Cognitive Therapy Today
a publication of the Beck Institute for Cognitive Behavior Therapy
Volume 17, Issue 1: March 2012

In This Issue
Is There Value in Negative Thoughts?
People's Reactions Always Make Sense
Dr. Mayberg's Visit to Beck Institute
Overcoming Cravings
Awards Received by Drs. Aaron and Judith Beck

Is There Value in Negative Thoughts?
From an interview with Aaron T. Beck, M.D., President Emeritus 

The whole idea of negative thoughts (actually negative interpretations or expectancies contained in automatic thoughts) derives from work with depressed patients in whom extreme negative thoughts are highly dysfunctional: "I flunked the exam and that means I am a failure. . . I'll never make it in this world. . . I might as well commit suicide."

Above: Dr. Aaron Beck converses with
workshop trainees at Beck Institute.

The question about any given automatic thought is not entirely whether it is irrational (Albert Ellis's term) or invalid but whether it is dysfunctional, maladaptive, counter-productive, or unhelpful (various adjectives that have been used). Depressed patients may have dozens or hundreds of negative thoughts throughout a day, some of which are true ("I don't want to get out of bed") and some of which, upon evaluating their validity, are found to be untrue, or largely untrue ("No one cares about me"). Most of their negative thoughts, regardless of their degree of validity, are unhelpful.   

In contrast, when people are not suffering from a psychiatric disorder and are functioning well, negative thoughts can be useful. I have found over the years that my negative self-critical thoughts have helped me to compensate for mistakes I have made, prompting me not to make the same mistakes again. Many of our negative predictions, if we do not have an anxiety disorder, can help keep us safe. Negative thoughts associated with mild anger can propel us into constructive action. So, the essence of any type of cognition, behavior, affect, or physiological response is whether it is constructive, destructive, or neutral. (Most negative thoughts are probably fleeting and not terribly relevant to an individual's well-being.)  

Of course, there are repetitive thoughts, as in obsessions, ruminations, and some types of worry. It seems that these problems might be best addressed by some type of acceptance/meditation approach, whereas automatic thoughts might be evaluated through a more empirical/logical approach. In no event do we "challenge" negative thoughts, or any other thoughts for that matter.
 People's Reactions Always Make Sense 
Judith S. Beck, Ph.D., President

My patients are often mystified by their strong emotional or behavioral reactions, or the reactions of other people. "I don't know why I got so upset." "It was a really happy occasion. I don't understand why I felt so sad." "What made my brother blow up like that?" "My [coworker's] reaction just seemed to come out of nowhere."


People's reactions can be mystifying if you don't understand the cognitive model: that the way people interpret their experience influences how they feel and what they do.


Tania, a young woman who works in the office of an automotive service agency, bursts into tears when her boss announces to the staff that he is promoting her to office manager. Carl, who has just returned from his honeymoon, becomes infuriated with his wife when she tells him she's going to the supermarket. Edward, a high school student, becomes highly anxious when his homeroom teacher tells the class that she is going to rearrange the seating chart. Ellen, who recently returned from a trip to the emergency room, has a flashback when her friend pulls up to the curb in his new red car.  

Judith Beck

Above: Dr. Judith Beck conducts a demonstration
roleplay with a workshop participant.


Why do these four people have such pronounced emotional reactions in seemingly innocuous situations? People's reactions always make sense when we know what they were thinking. Tania, for example, had the automatic thoughts, "I don't deserve the promotion and I won't be able to handle the job. I'm going to feel so much pressure!" Carl's thoughts were, "She's using the supermarket errand as an excuse. She just wants to get away from me!" Edward's automatic thought was in the form of an image. In his mind's eye, he saw himself seated next to his nemesis, who was needling him unmercifully. Ellen perceived "Danger!" The car looked almost identical to the one that had plowed into her car earlier that day.


It can be very helpful to patients to apply the cognitive model to themselves when they notice they are experiencing a strong reaction and also to other people with whom they are interacting. Mark, for instance, was continually exasperated by his wife's tears, over seemingly very small matters. Once he understood that she often interpreted his actions as meaning she was unimportant to him, he was able to reassure her and modify his behavior. Joan couldn't figure out why her boss sometimes started to harp about very small mistakes. Once she and her therapist hypothesized that his increase in criticism seemed to arise when he was overwhelmed with deadlines, Joan was able to take his negative remarks less to heart.


Therapists, too, are sometimes mystified by their patients' reactions. An adolescent who suffers from depression is gradually but definitely improving; she suddenly tells her therapist at the beginning of a session that she is seriously contemplating suicide. This setback is understandable once the therapist ascertains that the teen, having received a failing mark on an exam, began to catastrophize: "This shows what a failure I am. I'll never get into college. My life will be totally miserable. I might as well end it all now." A man whose therapist is reviewing his safety behaviors (unhelpful coping strategies that are prolonging his anxiety disorder) becomes quite angry in session and almost storms out. Why? His automatic thought was, "My therapist is blaming me for doing the wrong things. I can't believe she's doing that. How dare she!" A woman becomes acutely uncomfortable when her therapist starts to ask her about his childhood history. Her therapist understands why she feels this way once she elicits the patient's assumption: "If my therapist knows about the abuse I suffered, she'll think it was my fault."


When patients have strong negative reactions in session, it is essential to reinforce them for being willing to express their discomfort. Then the therapist can plan a strategy to ameliorate the problem. An understanding of the cognitive model as applied within the therapy session helps both therapists and patients make sense of strong reactions, and figure out what to do next.


A Visit from Dr. Helen Mayberg to Beck Institute

Above, left to right: Dr. Julie Hergenrather, Dr. Judith
Beck, and Dr. Helen Mayberg at the Beck Institute.
Dr. Helen S. Mayberg is a Professor of Psychiatry and Behavioral Science and Neurology and the Dorothy Fuqua Chair in Psychiatric Imaging and Therapeutics at Emory University. Her research has focused on neural systems mediating mood and emotions in health and disease with a primary emphasis on major depression and its recovery. Dr. Mayberg  has carried out FMRI studies of clinically depressed patients and found that a designated area of the brain (Brodmann area 25) is a center of abnormal activity in depressed patients. 

During a recent visit to Beck Institute, Dr. Mayberg further described her research:

My research group utilizes functional and structural brain imaging methods (resting state, task-based PET and fMRI, sMRI volumetrics, DTI tractography) to characterize neural circuits mediating both clinical symptoms and illness recovery in patients with major depression. We have systematically examined depression pathophysiology in both psychiatric and neurological patients, as well as mechanisms mediating antidepressant response to various modes of treatments (medication, cognitive therapy, placebo, DBS). Current projects emphasize development of novel imaging biomarkers predictive of treatment response and optimal treatment selection for individual depressed patients at all stages of illness. My long-term interest in neural network models of mood regulation in health and disease was the basis for a new intervention for treatment resistant patients using deep brain stimulation, a continued focus on ongoing research and a foundation for reverse translational studies in animal models. Active collaborators include psychiatrists, neurologists, neurosurgeons, psychologists, and cognitive neuroscientists; as well as neuroanatomists, neurophysiologists, biomedical engineers and biostatisticians. Our ongoing studies are multidisciplinary and members of the lab and our collaborators reflect my research and clinical philosophy that broad-based, translational science is and will be essential to understanding, preventing and curing depression and other neuropsychiatric disorders.


Dr. Mayberg recommends that treatment resistant patients who respond to deep brain stimulation receive CBT to enhance their recovery.


Overcoming Cravings
Deborah Beck Busis, LSW, Diet Program Coordinator

An increasing body of research demonstrates that programs with a CBT component are effective for weight loss and weight maintenance (see, e.g., Shaw, 2005; Werrij et al., 2009; Spahn et al., 2010). An essential skill for losing weight (and especially for keeping it off) is learning to overcome cravings without eating. In our work with dieters, we use a number of cognitive and behavioral techniques to help patients master this skill. And we have dieters practice these techniques, over and over, even when they are not experiencing cravings, so they are well prepared when cravings do arise.

Initially, many dieters report automatic thoughts such as: "The only thing I can do to make this craving go away is to eat," "This craving will just get worse until I can't tolerate it, so I may as well give in now," and "I have no willpower against cravings."

Psychoeducation is one of our first interventions. We teach dieters that cravings arise from a number of different triggers: environmental (dieters see or smell a particular food), social (others around them are eating or drinking), mental (they are just thinking about a particular food or meal), or emotional (they feel tired, stressed, sad, happy, etc.). They may think about how wonderful a particular food will taste; they may visualize themselves eating the food and receiving great satisfaction; they may even get a sensory image, almost tasting the food in their mouths. They may also have memories in which the physiological tension that accompanies cravings dissipates as they take the first bite of the food they are craving.    


We explain to dieters that when they experience a craving, they likely experience some emotional discomfort related to that craving also. The discomfort is usually anxiety or irritability. When dieters experience a craving for something they know they have not planned to eat, they may have anxious or irritable thoughts and argue with themselves about whether or not they are going to allow themselves to give in and eat the unplanned food. We discuss with dieters a concept that is new for most of them. That is, there are actually two ways to make this discomfort go away- either by firmly deciding they are going to eat the food they are thinking about, or by firmly deciding they are not going to eat the food they are thinking about, then turning their attention to a compelling activity. We frequently have dieters do experiments to demonstrate this point. They find that as soon as they decide to give into a craving, their discomfort starts to diminish-even before the food is in their mouths because their decision has been made. What often surprises dieters is that their discomfort also starts to diminish as soon as they make the definite decision not to eat, even before they turn their attention outward to an activity. To facilitate the latter, we help dieters create a list of activities they could choose to turn their attention to when they begin to experience a craving (e.g., taking a walk, playing a game on their phone, looking at an entertaining website, calling a friend, cleaning or organizing a room, or listening to music, to name a few).    


A technique to motivate dieters to overcome cravings is having them remind themselves exactly why it is worth it to them to resist their urges. We reinforce this skill by having them read, twice or more daily, a long list of reasons why they want to lose weight. When dieters find that their attention has been captured by how uncomfortable they feel (which tends to lead to more discomfort), we coach them on how to correctly label their feelings and to remind themselves that the craving is temporary: "This is just a craving. It may be mildly uncomfortable now, but pretty soon it will go away." They also learn to motivate themselves: "If I stand firm and don't give in, I will be SO GLAD that I did; I will feel proud of myself once the craving has passed. But if I do give in, I will feel bad about myself; I will feel guilty and weak." (They also read coping statements like this at least twice a day, even in the absence of cravings.)    


By using these techniques -- labeling feelings, deciding firmly that they are not going to give in to cravings, and getting immediately distracted -- (and other techniques as well), dieters prove to themselves that cravings DO decrease, that they DON'T just get worse and worse, that they DO have willpower to withstand them, and that they CAN make them go away without ever putting a single bite of food in their mouths. Dieters often have to deliberately practice this skill over and over again, and give themselves credit for each success, before they really start to gain confidence that they can overcome cravings. Once they start to build a memory bank of successful experiences, it gets easier and easier for them because they are more firmly able to just say "No, I'm not giving in," and move on.

Through all of these methods, dieters are able to change their thinking about cravings:

  • The idea "If I'm having a craving, the only thing I can do to make it go away is eat," changes to, "I don't need to eat to make this craving go away. The moment I decide that I'm definitely not giving in to it, the craving will start to diminish. And as soon as I fully turn my attention to something else, I won't be thinking about it at all."   
  • "This craving will just get worse until I can't tolerate it, so I may as well give in now," changes to, "Cravings don't get worse and worse. Even if I do nothing, the craving will start to go away on its own, once my attention is turned elsewhere. At worse this craving is mildly uncomfortable, especially compared to other discomforts I've experienced in my life; I can certainly tolerate it, and it is so worth it to me to do so."    
  • "I have no willpower against cravings," changes to, "I can withstand cravings without giving in, and there are things I can do to make them go away faster. I have withstood cravings many times before and I know I can keep doing it. Besides, it feels so good when I do."

Ultimately, we teach dieters to take a short-cut. Instead of distraction, we have dieters label their experience ("This is just a craving," or "This is just discomfort,"), tolerate it, and go about their business. They soon notice that they experience cravings less and less -- and they are prepared and able to stand strong when cravings do arise.


For more information about a CBT approach to weight loss and maintenance, visit


Awards for Drs. Aaron T. Beck and Judith S. Beck

In December 2011, Dr. Aaron T. Beck, M.D., was awarded the Edward J. Sachar Award for his distinguished research in the treatment of low functioning patients with schizophrenia.  

In this video, Dr. Beck is first introduced by Nobel prize-recipient, Dr. Eric R. Kandel, who refers to Dr. Beck as "the most original and important contributor to psychotherapy and psychiatry of the last 50 years, and the most important psychoanalyst since Freud." Each year, this award is presented by the College of Physicians and Surgeons, in the Department of Psychiatry at Columbia University, to an individual who has made extraordinary contributions to the field of psychiatric research and promoted the research careers of younger colleagues.


In January 2012, The Prince Mahidol Award Foundation under Royal Patronage presented Dr. Aaron Beck with the Prince Mahidol Award in Medicine for outstanding research in the field of medicine for the benefit of mankind. The award was founded in 1991 to honor the memory of His Royal Highness Prince Mahidol of Songkla. You can watch Dr. Beck's acceptance speech (below) on YouTube.


Above: Dr. Aaron Beck's Acceptance of the Prince
Mahidol Award in Medicine; January 2012.


In November 2011, Dr. Judith Beck was presented with the Award for Outstanding Contributions by an Individual for Clinical Activities by the Association for Behavioral and Cognitive Therapies (ABCT), at the annual conference in Toronto.
CBT Workshops at Beck Institute
Click here to view our 2012 Calendar of Workshops
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