A Special Feature in Commemoration of Aaron T. Beck’s Contributions to the Science and Practice of CBT

This special feature in Cognitive and Behavioral Practice is a commemoration to Aaron T. Beck’s contributions to the science and practice of CBT. The fact that so many leading scholars participated, including several Past Presidents of the Association for Behavioral and Cognitive Therapies, speaks volumes about the high regard held for Beck. Included are papers that cover the Beckian model of depression, its refinement and application to obsessions, compulsions, hoarding, as well as how the model addresses interpretational biases in emotional psychopathology and has been adapted for youth. Additionally there are papers conveying how Beck’s phenomenological approach to understanding the client’s perspective is useful in attending to cultural differences, and in mitigating the mental health impact of marginalization and discrimination. Expert commentaries are extended to relational processes (case formulation, therapeutic relationship, collaboration and guided discovery, alliance, rupture repair, homework), change processes (cognitive reappraisal, dialectical thinking, acceptance and defusion, emotional schemas), and to important scientific advances (conceptualizing processes within techniques, data analytic advances that bridge the scientist-practitioner gap, and technology augmentation). Many of the contributions herein also include brief personal stories to help illustrate the enormity of Beck’s contributions.     

有偿献血HIV感染者的情绪障碍

考察有偿献血HIV感染者的情绪状况,探讨他们面临的艾滋病压力和对感染HIV的认知评价对其情绪的影响。方法：采用Beck抑郁量表、焦虑自评量表、艾滋病压力量表、认知评价量表作为测查工具,测查了185名有偿献血HIV感染者,并收集了人口学资料、症状资料和其它信息。结果：（1）92%的有偿献血HIV感染者有中、重度抑郁障碍,他们的焦虑程度高于神经衰弱者和焦虑症者;（2）艾滋病压力不仅通过认知评价而且会直接对情绪障碍产生影响;（3）认知评价在艾滋病压力和情绪障碍之间起部分中介作用。结论：有偿献血HIV感染者抑郁、焦虑情绪障碍严重,艾滋病压力和认知评价对情绪障碍的产生都有直接或间接的影响     

Introduction

According to cognitive therapy as espoused by Aaron T. Beck, the transfer and maintenance of behavioral and cognitive skills into practical and sustainable real-life application ultimately determines positive therapeutic outcomes. However, the optimal process for ensuring this transfer and maintenance has not been explicitly studied. This particular series of C&BP adds to the growing body of literature on cognitive therapy for complex and chronic problems. A case conference and supervision recommendations are presented as a resource for cognitive and behavioral practice. The focus of this series is the integration of homework assignments into therapy. Developing a collaborative therapeutic relationship and individualized cognitive conceptualization were part of the original formulation of standard cognitive therapy (A. T. Beck, Rush, Shaw, & Emery, 1979), and are essential foundations to therapeutic work with challenging patient problems (J. Beck, 2005). Therefore, in keeping with the spirit of cognitive therapy, this series of C&BP places emphasis on the therapeutic collaboration and cognitive conceptualization processes that greatly enhance the effective use of homework assignments.     

Cognitive Reappraisal

A central tenet of Beck’s cognitive therapy (or cognitive behavior therapy) of the emotional disorders is that change in negative thought and beliefs is necessary for clinically significant symptom reduction in anxiety, depression, and other psychological conditions. Cognitive restructuring, a uniquely Beckian innovation, is a treatment strategy that directly targets cognitive reappraisal as the change mechanism responsible for symptom reduction. This commentary considers the origins of cognitive reappraisal in Beck’s cognitive therapy through the lens of cognitive restructuring and what treatment process research tells us about the mechanisms of change in cognitive restructuring.     

Life events and depression: The plot thickens

Although we certainly agree with Beck's original ideas that depression results from people's negative interpretations of events, unlike Beck we believe that many of the interpretations are not necessarily distortions. Awful and difficult events happen to many people, and many depressions are preceded by truly negative life stressors. We propose that stressors result both from fate and from human agency. And maybe we will get as much mileage from studies of individual differences in stress generation and stress resolution as from a previous round of studies of individual differences in cognitions about stress. How do people create and manage their environments? Just as the study of depression has profited enormously from exploring its antecedent social context, we propose that even stressful events need to be studied in context—especially the interpersonal and family context. These processes shift over time and have mutual influences on each other. This leads to some very complex multigenerational, historical, transactional, and cognitive models, and that is what I meant when I titled this work “the plot thickens.”     

Acceptance and Defusion

The waves and generations of behavioral and cognitive therapy are normal features of a progressive science. Two of the key processes in modern CBT are briefly examined: defusion and acceptance. Both had important antecedents in the work of Aaron Beck, among others; at the same time, they both represent meaningful changes. This dialectic of continuity and change is to be celebrated—it means our current work stands on the shoulders of past intellectual giants. The entire field owes a permanent debt of gratitude to Aaron T. Beck.     

Hoarding

This commentary highlights areas of research during my career that have been very positively influenced by Dr. Aaron T. Beck’s work on cognitive theory, assessment, and treatment of behavioral disorders. These include collaborative efforts to develop assessment of beliefs and interpretations, as well as cognitive therapy for obsessive-compulsive disorder, and especially recent work on assessing, understanding beliefs about possessions, and cognitive behavior therapy for hoarding disorder.     

Family therapy beyond postmodernism: some considerations on the ethical orientation of contemporary practice

Ethics is a subject that is self-evidently important for systemic therapy, as for therapy generally, yet arguably it is one that has not received nearly as much attention in the literature as it warrants. This paper looks at the historical context for the marginalization of ethical discourse and suggests that the contemporary influence of postmodernist and hermeneutic thinking reinforces this tendency. Flaskas' (2002) recent argument for the reclamation of an idea of truth and reality as a social and emotional process is considered, and it is suggested that this needs supplementing with a perspective on truth and reality as an ethical process. Consideration is given to the enduring influence within postmodernist approaches of the modernist Kantian conception of ethics as centred in individual consciousness. I argue that important elements of contemporary systemic practice (for example, the reflecting team approach) are also pointing towards a different formulation of ethics that is focused more specifically on processes of communication. In elaborating this theme the paper draws on the work of the German social theorist Jürgen Habermas who writes on the ethics of communication.     

基于不同研究取向的应对问卷述评

随着社会的发展,人们现实和精神压力的增大,压力应对方式的研究日益受到广泛重视。研究者们依据不同的理论模型建构了各种应对问卷,此文总结了5种主要的应对研究取向,包括应对过程研究取向、应对特质研究取向、应对认知思维研究取向、应对能力研究取向以及特定情境应对研究取向等,并对相应的问卷做了一个整体的回顾,最后提出了应对研究发展的新方向以及对应对测量工具提出的新要求     

Linking work conditions to unpleasant affect: Cognition,categorization and goals

Current approaches to work stress do not address in detail the mental processes by which work events cause unpleasant affect. We propose a cognitive account that incorporates: (1) the distinction between controlled and automatic information processing; (2) the categorization of emotionally relevant stimuli; (3) the role of mental models in coping choice; (4) the enactment of beneficial job conditions through coping; and (5) reciprocal influences between cognition and affect. We conclude by discussing how this account can help explain a range of findings in the work stress literature and how a cognitive approach to work stress informs practice.     

Job characteristics: their relationship to job satisfaction,stress and depression

This study investigated the influences of job characteristics on job satisfaction, stress and depression among South African white collar workers. Participants were managers in full-time employment with large organisations. They completed the Job Diagnostic Survey, the Perceived Stress Scale and the Beck Depression Inventory. A regression approach was used to predict job satisfaction, stress and depression from job characteristics. Job characteristics (skill variety, task identity, task significance, autonomy and feedback) predicted job satisfaction, as well as stress and depression. Job characteristics are weak predictors of perceived stress and depression. Work related factors, such as interpersonal relations and organisational culture, may better predict mental health in work settings.     

Fallbeispiele zum Thema Burnout

Burnout is a process, in which dysfunctional interactions between a person and external stresses (professional, nonprofessional) play a central role in its development. It is accompanied by emotional and physical exhaustion, decreased productivity, and a negative attitude toward work, other stress factors, and people associated with work. Depressive disorders, anxiety disorders, other psychiatric and psychosomatic disorders, and physical and cognitive disorders are often observed as part of burnout. Differentiation from other (in particular psychiatric) diseases is mainly possible based on a history of a lengthy (months, years) process of development associated with external stress factors. This differentiation is essential to determine an appropriate, multiprofessional approach, in which drug treatment, psychotherapy, coaching, lifestyle modification, and methods of stress reduction are available and should be used in a coordinated manner.     

RACE, IDEOLOGY, AND IDEAL THEORY

Abstract: Philosophers who have addressed the problems of enduring racial injustice have been suspicious of the role played by ideal theory in ethics and political philosophy generally, and in contemporary liberal political philosophy in particular. The theoretical marginalization of race in the work of Rawls has led some to charge that ideal theory is at the very least unhelpful in understanding one of the most significant forms of contemporary injustice, and is at worst ideological in the pejorative sense. To explore these concerns, I formulate five related criticisms of ideal theory and examine each as it would be applied to Rawls's political philosophy. My thesis is that the strongest criticisms—namely, that ideal theory is essentially ideological and cannot provide adequate grounds for justifying race-conscious, equality-securing measures—ultimately miss the mark. But other criticisms of ideal theory are more plausible, and most plausibly directed to an area of Rawls's thought often ignored in discussions of liberalism and race, namely, his account of citizenship and public reasoning.     

Thought control strategies in acute stress disorder

Intrusive trauma-related thoughts and the means to manage them are a central dynamic in posttraumatic stress. Thought control strategies were investigated in survivors of motor vehicle accidents with either acute stress disorder (ASD; n=20) or no ASD (n=20). Participants completed the Acute Stress Disorder Interview, the Beck Depression Inventory, the Beck Anxiety Inventory, the Impact of Event Scale, and the Thought Control Questionnaire (TCQ) within four weeks of their accident. Although distraction, social control, and reappraisal were the most common strategies in both groups, ASD participants engaged in punishment and worry more than non-ASD participants. Worry and punishment were also strongly associated with severity of intrusive, avoidance, arousal, and depressive symptoms. Findings are discussed in terms of the role of cognitive strategies in resolving posttraumatic stress.     

Cognitive bias in acute stress disorder

Cognitive bias was investigated in survivors of motor vehicle accidents with either acute stress disorder (ASD; n=17) or no ASD (n=17). Participants completed the acute stress disorder interview, the Beck depression inventory, the Beck anxiety inventory, the impact of event scale, and a probability questionnaire (PQ) and a cost questionnaire (CQ) within four weeks of their accident. ASD participants exaggerated both the probability of negative events occurring, and the adverse cost of those events more than non-ASD participants. IES-Avoidance scores were the only significant predictors of both PQ and CQ scores. Findings are discussed in terms of the role of cognitive errors in posttraumatic adjustment.     

Cognitive Schemas as Mediating Variables of the Relationship Between the Self-Defeating Personality and Depression

The current investigation was designed to examine particular maladaptive cognitive schemas as mediating variables of the relationship between the self-defeating personality and depression. A total of 82 mildly to severely depressed adult outpatients, referred for counseling and psychotherapy services, were assessed in terms of self-defeating personality and maladaptive cognitive schema characteristics. Results indicated that 57% of the variance within depression, measured by the Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979), was accounted for by the self-defeating personality and five maladaptive cognitive schemas: abandonment/instability; defectiveness/shame; failure; subjugation; and vulnerability to harm. Further, mediation analyses indicated that abandonment/instability and defectiveness/shame statistically mediated the relationship between the self-defeating personality and depression. Results are discussed in light of contemporary theories of depression.     

德里达、利科和基督宗教的边缘化——出场的上帝可以被拯救吗?

后现代主义对当代文化的批判导致了基督宗教的逐步边缘化,“拒绝出场的上帝有何得失?”的问题亟待我们解决。该文通过比较德里达与利科的著作,尤其是他们对正义、礼物的概念以及信仰与伦理之间关系的不同理解,寻求保留上帝出场并能回应后现代挑战的可行方法,从而把握到真正的《圣经》信仰,力图将滑落边缘的基督宗教再拉回来。     

Phenomenology and Cultural Considerations

The author discusses how his early exposure to Dr. Beck’s work shaped and directed his development as an emerging psychologist. Focusing on Beck’s assessment of hopelessness, the author discusses how he developed an appreciation for both the multidimensionality and multifunctionality of the construct in his own works focusing on cultural differences. The author argues that Beck’s early strategy to use a phenomenological approach to understanding clinical conditions remains important for appreciating the different functional meanings that cognitions might embody for different individuals.     

Depressogenic cognitive styles: predictive validity, information processing and personality characteristics, and developmental origins.

Two of the major cognitive theories of depression, the theory of Beck [Beck, A. T. (1967). Depression: clinical, experimental and theoretical aspects. New York: Harper & Row. and Beck, A. T. (1987) Cognitive models of depression. Journal of Cognitive Psychotherapy: an International Quarterly, 1, 5-37] and the hopelessness theory [Abramson, Metalsky, & Alloy, (1989) Hopelessness depression: a theory-based subtype of depression. Psychological Review, 96, 358-372], include the hypothesis that particular negative cognitive styles increase individuals' likelihood of developing episodes of depression, in particular, a cognitively mediated subtype of depression, when they encounter negative life events. The Temple-Wisconsin Cognitive Vulnerability to Depression (CVD) project is a two-site, prospective longitudinal study designed to test this cognitive vulnerability hypothesis, as well as the other etiological hypotheses of Beck's and the hopelessness theories of depression. In this article, based on CVD project findings to date, we review evidence that the hypothesized depressogenic cognitive styles do indeed confer vulnerability for clinically significant depressive disorders and suicidality. In addition, we present evidence regarding moderators of these depressogenic cognitive styles, the information processing and personality correlates of these styles and the possible developmental antecedents of these styles. We end with a consideration of future research directions and the clinical implications of cognitive vulnerability to depression.