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 based around the notion that emotional problems are largely caused by faulty thinking habits. If you can learn to identify and correct problems in your thinking, you can substantially reduce the amount of emotional pain you experience. Cognitive therapy has grown from a singular treatment for depression to a therapy for anxiety disorders, and more recently, a therapy for many different sorts of problems, including aspects of schizophrenia, addictions, personality disorders and eating disorders.

Dr. Judith Beck is the daughter of Dr. Aaron Beck, who is one of the founding fathers of Cognitive Therapy (CT). Aaron Beck trained as a psychoanalytically oriented psychiatrist back in the 1950s, but became disillusioned with that approach after he demonstrated through research that some of its core assumptions about depression were unfounded (for instance, that depression was best characterized as "anger turned inwards"). He developed Cognitive Therapy as a way to help depressed people alter their negative beliefs about themselves, the world and other people. Though he didn't realize it at the time, Dr. Albert Ellis was independently developing Rational Emotive Therapy (RET) along the same lines as Aaron Beck. Largely identical in approach, both RET and CT were well established therapies before the two men ever met. both CT and RET were unique at the time for being psychotherapies that focused on present-day problems (rather than problems from the past), and on the way that thinking habits influence suffering.

Dr. Van Nuys asks Dr. Beck about the differences between Cognitive Therapy and Cognitive Behavior (or Behavioral) Therapy. She replies that Cognitive Therapy is generally more narrowly conceived than CBT approaches, at least in the United States which may include behavioral components such as Exposure with Response Prevention that would not be found in Cognitive Therapy which is more purely focused on helping people identify and alter problematic thinking patterns.

Dr. Beck describes interesting recent research findings, for example demonstrating that CT has a measurable effect on the brain similar in nature to that caused by antidepressants. 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 relapse back towards becoming depressed at twice the rate of patients 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 an exploration of the ways that people's problematic thinking processes sabotage their efforts at weight loss. In the book she outlines a 6 week program which helps people identify and address their thinking problems related to eating and exercise.

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 anxious and fearful over 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 confronted and corrected in Dr. Beck's approach. Her approach is designed to help people think about diet in a systematic way so that they consistently strengthen their willpower to resist temptations and 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 stick to that plan, on a day by day basis, building into their plan the idea that they can spend some calories on treats in a planned manner. She also helps people learn how to better tolerate hunger feelings so that they are less driven by them towards temptation. She notes how frequently people use a minor example of giving in to temptation as an excuse to more fully given in to temptation, and targets that tendency (which is based on just another faulty belief) in her program.

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 than heavier people. Where a heavier person might look at a friend eating a cookie and say, "I should be able to have one too if she is eating one", a thin person will tend to look more towards their own internal hunger cues to guide their eating. Thin people tend to eat at mealtimes in comparison to heavier people who may eat because food is in front of them. Thin people do not fear hunger or food deprivation nearly as much as heavier people, who may over-eat just to avoid having to feel any hunger pangs. Thiner people do not turn to food as a source of comfort with as much regularity as heavier people. Instead, they may be motivated to engage in other calming behaviors. By challenging some of the beliefs and fears that motivate them to over-eat, heavier people can learn to think more like thinner people, and this change in their approach to food will often result in their experiencing weight loss.

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.

Links Relevant To This Podcast:

• Judith Beck, Ph.D. is director of the Beck Institute for Cognitive Therapy and Research, which provides professional training in cognitive therapy to mental health professionals.


• Dr. Beck's most recent book is The Beck Diet Solution, which applies the principles of cognitive therapy to the problem of weight loss. The support website for the book can be found at www.beckdietsolution.com

About Judith Beck, Ph.D.

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.

For more information about Dr. Judith Beck's Beck Diet Solution, please visit the Beck Diet Solution website.

For updates about Cognitive Therapy, including regular contributions by Judith S. Beck, please visit the Beck Institute blog, Cognitive Therapy Today.