say
there were plenty of depressed patients to be treated. It
seems that you were challenged to determine whether
Freudian ideas about melancholia could be tested and
validated.
AB: I thought the most elegant, plausible theory in
psychoanalysis concerned depression, that it played out
logically. You could take the whole set of depressive
phenomena, such as self-criticism, courting of rejection,
loss of appetite, loss of sleep, suicidal motives and
immobility, and readily explain it by the psyche turning
against itself. Certain unacceptable impulses, usually
hostile, would hit up against a particular defence mecha-
nism and therefore not be expressed but be turned in
against oneself. And this could explain all the features of
depression. Many people, particularly in academic psy-
chology and some in psychiatry, really did not believe
this. I thought it would be interesting to try to demon-
strate to non-believers that there was truth in Freud’s
formulation.
857
SB: You obtained funding from the National Institute
of Mental Health in the 1950s and 1960s to study depres-
sion. What did you investigate?
AB: I first did a clinical study, without funding, and
decided that the answer to validation of psychoanalytic
concepts lay in tapping into unconscious mechanisms.
These by definition would not be accessible in ordi-
nary interviews or even projective tests but through
dreams. So I elicited a series of dreams from depressed
and non-depressed patients and developed a manual
through which we hoped to show that the depressed
group had more hostility in their dreams than the con-
trols. This would then fit the credo we had then that
patients harboured hostility. The hostility could not be
expressed directly but got channelled into the dream.
The scoring of dream content was done by a psycholo-
gist, blind to the identity of the patients. A serious
anomaly emerged in that the depressed patients had less
hostility than the non-depressed controls. We rational-
ized that the patient still had the hostility but it was
beneath the surface, and came out in the dream as a
range of unpleasant experiences. We therefore con-
cluded that these dreams were masochistic in content
and still supported psychoanalytic philosophy. We then
obtained a grant from the National Institute of Mental
Health to see whether hospitalized depressed patients
had similar dream content. We asked a large number to
describe their dreams and compared them with the
dreams of non-depressed patients. The depressed sample
again had more masochistic dreams, a form of cross-
validation. However, sceptical psychologist colleagues
brought up the point that we had not proven depressed
patients’ need to suffer, the basis for the masochism. We
therefore set up several experiments in which the need to
suffer was examined directly. Specifically, we hypothe-
sized that depressed patients would court negative or
aversive reinforcement as opposed to positive reinforce-
ment compared to non-depressed patients. It turned out
that far from this being the case, the depressed group
actually sought out positive reinforcement. This was a
little link in the chain of my beginning to question the
whole psychoanalytic structure, but it was only one of
the links.
SB: I remember reading your articles on hopelessness
and suicidality. Were seeking out positive reinforcement
and hopelessness related?
AB: Looking at hopelessness came later, as an expla-
nation for suicidality as well as for other symptoms.
To reconcile these two components, patients can feel
hopeless but still seek solace, and even though feeling
hopeless they certainly do not seek punishment. We
found that hopeless people did not seek punishment but
looked for positive reinforcement.
858 INTERVIEW WITH AARON BECK
SB: I have treated many depressed patients over the
years and certainly the more severely depressed do talk
about how useless they feel, how they have been terrible
mothers and the like. I suppose that I remain wedded to
the idea that a self-punitive quality prevails. Are you
saying that this is not so or that there is more than one
type of depression?
AB: I think our conflicting points of view could be
better understood in terms of the new formulations I
developed, which is that people will behave or feel
according to the way they perceive. Thus, if a person
perceives herself as bad and useless, she might want to
punish herself or she might not. The key thing is not the
motivational aspect of wanting to punish oneself but
the self-perception. What we would focus on then is the
sense of uselessness per se, which I think is itself a
powerful belief. Perhaps I have put the cart before the
horse or you have put the cart before the horse, but I
would say the cognition comes first.
SB: Have we reached the central role of cognition in
your approach? Where does that begin to feature in your
research?
AB: A number of trends were taking place. I was only
a part-time researcher. I was also seeing a lot of
depressed patients. Over the course of time it became
apparent to me that the way the patients viewed them-
selves was at the core of the way they felt about
themselves. If they viewed themselves negatively they
would feel negatively about themselves. When I made
my sea-change, it was a kind of quasi-experiment – if
you change the way people think about themselves,
such as a mother considering herself as useless, we
could address that in a wide variety of ways. Changing
this thinking changes the motivation, the inertia, the
self-punitiveness, and the negative affect. In actual fact
I was testing an hypothesis and confirmed that by
getting patients to test reality regarding their negative
beliefs, we were able to turn around their depressive
symptoms.
SB: What were your thoughts about psychoanalysis at
this stage?
AB: I started off believing that I was going to practise
psychoanalysis for the rest of my life but when I started
observing patients’ automatic thoughts, I thought it
much better to have them sit up so that I could look at
their expression and non-verbal communication. I would
ask them what was going through their mind at that time.
And that is where I got my raw data. When asking
patients what they were thinking, they would say: ‘I
think that I am boring you’ or ‘I am stupid’ or ‘I do not
make sense’ or ‘You are not going to like me’, and so on.
These were clues to what was going on in their minds
outside of therapy.
When I focused on these negative thoughts, patients
got better fairly soon, in 10 or 12 sessions. Patients
whom I thought would be with me for a year or two or
three reported: ‘I am finished Dr Beck; you have helped
me a lot and I do not need you any more.’ My clinical
load shrunk enormously. At that point Professor
Stunkard, the Chairman of the Department of Psychiatry,
offered me a full-time job. I got into research and teach-
ing from that point onwards.
SB: Before we talk about your research career, can you
reminisce about your role as a psychoanalyst?
AB: Let me respond with a clinical illustration. A
woman patient is on the couch and she spends the entire
time talking about her sexual escapades. At the end of
the session I do what I think analysts are meant to do –
I ask her how she feels. ‘Very anxious’, she responds.
This makes good sense, I say, because you have these
sexual impulses but since they are forbidden, they rise to
consciousness and break through your defences, and this
causes anxiety. And she says: ‘You’re right; that is
brilliant’. But she has a tentative tone in her voice. I
indicate that she seems tentative. She replies: ‘Yes, I was
afraid that I was boring you’. I seize on that. ‘You have
been here all these months and this is the first time you
have told me about your fear of boring me.’ ‘It had never
occurred to me to reveal this’, she retorts. I ask how
often she thinks like this. ‘All the time. I think it when I
am with you and when I am with other people.’ I then
noted that other patients also were not reporting what
they thought. It then occurred to me that there are two
types of communication: internal and external. Internal
refers to the automatic thoughts people have about them-
selves which they do not ordinarily share. On the other
hand, thoughts usually communicated (i.e. external) in
psychoanalysis are of the kind that people do communi-
cate to other people. At this point I thought that if I was
going to get at what I call automatic thoughts, I ought to
sit them up so that we could talk back and forth. I also
discovered that I was having automatic thoughts. I had
not been aware of them until I started focusing on them.
That is how I abandoned the couch. This fitted into the
cognitive model I was gradually formulating and also
gave me an approach to therapy.
While these things were happening, I had to do some-
thing about what was then the dominant theory of human
nature, psychoanalysis. In order to address the question
whether this cognive model fitted better with the data
than did psychoanalysis, I went through everything that
I had learned in psychoanalysis as well as looked for
empirical data to support psychoanalytic hypotheses,
from psychosexual development to the concept of the
ego. I concluded that psychoanalysis was a faith-based
therapy and that if I was going to practise or teach
 S. BLOCH
therapy, it had to be empirically driven. Why the term
cognitive? Because the cognitive revolution was occur-
ring in psychology at the time and I was picking up a lot
of its terminology.
SB: I assume this work culminated in your first book,
published in 1967, Depression: clinical, experimental,
and theoretical aspects.
AB: Let me tell you how I happened to write the book.
I had published a couple of papers on a cognitive
approach to depression in the Archives of General Psy-
chiatry [1,2]. One was empirical/clinical, the other
theoretical. I then asked myself what I really knew about
depression. I realized it was only what I had learnt in my
psychoanalytic training, during my residency and from
my patients. I thought that if I were going to say any-
thing about the subject and be true to my own ethos, I
ought to know much more. I decided to review the entire
literature. Once I got into that, I thought that in order to
learn this material systematically I ought to turn it into a
book. The first part actually is a review of biological,
psychological and psychotherapeutic aspects; and the
second my own cognitive theory of depression. I also
brought in my research findings. I had already developed
a depression inventory and included that too.
SB: I take it the book was a milestone in your career.
Your subsequent story is very well known because
dozens more research papers and many books emerged.
Did you actually say to yourself at this point: I am an
empiricist, this cognitive approach seems to hold, the
psychoanalytic one has disappointed me and I must
break with one and embark seriously on the other? Or
did you retain certain psychodynamic ways of thinking?
AB: You are posing two questions. There was a break
but a fuzzy one. People have said – I do not know if this
is correct – that I was a rebel. And it is true that I did feel
it was a rebellion against the autocracy of the psycho-
analytic establishment. Psychoanalysis is comparable to
an authoritarian type of religion where people have abso-
lute control of the faith and there is no place for dissent.
Everything is predetermined. The more contact I had
with the psychoanalytic establishment, the more dis-
tasteful it became to me. If there was an emotional
component in my rejecting psychoanalysis, it is that I do
not like to be wrong. I did not want to be wrong by
rejecting it totally and I do feel that I learnt a number
of important things from psychoanalysis which other
schools were not aware of. Transference is one of these
things, and I do deal with transference in my work. The
second is looking for themes across all the patient’s
disclosures, except that as a cognitive therapist I look
for more or less conscious themes rather than those
being repressed or being represented in a distorted way.
The third aspect is to listen and then make appropriate
859
interventions. When I came to deal with personality dis-
orders it was clear I had to explore childhood material.
Patients might become expert at correcting their cogni-
tive distortions but there was still a layer of self-criticism
that we could not get at in the usual way. It became
important to see what could account for this. We had to
get patients to relive their childhood experiences and
then look at these through the eyes of a mature adult in
order to ascertain where their early perceptions were
incorrect and then, in a state of emotional arousal be able
to correct them. The patients were instructed to leave
images of early formative experiences, recognize how
their childish interpretations were no longer valid, and
reframe them as a mature adult. So I have carried over
various psychoanalytic notions.
SB: I think your critics may argue that the cognitive
approach minimizes, even denies, the relevance of early
aetiological influences. You have just mentioned that in
the personality disorders you have had to think this
through and you have described it very precisely. I
suppose the critics would contend that this does not only
apply to personality disorders but to all clinical condi-
tions, and that without pursuing early antecedent factors
and only looking at negative schemata in the present, we
are missing whole chunks of relevant data. How do you
respond to such criticism?
AB: Firstly, in terms of theory – a therapist can have a
theory about ultimate causality but does not have to
prove it in a given case. Regardless of cause (genetic,
neurochemical, psychological) we believe we can
correct the condition by correcting the present-day
effects. At our clinic, where we see complex cases,
however, we always do a formulation which is based on
childhood and later experiences. However, having said
that, in our early work on depression, uncomplicated
depression, it was not economically wise if we wanted to
treat patients within 12 sessions to go back into child-
hood material. We found that by using simple devices
like structuring the patient’s day, correcting cognitive
distortions, and so on, we did get them better. We do not
see those types of patients any more. They are treated by
primary care doctors, given medication and improve
within three months, just the same way as they would
with cognive therapy. The patients we see today are
complex and the theory we subscribe to becomes impor-
tant in treatment. Nonetheless, we do not spend as much
time delving into childhood material as we would if we
were doing psychoanalysis. Moreover, we only deal with
this aspect when it is specifically relevant to what is
bothering the patient currently.
SB: Can we take an example of these sorts of patients,
those with deep roots if you like? Say someone has been
emotionally neglected or abused in childhood, what sort
860 INTERVIEW WITH AARON BECK
of recognition will you give to that and how will it play
a role in your approach? You say you will only go as far
as you need to go because your purpose is to get them
well, but given a certain type of childhood history, what
do you do with data like abuse?
AB: The patient gives the history and usually recovers
relevant memories (we do not, I believe, have to deal
with unrecovered memories). In doing a formulation,
we try to see what the connection could be, at least
theoretically, between childhood experiences and adult
beliefs. For example, a woman’s main complaint is that
she cannot establish relationships with men, with the
result that she feels depressed a good part of the time.
She not only wants to get over her depression but
would like to get more out of life. Not to oversimplify,
she wants to have a relationship with another man. We
then find out that she was abused as a child by her
father. We would say something like this: ‘What kind
of attitude do you think you developed towards your
father?’ This is similar to what psychoanalysts might
do. She might say that she thought he was mean and
horrible and rejecting. We would ask her to relate that
to the present: ‘Who is the last person you had a
relationship with?’ She might reply: ‘I haven’t been
able to get close to many since they reject me’. ‘Is it
possible that you have a view of men you get close to
that they are hostile and rejecting?’ Her reply: ‘I do
think they are’. We would then suggest we focus objec-
tively on what the man is like. In so doing, we would
deal with the past but try to identify what beliefs have
emanated from past experiences and how these play out
today. We would then try to correct them in today’s
world. That might not work though, in which event we
would have to go back and have her relive her experi-
ences with her father and then correct her anachronis-
tic, childhood-based beliefs.
SB: The last thing you said is interesting because the
role of trauma has become a prominent theme in contem-
porary psychotherapy, both theory and practice. You say
that if there is a need – in other words it is empirically
determined – and your standard approach doesn’t hold
for a particular patient, you will go beyond it. I am still
unclear what the work entails.
AB: We think in terms of time-limited therapy.
Therefore, if we reach a certain benchmark by follow-
ing the standard approach, we stay with that. If we do
not reach the benchmark, we will go further and apply
a wide range of strategies. This varies from patient to
patient but we follow a hierarchy starting with the
standard model, then the modified standard, and then
the revised, modified standard, and so on. But basically
what I have been interested in is testing out how things
go. In order to answer your question I have to tell you
what I have actually been doing. We developed a
manual for suicidal, borderline personality disorder
patients, which we consider a tough challenge. This
contains different strategies, including going into child-
hood material. Many strategies however, deal with the
here and now, such as the patient’s self-destructiveness,
poor impulse control and affective dysregulation.
Indeed, most of the manual covers the present because
these patients are very disorganized and dysphoric. We
only accept patients into treatment who are suicidal and
meet borderline criteria. Our first study was uncon-
trolled, the one we are doing now is controlled. Patients
are in therapy for a year, at the end of which most of
them no longer meet diagnostic criteria for borderline
personality disorder. There is one feature, however, in
which none of them have improved at the end of
treatment – the fear of abandonment. They are still
afraid they cannot live in the world on their own. We did
a follow-up study at six months. To our surprise, they no
longer had this fear of abandonment. This tells us some-
thing. Long-term therapy can go on indefinitely, as long
as patients are afraid they cannot make it on their own
and the sympathetic therapist is not going to throw them
to the wolves. By contrast, in a clinical trial, you have to
end at a given point. It turns out that patients who
terminate therapy in this way have learnt enough and
have acquired resources to deal with things on their own
and continue to improve without needing the therapist to
back them up.
SB: Is it made explicit that treatment is of one year’s
duration?
AB: They have to sign a consent form which stipulates
they will have one year followed by a couple of booster
sessions. And if they want more therapy they will have
to seek it elsewhere. We are now doing another study
with borderline patients. They are randomly assigned to
an experienced cognitive therapist or to an experi-
enced psychodynamic or eclectic practitioner for six
months only. This sounds very brave but we found in our
earlier study that most of the improvement occurred in
the first six months. Moreover, healthcare insurance
commonly runs out at the end of six months, a highly
realistic constraint.
SB: I suppose all treatments today are buffeted by such
economic realities. There are two other aspects of cogni-
tive therapy that I want to pursue now. The first is
whether there is a generic model; the second concerns
indications. The approach is being applied to a growing
range of clinical conditions and situations (e.g. pain,
anxiety, substance abuse, marital conflict, personality
disorder). Is the same theoretical model being applied or
are you acting empirically and pragmatically and modi-
fying it to suit new patient groups?
 S. BLOCH
AB: I can address your two questions almost simulta-
neously. Is there is a generic cognitive model? I never
actually used that term until an Oxford colleague stated
that they were applying the generic cognitive model in
their work. Let me define cognitive therapy to clarify the
matter. The model stipulates that people have certain
dysfunctional beliefs which generally originate early in
their lives; they do not come overnight. (This is not true
of PTSD, which can originate at any time.) These
beliefs, particularly when activated, can but do not
necessarily, dominate their behaviour and feelings and
displace other aspects of the personality. Cognitive
therapy is based on this cognitive model. The applica-
tions to a variety of disorders are derived from the
generic model but based on a formulation of the unique
features of the different disorders. Techniques vary con-
siderably, again depending on our specific formulation
of the type of disorder. In depression, for example, the
patient comes with many kinds of dysfunctional ideas,
which we call ‘hot cognitions’. It is easy to address the
beliefs since they are right on the surface. By contrast,
people with panic attacks do not have these dysfunc-
tional beliefs when they come for treatment because
they feel secure in the therapeutic situation. The
problem then is to get to the hot cognitions. We try to
activate their panic beliefs by precipitating a mini
attack. For example, we will have the patient over-
breathe for a period so that they feel faint. They will
then have images of themselves having a stroke or heart
attack, collapsing, ending up in a graveyard, and so on.
Thus, we reproduce the panic attack, but to a lesser
degree, and get the patient to reframe their catastrophic
interpretations on the spot.
Now to your other question – does cognitive therapy
lose its real definition by being used in so many different
areas? I used to find it awkward when people would say:
‘Well, how many conditions can cognitive therapy treat?’
I would have to reply: ‘I do not know because it hasn’t
been tested out in a wide variety’. Originally, the only
things I could speak to were depression, anxiety and panic
disorder. However, people who trained with me or with
my former students have used the cognitive model until it
now encompasses practically every psychiatric condition
that I can think of, medical conditions with psychological
overlay, and so on. I feel like a snake salesman sometimes
when people say: ‘What can it cure?’ and I reply: ‘What
can’t it help?’ It has been used in people who have had a
stroke or a heart attack, in diabetic patients who have
psychological problems. A former student has even used
it in Asperger’s disease. I now have to cross that off the
list of conditions for which it can’t be used.
SB: Hearing this makes me anxious on your behalf
because, as you know, the criticism made against
861
psychoanalysis was that it could explain and deal with
everything; it was going to be a panacea. Given my
inherent scepticism, healthy scepticism I hope, it worries
me when I hear that a single approach, albeit with
modifications, is applied to so many states. I think that,
empirically, it may help but this may have nothing to do
with the conceptual principles claimed by its proponents
but be attributable to non-specific factors like instilling
hope and the others examined systematically by Jerome
Frank over three decades. I surmise that these non-specific
factors are fundamental rather than incidental. Do you
share my worry on this issue?
AB: I think you are with the compact liberal majority
and I in the minority. There are two things to stress here.
Psychoanalysis explained everything and was the answer
for everything but the criterion for its acceptance was
faith. Whatever my colleagues and I have stated has been
based on empirical data, using the same canons of
science applied to other spheres of medicine. Thus, if
chemotherapy is found to do better than placebo, that’s
generally accepted. Controlled conditions are extremely
important. With cognitive therapy we must ensure that
all the non-specific factors, which are actually specific,
are addressed. In my very first paper, a report on a
clinical trial [3], we controlled for every non-specific
factor we could think of. If patients in both groups have
the same level of expectations and other factors such as
the personality of the therapist are controlled, then you
can assess the effectiveness of the specific technique.
Jerry Frank and I had many discussions about the role of
non-specific factors. I think he goes overboard on them.
It is true that if one compares cognitive therapy with
another type of psychotherapy, the so-called placebo
response can contribute a certain degree of variance to
improvement, as is the case with drug therapy. Similarly,
the question, as with drug therapy, is whether cognitive
therapy adds anything to the placebo effect. This can
only be decided empirically by comparing it with
another type of therapy where these variables, such as
empathy of the therapist and patient expectancies, are
taken care of. It is interesting how these non-specific
factors operate. Rob DeRubeis has conducted an unpub-
lished study in which cognitive therapy was compared
with medication and patients asked in advance which
type of therapy they thought was better – biological or
psychological. They also indicated whether they regarded
depression as a psychological or biological disorder. We
thus can determine the link between patients’ beliefs and
outcome. If they believe in the biological and are
assigned to medication the effect should be congruous
and they should do well. If they are assigned to the other
group, the effect will be incongruous. In fact, patients’
beliefs did not have any impact. Biologically-orientated
862 INTERVIEW WITH AARON BECK
patients not only did as well in psychotherapy as they did
with drug therapy, but also gave a congruent answer at
the end of treatment. We may infer that the specific
aspects in the therapy altered their beliefs.
SB: I take it that the principles of science and corre-
sponding systematic research are your safeguards?
AB: Yes, safeguards that are bolstered by the many
people who, through doctoral or other programs, exhibit
an interest in clinical trials and outcome. I referred to my
current and former students in this context but a wide
assortment of people who have not been trained by us
and have no allegiance to cognitive therapy are achiev-
ing similar results. I believe this takes care of investiga-
tor bias.
SB: If we go back to the 1960s, would you have
anticipated that decades later you would be seeing your
model applied so widely?
AB: No. Originally, I thought that the formulation in
my 1967 book would suit about seven or eight condi-
tions, including anxiety, depression, obsessive compul-
sive neurosis, hysteria and acute anxiety attacks (later
called panic). In essence, the neuroses. I did not have any
formulation for psychosis. Since I saw a theory behind
the therapy, I expected these neuroses would respond. I
did not envisage effective cognitive therapy for psycho-
sis. This form of treatment has now evolved in the UK,
Canada and Australia. British researchers, for example,
with whom I have talked, learnt how to apply cognitive
therapy to depression and then translated it to deal with
psychosis; this is not a dilution. Anybody who has learnt
how to do cognitive therapy with depression can learn
how to apply it to psychosis.
SB: Psychosis is clearly a big jump. Even Freud
doubted he could deal with it. The question I posed
earlier about the limits of cognitive therapy becomes
even more pertinent when some colleagues claim they
can alter delusions or lessen the impact of hallucinations.
What do you think?
AB: This is an empirical question. Very few psycholo-
gists or psychiatrists in the US would even consider the
possibility that any kind of psychosocial intervention
could seriously modify ingrained phenomena like hallu-
cinations, negative symptoms and thinking disorders.
When I lecture in the US on this topic, people with a
strong adherence to a cognitive model for, say, depres-
sion do not buy into it and later, out of respect, conceal
their obvious scepticism. It has been practically impos-
sible to get American funding for empirical trials. A
widespread scepticism definitely prevails that anything
as organic as schizophrenia could possibly be addressed
by a psychological intervention, be it cognitive therapy
or any other type. This is quite understandable. How-
ever, I think it is based on a misconception about the
brain. Neuroplasticity shows that even people with
severe brain damage can compensate well. The notion
that a biologically-based disorder like schizophrenia
cannot be helped by psychotherapy is based on errone-
ous conception of the way the mind works. This is
notwithstanding the fact that following a paper I pub-
lished over half a century ago [4], I did not treat psycho-
sis again (until recently). Now, when colleagues use the
cognitive model in psychosis, it does make sense and I
can describe how the theory can be applied. For instance,
delusional thinking will affect a patient’s interpretation
of reality. One way to deal with this, and it is only one
approach, is to train the patient to look at the evidence
for his interpretation. The therapist can start with: ‘What
kind of problems do you have today?’ The patient might
reply: ‘I got into a fight with my wife and I decided she
is going to leave me’. ‘What is the evidence for that?’
We can ask about, and train them to deal with, non-
psychotic interpretations. It is perfectly possible, having
established a therapeutic relationship, to test psychotic
beliefs. British cognitive therapists have been marvel-
lous at this and are miles ahead of their American
counterparts in devising behavioural experiments. The
Oxford group is due to publish a book on behavioural
experiments in cognitive therapy. Let me illustrate. A
patient felt she had an implant in her brain and that it was
dominating her thinking, controlling her actions and
making her hallucinate. The therapist asked her: ‘How
long have you had this implant?’ She thought it had been
inserted into her brain in a surgical operation seven or
eight years previously. ‘I am puzzled about what is
powering this implant’, the therapist comments. ‘Batter-
ies, I guess’, she states. He asks whether batteries could
last that long? The patient does not know. This is an
example of guided discovery, one of the fundamentals of
cognitive therapy. ‘How could we find out,’ asks the
therapist. ‘I suppose we could go to Radio Shack’, she
suggests. And she did and, of course, learned that the
batteries would be dead by now. She obviously believed
she had this implant, but there were gradations in the
intensity of the belief. When she was disturbed it would
go up to 100%, when improved drop to 40%. One day
she sustained a head injury and had a skull X-ray. The
doctor, showing her the plates, reassured her they were
perfectly normal, and she could not see any implant, so
experience put the delusion to rest. Thus, patients can
be helped by gradually using sophisticated reality test-
ing. I think this is still cognitive therapy because we
are dealing with cognitive distortions. It takes artistry
and sensitivity, and you should not push the patient too
fast.
I want to mention another thing. We worked with a
group of patients who had been psychotic for at least
 S. BLOCH
30 years, some longer. They were offered psycho-
education, part of which was stress management. They
learned how they misinterpreted situations and devel-
oped appropriate coping strategies, both aspects of cog-
nitive therapy. By the end of therapy their hallucinations,
delusions and negative symptoms had all improved.
Stress management is an important part of therapy.
SB: Are these not behavioural interventions? Are you
not taking aspects of behaviour and using techniques like
stress management to modify them? Would it not be
prudent to conclude that this is not cognitive therapy as
you have formulated it over 40 years but a range of
behavioural strategies which you are using empirically.
AB: Well, for starters, behavioural therapy did not
work with the symptoms of schizophrenic patients. It
might reinforce doing various objective tasks but not
carry over to real life. The essence of our cognitive
interventions is based on the cognitive model and the
focus is on what they are thinking. People are stressed by
their exaggerated interpretations of situations. But we
can use behavioural components in order to change
thinking; that was true from the outset. In our book on
depression [5], an early chapter covers behavioural acti-
vation. By getting patients to act, they are able to change
their beliefs that they are helpless and inadequate, and
this is a powerful thing. I owe a lot to the behaviour
therapy movement which I became aware of early on in
my thinking. I credit behaviour therapists for their highly
structured interviews. They set an agenda and would
look at the process of what was going on during the
therapy session. They would also look at goals. I incor-
porated all these aspects into my work after my 1967
book. The approach has been called cognitive behaviour
therapy by some people and I accept the term. But the
behavioural dimension is not based on conditioning
theory, rather on cognitive theory. We use behavioural
techniques not to satisfy reinforcement theory but to
modify beliefs. We also deploy experiential methods.
For instance, we treat panic in such a way that the patient
actually experiences in the session that the panic is not
disastrous. Now with the psychoses, we are using strate-
gies that are similar to what we would apply in depres-
sion but take into account that these patients have very
strong beliefs and are easily alienated if one doesn’t take
that into account. It requires more sensitivity than it
might with a straightforward depression.
SB: You have alluded to an issue I intended to raise
later: how vital is the ‘B’ in CBT? When reading your
work you refer to cognitive and to cognitive behavioural.
I have never been clear what weighting you give to the
behavioural component. Is it truly behavioural or is it
more a series of techniques and strategies which arise
from various theoretical sources.
863
AB: This question comes up all the time. The term
cognitive behaviour therapy is an historical accident.
The first term I used for the treatment I was devising was
‘insight’ therapy, with ‘cognitive insight’ in parenthesis.
What I thought of as insight was not into the unfathom-
able unconscious but about what was going on at the
level that was accessible. At the same time I was
developing the cognitive model and corresponding tech-
niques, a group in the behaviour therapy movement
became very interested in dealing with a variety of
problems rather than just snake phobia and the like.
However, they found that strict behavioural methods did
not work for a condition like depression. They began to
use the term ‘cognitive behaviour therapy’. Cognitive
behaviour therapy today encompasses a wide range of
approaches, with the common denominator probably
being that they take beliefs and thinking into account. At
one end is the large B/small C – for example, relaxation
therapy, feedback, aversive conditioning and so on. At
the other end is the pure cognitive restructuring we have
been talking about, with behavioural strategies utilized
only if necessary.
Let me give you an example. Jack Rachman started out
as a behaviour therapist but became more ‘cognitive’
with time. In essence, he began to use cognitive restruc-
turing more and more and taught this to his students.
When they got positions elsewhere they adopted the
term Rachman was using, namely cognitive behaviour
therapy. They in turn were heavily influenced by the
cognitive therapy movement and some eventually
adopted the cognitive model in toto. They became, in my
opinion, pure cognitive therapists. They still used a
behavioural component. The behavioural experiments
they incorporated could be called cognitive experiments,
since cognitions are tested out in real life. The patient
who thought she had a brain implant would test that out
by finding out about the batteries.
SB: Although it doesn’t seem to worry you what it is
called, I am pursuing this because of my impression that
the behavioural school was waning in the 1970s,
welcomed the cognitive revolution, and perhaps even
appropriated a bit to themselves.
AB: I would summarize the situation as follows: the
first generation of behaviour therapists began to call
themselves cognitive behaviour therapists as part of a
transitional process. The next generation may still use
the term, perhaps anachronistically, but do so because it
is traditional. In effect, they are pure cognitive therapists
with the behavioural component used, as you say, simply
as an adjunct.
SB: Aaron, may I now ask you about influences on the
way you think about your work overall. I notice that
when you have written about influences you have
864 INTERVIEW WITH AARON BECK
mentioned a series of philosophers and people like
Adler, Rank, Rogers, Horney, Kelly and of course,
Albert Ellis. The range seems broad.
AB: All these were undetected influences. I saw some
of these antecedents only when I began writing about
cognitive therapy. The most profound influences of the
people I read were Horney and Adler (later, Ellis). As I
have read further, I have realized there is truth to the
expression: ‘There is nothing new under the sun’. I can
see antecedents in people like Kant. I picked up the
notion of a schema from psychologists who had read
Kant. In many ways I am second or third generation
removed from the original philosophers. I only found out
about Epitectus, for example, when Albert Ellis brought
him to my attention.
SB: Why Horney?
AB: In Our inner conflicts and The neurotic personal-
ity of our time, she dealt with types of conflicts which
were accessible and understandable. From a theoretical
standpoint Kant stands out because of his concept of
schemas.
SB: It is ironic that you cite Horney since she is mostly
forgotten. When you say there is nothing new under the
sun, do you think there is a need for every generation to
discover something that has been there but perhaps has
to be addressed afresh?
AB: I do think about it and I am always amazed at how
little present generations know about the past.
SB: This is a convenient bridge to ask you something
more personal. I hope you don’t mind. I see from your
CV that you are 83 years old. Most people of that age
would say they had ‘done their thing’ and would relax a
bit. You are beavering away at all your pursuits as much
as ever. I well remember meeting you in 1980 in Oxford
for the first time; nothing has changed in terms of your
abundant mental acuity and energy. Do you have a view
about ageing?
AB: I can only speak for myself. I know that practi-
cally all my colleagues from medical school days who
are still around have retired. That is not something that I
think about. It is no more on my horizon now than it was
when we first met a quarter of a century ago. I keep
looking ahead. You will be interested to know that trying
to make sense of schizophrenia in cognitive terms is the
biggest challenge I am facing right now. I have written
several papers on the theory of delusions [6] and halluci-
nations [7] and one on cognitive approaches to negative
symptoms. My next big task is to complete a cognitive
formulation for schizophrenia as a whole, which takes its
major organic defect into account but tries to show how
responses to this defect lead to delusions, etc. The defect
in itself has never satisfactorily explained why people
have delusions, hallucinations and negative symptoms.
In my opinion, inability to cope with the psychological
reaction to the defect contributes to the variety of
schizophrenic symptoms. We have no unifying theory of
schizophrenia. There are theories for delusions, for dis-
organization, for all sorts of things. My ambition is to
formulate a unifying psychological theory. I do not think
of age or my past history or what I may have or have not
accomplished. It is as if I am starting afresh, starting on
a new venture.
SB: This is most inspiring. I think psychiatry is going
through a difficult phase because of economic constraints
on what we can offer society. We face uphill battles. On
the other hand, exciting things are going on in neuro-
biology, genetics, the psychotherapies, epidemiology. It
seems to me that psychiatry is like Janus. If you look one
way it appears as bright as can be; if you look the other
way it is dismaying. If there was a message you could
pass onto our younger colleagues embarking on their
careers in psychiatry, what would it be?
AB: Although much of what is happening to our
younger colleagues is dictated by cultural and economic
trends which may be beyond their control, I do have
something I wish to offer them. I have always liked to
unify different fields. Given my background in neurol-
ogy, I do not see a conflict between neurology and
psychology. But if you look at the training of contempo-
rary psychiatrists for example, the two domains are
totally distinct. If psychiatry is to survive as a discipline,
a merging of the concepts of neurology and psychology
will need to occur. For example, it has been shown that
schizophrenic patients who are under stress have
increased dopamine and then show more disorganization
of thought. What causes the stress? They may be react-
ing to stressors that all people face. The key question is
what the patient makes of the stressful stimulus which
produces a biological reaction, which in turn produces
a psychological reaction, which is the disorganization
of thought. The neuropsychiatrist can deal with each of
these steps, including the last, since people who are
disorganized in their thinking can be brought back to
normal by helping them to deal more effectively with the
stress. The artificial dichotomy between neurology and
psychiatry, I would argue, works against psychiatrists.
While I would like to be positive, I have to be honest and
say that if something is not done, our field will go to
neurologists and psychologists, with psychiatrists falling
between the cracks.
SB: I must say that I have never seen evidence of
neurologists wanting to take on our patients. Neurolo-
gists seem to be interested in organic conditions like
strokes, movement disorders, cerebral tumours. As for
psychologists, would it make a big difference if they,
rather than psychiatrists, did the sort of work you have
 S. BLOCH
outlined? Some people argue that the psychotherapies,
for instance, do not need a dozen years of medical and
psychiatric training.
AB: My allegiance is to psychiatrists and I would like
to see them taking over psychotherapy to a larger degree.
However, current trends show psychologists moving into
that area. The probable outcome will be a new discipline
called medical psychology, where people obtain a com-
bined medical/psychology degree, which qualifies them
to do medical psychotherapy. I hate the idea of going
to different professionals for pharmacotherapy and for
psychotherapy. I would like to see the two combined in
one person. My answer therefore would be medical
psychology, or psychological medicine, which I think
was once a popular concept in Britain but did not come
to anything.
SB: In looking back at your long and distinguished
career, you have won many prizes and awards. Is there
one that stands out, one which you think testifies to
something important in your contribution?
AB: I am probably most pleased with being voted in as
a member of the Institute of Medicine (a branch of the
National Academy of Sciences) a prestigious organiza-
tion made up of all the medical specialties. What it
meant to me was that cognitive therapy was recognized
as a legitimate discipline in the whole range of medical
specialties.
SB: You have stuck to your guns in all sorts of ways,
but especially by developing a way of working psycho-
therapeutically and then, painstakingly, chipping away at
it. You have also been on the faculty of the University of
Pennsylvania for decades and haven’t moved around
from one place to another as is so often the case with
American academics. Is there something about this way
of living that is important to you?
AB: I certainly like stability and I have never felt the
need to go away from this straight path I have been on.
But there are other things. It was good for my family to
stay put all these years. My wife is a judge, a state
position she would lose if we ever moved. There are
other extraneous factors but I think the key personality
variable has been my need for stability, consistency,
regularity and predictability.
SB: You mention your family. You have four children,
one of whom has become prominent in the cognitive
arena in her own right. I gather you work together at the
Beck Institute.
AB: My daughter, Judith, is the director of the insti-
tute, which is a carryover from the Centre for Cognitive
Therapy which I directed for several decades. I basically
work for her as a consultant. I see patients that therapists
would like my help with. My interviews with patients are
through closed circuit television so that other staff and
865
clinicians from all over the city and in many cases, from
other countries, can observe and discuss them. Judith
also consults me on various practical and theoretical
questions.
SB: And your work at the University of Pennsylvania
still continues?
AB: We are engaged in several clinical trials in our
new unit called the Psychopathology Unit. Six mental
health professionals, four research assistants, a couple of
clerical staff and I make up the research team. We have
been awarded a centre grant to investigate suicide
prevention. This will involve several studies of cognitive
therapy to prevent subsequent suicidal behaviour in
people who are highly suicidal. We are also carrying out
a controlled trial of cognitive therapy with borderline
personality disordered patients. A third study is of cog-
nitive therapy in conjunction with pharmacotherapy to
treat patients with schizophrenia. These three major
studies are among the most difficult and challenging I
have ever done.
SB: Obtaining a centre grant at the age of 83 must be
a record.
AB: I would say so! I am not sure if the reviewers
actually looked at my age when they gave me the grant.
SB: Returning to the other members of the family,
have they followed in your footsteps?
AB: Interestingly, each one of my four children
worked with me at some stage and three of them have
ended up in careers closely associated with my own. Roy
helped me with a clinical trial as a high school student!
He went on to become a neuro-ophthalmologist and is
involved in a number of multicentre clinical trials. He
is a superb statistician and also has a PhD in epidemiol-
ogy; he can therefore deal with all the variables that go
into clinical trials.
SB: You mentioned another son?
AB: Daniel is a cognitive therapist in Boston and has
participated in several clinical trials, including treatment
of psychosis and hypochondriasis. Our other daughter,
Alice, a lawyer, has followed in her mother’s footsteps,
and teaches at one of the local universities.
SB: Don’t they say that behind a successful man stands
a good woman? Your wife of course has enjoyed a
career in her own right but I have read somewhere that
she has played an important role in your work?
AB: My wife was the first woman to be elected to
the Appellate Court in the State of Pennsylvania. At the
dinner for the new judges, I was asked to say a few
words. I said that behind every successful woman is a
tender-loving, devoted spouse! In fact, my wife has
always encouraged me in my work. At one time there
were only two people with whom I could discuss my
ideas – my wife and my daughter Judith, who was just a
866 INTERVIEW WITH AARON BECK
teenager then. Judith would say: ‘Dad that sounds very
sensible’. It seems obvious, not just coincidence, that she
ended up as a cognitive therapist.
SB: You mention only these two supports. Was there a
time when your colleagues were dubious about what you
were up to? Did they regard you as a renegade from the
analytic ranks?
AB: I was a renegade. Although my colleagues at the
University of Pennsylvania were always respectful, they
were not particularly interested in what I had to say.
Many of them were working in biological research, for
example, and my area was so totally different. They
eventually became interested and Mickey Stunkard, the
chairman, was always most supportive.
SB: Psychiatry does not have many figures who
create a whole new way of thinking. I predict that
when the historians come to talk about the second half
of the 20th century they will refer to a Beckian revolu-
tion. I hope, however, that we won’t have Beckian
therapists. I believe that was the problem we had with
Freud. We got stuck with Freudianism instead of with
an area of academic discourse. It strikes me that in the
midst of your tremendous contribution you are quite
humble.
AB: Other people have said that too. It produces cog-
nitive dissonance in me because I do not perceive myself
as the great contributor that some people seem to state.
Instead, I see myself as somebody who is trying to come
to grips with many problems and that once I have a
tentative solution I forget about them and move onto the
next one.
SB: Perhaps you are expressing your humility now?
AB: I do not try to be humble; it is not a concept that I
think about. I do not think of myself as modest or
immodest. These dimensions do not figure in my think-
ing. What I do think about is how far cognitive therapy
can go, and whether other approaches may be more
effective in the future. I have been asked where cognitive
therapy will be in 10 years time. I reply that we may not
even be using the term. We may be back to using the
term psychotherapy as the preferred concept, which will
include all the most powerful ingredients identified in
different approaches to cognitive therapy. I want to add
something else here. Many people have asked me what
the difference is between cognitive therapy and existen-
tial or humanistic therapy. My answer is that I consider
cognitive therapy as a very humanistic therapy. With the
old kind of ‘simple’ depressions, you could not detect
too much of the humanism in the therapy, although the
goal was to relieve suffering. In many ways these
depressions could be treated mechanically. You gave
people a schedule of activities and you worked out their
distorted cognitions. As we deal with more complex
cases today the humanity of the therapist becomes
extremely important. Therapists who are good at the
technical end of cognitive therapy fall flat on their faces
when it comes to the more complex case. Empathy,
sensitivity, considerateness – together with the ability to
put them together with technical aspects – is the combi-
nation needed. These fine therapeutic qualities – warmth,
adaptiveness and so on – plus technique is the most
powerful set of requirements.
SB: We have been conversing the whole morning.
I wish we could do so the whole afternoon! I understand
you have a full schedule of activities. I shall have to
return another time. In any event my colleagues and I
will need to learn about the findings of your current
research program. On behalf of the Journal’s readers,
can I express my heartfelt gratitude to you for enabling
us to have this encounter today. I personally shall cherish
the experience for a long time to come.
AB: This has been a rewarding experience for me. It
has given me a chance to reflect on what we have done
and what still needs to be done.
Books published by Aaron Beck
Alford B, Beck AT. The integrative power of cognitive
therapy. New York: Guilford, 1997.
Beck AT. Depression: clinical, experimental, and
theoretical aspects. New York: Harper and Row, 1967.
Beck AT. The diagnosis and management of depres-
sion. Philadelphia: University of Pennsylvania Press,
1967.
Beck AT. Cognitive therapy and the emotional dis-
orders. New York: Meridian, 1976.
Beck AT. Love is never enough. New York: Harper
and Row, 1988.
Beck AT. Prisoners of hate: the cognitive basis of
anger, hostility, and violence. New York: HarperCollins,
1999.
Beck AT, Clark D. Cognitive psychotherapy: Anno-
tated guide to the psychiatric literature. New York: APA
Press, 1996.
Beck AT, Davis DD, Freeman A. Cognitive therapy of
personality disorders (2nd Ed.) New York: Guilford,
2004.
Beck AT, Emery G, (with Greenberg RL). Anxiety
disorders and phobias: a cognitive perspective. New
York: Basic Books, 1985.
Beck AT, Freeman A and associates. Cognitive
therapy of personality disorders. New York: Guilford,
1990.
Beck AT, Resnik HLP, Lettieri DJ, eds. The prediction
of suicide. Bowie, MD: Charles Press, 1974.
 S. BLOCH
Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive
therapy of depression. New York: Guilford, 1979.
Beck AT, Wright FW, Newman CF, Liese B. Cogni-
tive therapy of substance abuse. New York: Guilford,
1993.
Clark DA, Beck AT. Scientific foundations of cogni-
tive theory and therapy of depression. New York: Wiley,
1999.
Scott J, Williams JMG, Beck AT. Cognitive therapy in
clinical practice. London: Croom Helm, 1989.
Winterowd CL, Gruener D, Beck AT. Cognitive
therapy with chronic pain patients. New York: Springer,
2003.
Wright J, Thase M, Beck AT, eds. The cognitive
milieu: inpatient cognitive therapy. New York: Guilford,
1993.
867
References
1. Beck AT. Thinking and depression: Idiosyncratic content and
cognitive distortions. Archives of General Psychiatry 1963;
9:324–333.
2. Beck AT. Thinking and depression: Theory and therapy.
Archives of General Psychiatry 1964; 10:561–571.
3. Rush AJ, Beck AT, Kovacs M, Hollon SD. Comparative efficacy
of cognitive therapy and pharmacotherapy in the treatment of
depressed outpatients. Cognitive Therapy and Research 1977;
1:7–37.
4. Beck AT. Successful outpatient psychotherapy of a chronic
schizophrenic with a delusion based on borrowed guilt.
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