An Interview with Judith Beck, Ph.D. on Cognitive Therapy and Weight Loss
David Van Nuys, Ph.D. Updated: Jul 17th 2008
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In this episode of the Wise Counsel Podcast, Dr. Van Nuys speaks with Psychologist Judith Beck, Ph.D. on the topics of Cognitive Therapy and the application of Cognitive Therapy to the problem of weight loss.
Cognitive Therapy is a time-limited psychotherapy based on the cognitive model - a set of assumptions validated by research and based around the notion that emotional problems are associated with faulty thinking habits and maladaptive behavior. If you can learn to identify and correct problems in your thinking, you can substantially reduce the amount of emotional pain you experience and you can engage act in a way to meet your goals. Cognitive therapy has grown from a singular treatment for depression to a therapy that has been demonstrated in hundreds of research studies and shown to be effective for scores of psychiatric disorders, psychological problems, and medical conditions with psychological components, including anxiety disorders, schizophrenia and bipolar disorder (combined with medication), addictions, personality disorders, eating disorders, couples and family problems, attention deficit disorder, insomnia, infertility, chronic pain, fibromyalgia, irritable bowel syndrome, and many others.
Dr. Judith Beck is the daughter of Dr. Aaron Beck, who is the founding father of Cognitive Therapy (CT). Dr. Aaron Beck trained as a psychoanalytically oriented psychiatrist back in the 1950s, but became disillusioned with that approach after he discovered, through research, that some of its core assumptions about depression were unfounded (for instance, that depression was best characterized as "anger turned inwards"). He recognized that a core feature in depression was negative thinking about the self, one’s world, and the future. He developed a treatment that was present-focused, goal oriented, and educative. One of Dr. Beck's most important contributions was to subject his new kind of psychotherapy to scientific testing. He and colleagues worldwide have conducted randomized controlled treatment studies that have demonstrated the efficacy of cognitive therapy, not only to get people better, but also to help them stay better. Cognitive Therapy helps people solve their current problems and think more realistically. As a result, their symptoms subside, they feel better emotionally and they behave in a more adaptive fashion.
Though Dr. Beck did not realize it during the early days of developing CT, Dr. Albert Ellis was independently developing Rational Emotive Therapy (RET), a psychotherapy that shares some theoretical and practice principles with Cognitive Therapy. Both CT and RET were unique in their early days for being psychotherapies that focused on present-day problems (rather than problems from the past), and on the way that thinking habits influence suffering. Both CT and RET have influenced what today has come to be known as Cognitive Behavioral Therapy.
Dr. Van Nuys asks Dr. Judith Beck (hereafter, "Dr. Beck") about the differences between Cognitive Therapy and Cognitive Behavioral Therapy. She replies that Cognitive Therapy and Cognitive Behavior Therapy are often used synonymously, though some specific forms of Cognitive Behavior Therapy are more narrow in scope, such as stress inoculation, motivational interviewing, or exposure with response prevention. Cognitive Therapy draws on techniques from all the various Cognitive Behavior Therapies (and, especially for patients with personality disorders, uses Gestalt and psychodynamic-like techniques within a cognitive framework).
Dr. Beck describes interesting recent research findings, for example demonstrating that CT has a measurable effect on the brain, just as medication does. Brain scans of groups of patients treated for depression with either medications or CT show that both treatments effectively alter brain functioning upon comparison of pre-treatment to post-treatment images, with the medications creating changes starting in the brain stem area and radiating outwards towards the cortex, and CT showing the opposite pattern, where changes start in the cortex and then radiate inward towards the brain stem. She also mentions research showing that depressed patients treated with medications alone have twice the relapse rate as those treated with CT.
Dr. Beck has recently published The Beck Diet Solution, a book adapting Cognitive Therapy for the purpose of helping people with weight loss. Her book is not a diet, but rather teaches people how to diet. In the book she outlines a 6 week program in which dieters learn a different thinking or behavioral skill each day to lose weight and keep it off. Her latest book (The Complete Beck Diet for Life), to be published in January, 2009, combines cognitive and behavioral skills with a step-by-step healthy eating plan that dieters use to lose weight and then modify, to maintain their weight loss permanently.
In Beck's view, the missing ingredient to most diets is that they do not address thinking habits that sabotage diets. People may tell themselves about how good a cookie looks, or that "I deserve it", or that "I exercised today so it's okay" and make lots of excuses that break down their will to maintain their diet. They may be actually concerned at the prospect of feeling hungry. They may tell themselves that they can diet for a short period of time, lose weight and then go back to eating however they want to. All of these beliefs and ways of thinking can cause problems and are identified and corrected in Dr. Beck's approach. Her approach is designed to help people think about diet in a systematic way and learn how to consistently strengthen their ability to resist temptations and how to weaken their tendency to give in to temptations. In order to make this happen, she recommends that people plan out in advance what they will eat, and then learn the necessary thinking and behavioral skills so they can stick to that plan. And they also need to learn, on a day by day basis, how to incorporate their favorite foods into their eating plan. She also helps people learn how to better tolerate hunger, seeing it as a mildly uncomfortable, but certainly tolerable sensation that comes and goes. She notes how frequently people use a minor deviation from their diet as an excuse to continue to eat whatever they want for the rest of the day (“I’ve blown my diet. I might as well start again tomorrow.”), sometimes turning a 300 calorie mistake into a 3,000 calorie mistake. She also teaches dieters exactly what to do so they can get back on track immediately after making a mistake.
Dr. Beck outlines several ways that thin people differ from people who have struggled with weight. One important difference is that thin people are less socially oriented with regard to food. If they have to restrict their eating, they don’t think, “It’s so unfair that I can’t eat the cookies that my friends are eating.” Thin people are much better at recognizing when they are hungry. People who struggle with dieting usually label any desire to eat as hunger. Even if their stomachs are full, they will say, “Oh, those chips look good. I’m hungry.” Or if they’ve eaten a good meal but are then bored, they’ll think, “I’m hungry. I think I’ll get something to eat.” People without weight problems are more attuned to their internal hunger cues to guide their eating. Thin people tend to eat at mealtimes with little snacking in between. People who struggle with losing weight may eat not only at mealtimes and scheduled snack times but also when they see a food commercial, smell food being cooked, are offered food by others, or spy food at the cash registers of stores, regardless of how full their stomachs already are..And they may over-eat at meals or carry food with them to avoid having to feel any hunger pangs. Thin people do not usually turn to food as a source of comfort. Instead they calm themselves in other ways. By learning how to change their thoughts and beliefs, , people who have struggled with dieting can make permanent changes in their eating behaviors in order to make permanent changes in their weight.
Dr. Beck concludes the interview by sharing her view on the best way to select a psychotherapy. In her view, it is important to select a therapy that has been subjected to scientific study and which has been demonstrated to be effective for treating the problem that you are faced with. Cognitive Therapy is such an "empirically validated" therapy for depression and anxiety problems, and for many other problems people live with.
Judith S. Beck, Ph.D., is the Director of the Beck Institute for Cognitive Therapy and Research in suburban Philadelphia and Clinical Associate Professor of Psychology in Psychiatry at the University of Pennsylvania where she teaches psychiatry residents. She received her doctoral degree from the University of Pennsylvania in 1982.
Dr. Beck directs the three major functions of the Beck Institute: education, clinical care, and research. She currently divides her time between administration, supervision and teaching, clinical work, program development, research and writing. She is a consultant for several NIMH research studies and often presents workshops nationally and internationally on Cognitive Therapy for a wide variety of psychiatric disorders. She is the author of the widely adopted textbook, Cognitive Therapy: Basics and Beyond, which has been translated into 12 languages, and Cognitive Therapy for Challenging Problems: What to Do When the Basics Don't Work, published by Guilford Press. Her latest book is The Beck Diet Solution, released in April of 2007. An editor of The Oxford Textbook of Psychotherapy and a co-author of Cognitive Therapy of Personality Disorders, she has written numerous articles and chapters on various applications of Cognitive Therapy. Dr. Beck also developed the Beck Youth Inventories (TM) with Aaron. T. Beck, M.D. Dr. Judith S. Beck is a Distinguished Founding Fellow and President of the Academy of Cognitive Therapy.