Rethinking Thought: Unpacking Cognitive Behavioral Therapy with Dr. Judith Beck

This week on the Corner, host Steve Martorano welcomes Judith S. Beck, PhD, a distinguished expert in Cognitive Behavioral Therapy (CBT) and co-founder of the Beck Institute. They delve into the intricacies of cognition, exploring the concept of automatic thoughts and their impact on our emotions and behaviors.  Don't miss out on this opportunity to rethink your thought process.

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Steve Martorano 
The Behavioral Corner is produced in partnership with Retreat Behavioral Health -- where healing happens.

The Behavioral Corner 
Hi, and welcome. I'm Steve Martorano, and this is the Behavioral Corner. You're invited to hang with us as we discuss how we live today, the choices we make, what we do, and how they affect our health and well-being. So you're on the corner, the Behavioral Corner. Please hang around for a while.

Steve Martorano  
Hi, everybody. Welcome again to the Behavioral Corner. It's me your favorite neighborhood corner hanger. Steve Martorano. Welcome aboard if you're just joining us for the first time. Simply put, we're a podcast about everything. Because everything affects our behavioral health. The whole shootin' match is made possible by our underwriting partners Retreat Behavioral Health, you'll hear more about them down the road. So let me welcome our guest right away. Dr. Judith Beck joins us. Dr. Beck is along with her dad. Aaron Beck, co-founder of the Beck Institute for Cognitive Behavioral Therapy, a topic that's very interesting to me. Anyway, I hope you'll find that as well. Dr. Beck, thanks for joining us on the program.

Dr. Judith S. Beck 
Oh, my pleasure.

Steve Martorano  
So what piqued my interest in this was a recent New Yorker article that I know you've seen that it's entitled, can cognitive behavioral therapy, change our minds in the subtitle they say that that premise is predicated on an unlikely idea. And the unlikely idea is what we're going to get into today with Dr. Beck before we get into the weeds on the therapy and that idea. When we talk about cognition, can you define cognition for us?

Dr. Judith S. Beck 
Sure. Cognition really means thinking. There are two levels of thinking that we particularly address in this kind of psychotherapy called cognitive behavior therapy. One is the thoughts that just seem to pop up into our heads, automatic thoughts, and we're particularly interested in the automatic thoughts that lead to an unhelpful reaction. So I'm not particularly interested in the unhelpful thoughts that are inaccurate. You know, most of us go through the day, and we don't think too much about our thinking, we may have some odd thoughts that pop up into our minds. But if we find that all of a sudden we're having a negative emotion, we're feeling sad or angry or anxious. It's probably because we have just had a thought, and the thoughts that pop up into our minds, as opposed to the ones that we want to be thinking, we call automatic thoughts because they seem to just pop up automatically. Now, when people are under a lot of stress, or when they have a psychological condition, or a psychiatric disorder, at least some of their thoughts are likely to be inaccurate, and unhelpful. And one of the things that we do in CBT, is to help people look for these automatic thoughts that pop up when either they're experiencing a negative emotion, or if they find that they're behaving in a way that is not in alignment with their values and their goals. We help people learn how to identify these thoughts and then how to ask themselves a series of questions to find out how accurate and helpful the thoughts really are.

Steve Martorano 
Well, that's why we want you here because that is the thorough and complete understanding of it. In my experience, I talk a lot about this...this falls under the broad umbrella of talk therapy, correct?

Dr. Judith S. Beck 
Correct.

Steve Martorano 
Okay. And that comes up very often when we do mental health programs here and substance abuse programs and all of that. So we talk about it a lot. And as the layperson in the room here, my simple description of CBT is, "Well if you change the way you think you'll change the way you behave." Is that pretty much it?

Dr. Judith S. Beck 
Yeah, that really is it you know, if you think about it, you know, here's so here's a typical everyday situation. I'm trying to eat in a healthy way. And I go downstairs and I open the freezer to pull out something to defrost for dinner and I see some ice cream. Well if I have the thought, "Wow, that ice cream looks good, but I'm going to wait till after dinner to have some." Then my behavior will probably be to close the freezer and not eat it. On the other hand, if my thought is "Wow, that ice cream looks really good and I know I'm not supposed to have it, but I really wanted to hell with it, I'm going to have it." Chances are my behavior will be to pull it out and start eating it. So the way that we think highly influences not only how we feel, but also our behavior.

Steve Martorano 
Where is the mind located? As opposed to...we know where our brain is?

Dr. Judith S. Beck  
Yes.

Steve Martorano 
Well, where is the mind located?

Dr. Judith S. Beck 
Well, we think the mind is really located in our brain. But there are a lot of different parts of our body that are constantly giving information to our brain.

Steve Martorano 
Yeah, the example I use a lot is, if you're looking at a picture or a movie of a sumptuous meal. And it just looks like the most delicious thing you've ever had, and you're suddenly hungry, you become hungry from looking at it. And then a bowling ball falls on your foot. And suddenly your consciousness has shifted to your foot. So your mind is sort of down there now. It's what leads to the New Yorker notion or at least premise that all of this CBT is predicated on what they say may be an unlikely idea that our irrational behavior can be solved by the very thing that caused the irrational thoughts or causing the irrational behavior yet, we're supposed to use the same tool, the mind. Well, I know, it doesn't strike you as an unlikely idea that we can be rational. Why would the New Yorker think it might be irrational?

Dr. Judith S. Beck  
Well, I think most of us go through the day just not thinking too much about our thoughts. And we might, we might be much more keenly aware of how we're feeling and what we're doing. You know, every once in a while, I'm sure most people have had this experience, where you have a thought such as, "Oh, I'll never get everything done." And then you look down at the list and you prioritize it, and you think to yourself, "Well, no, I guess I will, I'm just going to have to work really hard for the next few days. But we'll all get done." And that, in essence, is what we're trying to do for at least part of CBT is to identify the thoughts that could lead to unhelpful behavior or negative emotion and do a quick reality check on them. And what we need to do, particularly when people have a psychiatric disorder, or some kind of psychological condition, is to teach them the skills, because it's not intuitively obvious how it is that you figure out what you're thinking, it's not intuitively obvious about how you do a reality check. So at every session, we...at the beginning of the session, we do a lot of things, but one of the things that we do is to ask our clients, well, what goals do you have? What, goal or goals do you have for this week? Or what problems are you having that you want my help in solving? And then in the context of discussing specific problems or goals, we look for the thoughts that are going to help people live in alignment with their values and their goals. And then the ones that were probably bothersome to them that have really gotten in the way that have interfered with their being able to reach those goals. And we teach them how to evaluate their thinking.

Steve Martorano 
On the institute's website, which I recommend people don't want to know more about this therapy check out it's beckinstitute.org. You have a kind of flowchart...which is as clear as can be, it was a great aid and me trying to see what you guys call the cognitive mind. Yes, cognitive model, cognitive model. Yes. Can you take us through that chart?

Dr. Judith S. Beck 
Sure, so most people again, think it's situations that directly lead to their reaction. So someone might think, Oh, I'm so anxious because my boss is putting pressure on me. Or I feel so sad because my mother can't come to Thanksgiving. But it's not actually the situation that directly impacts how we feel and what we do and sometimes how our bodies react, but rather it's our interpretation of the situation. The woman who are the man who has the thought my boss is putting a lot of pressure on me and that's why I'm feeling anxious is probably what is closer to reality is that she's having the thought if I don't get it all done, he might fire me because another person in this situation might actually feel angry because he's had an angry...she's had an angry thoughts such as my boss shouldn't do that. This is unfair.

Steve Martorano 
Some others might be motivated.

Dr. Judith S. Beck  
That's right. So others might have a...it's conceivable someone might have a positive reaction and feel glad thinking, Well, finally, my boss is paying attention to what we really need to do to get this company, to produce what it has to produce.

Steve Martorano 
So in those situations when a situation arises, yeah, the problem occurs when the emotion attached to the situation is negative?

Dr. Judith S. Beck 
Well, not necessarily. I mean, there are certain situations where almost anybody would have a negative reaction. So what we're looking for are situations in which people have kind of a more extreme emotional reaction much more than the situation calls for. So CBT can't and doesn't want to get rid of all negative emotions. If you get the only way to get rid of all negative emotions is also to get rid of all positive emotions is to become like a robot. So we're looking for those situations that are connected to someone's goals values and aspirations in life. And where they are thinking has gotten them into trouble and posed obstacles to helping them get to where they want to be.

Steve Martorano 
What types of disorders are indicated for this kind of therapy?

Dr. Judith S. Beck 
Well, I'm glad you asked. The whole reason that people should learn more about CBT is because there have been over 2000 outcome trials that show that it's effective for a huge range of conditions. So it's been shown to be effective for a large number of psychiatric disorders, such as depression, bipolar disorder, all kinds of anxiety disorders, eating disorders, substance abuse, and even an adaptation of CBT called recovery-oriented cognitive therapy for people with serious mental health issues such as schizophrenia, or bipolar disorder. It's also been shown to be effective for a lot of psychological conditions like marital problems, couples problems, family problems, procrastination, test anxiety, public speaking phobias, and things like that.

Steve Martorano 
Well, well, yeah. And each of those is different. And I know you...you at the institute, you make a particular point, that one size does not fit all, in this kind of therapy, although the basics would apply to every situation since we're talking about the way we think we don't all think the same.

Dr. Judith S. Beck 
That's exactly right. Something else I'd like to point out is, that we've so far been talking mostly about negative thoughts and psychopathology, but recovery-oriented cognitive therapy, which I mentioned is an adaptation of CBT for people with serious mental health conditions, the focus is much more on increasing people's positive thinking and positive beliefs, much more so than correct negative thinking. And the principles of recovery-oriented cognitive therapy, are starting to now be integrated into more standard CBT. So in addition to focusing on negative thoughts, negative emotions, and so forth, we're also focusing on positive beliefs, positive thoughts, and positive emotions.

Steve Martorano 
You believe you can get better at thinking positively and having positive outcomes. Not unlike going to the gym and getting your body in shape by practicing a workout.

Dr. Judith S. Beck 
Yeah, that's what the research shows. Yeah. Research shows is when you engage in positive thinking, I just take as one example gratitude, it really does improve people's sense of well-being.

Steve Martorano 
Yeah. These are things that are, they seem anyway to be in shorter and shorter supply, things like gratitude humility, and empathy. Lacking those things, I guess would make open the floodgates to all kinds of negative thoughts. Let me ask you whether CBT therapy cognitive behavioral therapy is done in conjunction with medicine, with with drugs.

Dr. Judith S. Beck 
So CBT above all, is a very collaborative kind of therapy, and clients and therapists together, make decisions about what to discuss in treatment, how much time to spend on certain topics, and what the client is going to do between sessions. Many CBT therapists, in fact, most CBT therapists are not medical Doctors, they're not psychiatrists, psychologists, social workers, counselors, or people like that. And so, we don't usually get involved in the client's medication per se. But we do help clients figure out what kind of thoughts they might want to ask the prescriber about medication. We also help them adjust to the side effects of medication, if that's necessary. Also, if they in their provider have decided that the client should taper from a medication client might have withdrawal effects, and we certainly will help clients with that. But, but we don't prescribe medication. Having said that, at the Beck Institute, we have clients oftentimes, who have tried many different kinds of psychotherapy before and yet they still have problems, and many of them are on quite a lot of medication. If a client isn't sure whether or not he or she wants to take medication, then we would ask them, when would you like to look with me at what are the advantages and disadvantages of taking the medication? And what are the advantages and disadvantages of not taking the medication? And we might then also come up with a list of questions to ask the prescriber.

Steve Martorano 
We're talking about cognitive behavior therapy with Dr. Judith Beck. She is the co-founder of the Beck Institute, which is dedicated, as I said earlier, just improving people's lives through CBT. Dr. Beck, what else goes on at the institute, you also trained people in CBT.

Dr. Judith S. Beck 
Yes, we primarily do national and international training and CBT. So my dad and I established the Institute in 1994. And since then, we have trained about 40,000 people, from all types of all types of mental health professionals. And in recent years, we have begun training paraprofessionals and peer specialists, people with lived experience. And I should say we've also trained a large number of people in the medical field doctors, nurses, occupational therapists, and so forth.

Steve Martorano 
Well, that's great. It sounds as though you're saying that at some level of training, of course, a layperson could pick up the skills necessary to at least be able to discuss cognitive behavior with somebody who's troubled, is that right?

Dr. Judith S. Beck 
That's absolutely right. And in fact, this is being done in such innovative ways in other countries. So there's a country in Africa, for example, that teaches some of the elder women in the community how to do problem-solving and scheduling activities with depressed younger women and they sit on a bench, it's called a friendship bench, the women come and sit and talk to them about it. So these are not highly trained people. In fact, they're not mental health professionals at all. However, the techniques of CBT are pretty straightforward. One of the things we tell our own clients is that it's not enough just to come to treatment and talk for 45 minutes a week or so. They're going to learn things in every session. And they're going to practice these kinds of techniques of changing their thinking and their behavior every day at home. And we tell them, you know, our goal is to make you your own therapist, and the way that people get better is by making small changes in their thinking and behavior every day.

Steve Martorano 
Yeah, it sounds a lot like the origins of this are deeply rooted in, in community and folk remedies that existed in in organizations where there were empathetic people with people trusted, that you could talk to.

Dr. Judith S. Beck 
And having a strong therapeutic relationship is absolutely crucial for cognitive behavior therapy as it is for any kind of psychotherapy.

Steve Martorano  
Well, tell me about that because it would seem to me, that what's critical here is that the patient or client gets the right therapist.

Dr. Judith S. Beck 
There does have to be a good match. I have to say, I think there's a lot of uniformity among people who practice CBT where I think we tend to be really practical, nice people and that's why we're really drawn to it. It really makes sense to us that we want to teach our clients not only to help them get better but teach them skills so that they can stay better so they won't have a recurrence of the condition or the disorder.

Steve Martorano 
I can see the allure of this thing. I know why it's widely used and I know why people think it can be very, very beneficial because there is something second nature about this it seems to be something that we do all the time on our own and don't think of it as therapy, closing the refrigerator door and saying I'll eat the ice cream later. Doesn't sound like a therapeutic act, but it is.

Dr. Judith S. Beck 
You're right. And so much of this is common sense. When people first come to treatment, usually they're in a lot of distress. And one of the things we find out from them is what's really important to them in life. And how do they want to be how do they want their lives to be, and then at every session, we help them take steps toward that vision. And again, what gets in the way, sometimes they're practical problems. So you need to have a lot of common sense to be a good CBT therapist. And the other thing that frequently gets in the way, as we've been talking about all along is unhelpful thinking.

Steve Martorano 
And both people are certainly therapists is sort of a given that they would be rational, reasonable people. But what happens, I want to circle back this to this again, because when you're dealing with, let's say, a serious case of bipolar one, where the person's disorder, the very nature of the disorder is telling them falsehoods, lies and directing them towards destructive behavior. And the whole time, they're feeling great about it. They're feeling and when approached by a reasonable person saying, you need to do X, Y, and Z here. Their reaction is and it's reasonable to them in their state. Well, that's, I don't want to do that. I won't feel like this anymore. How does CBT break down that?

Dr. Judith S. Beck 
Oh, so I'm going to give you a short answer. But we could spend several weeks just talking about this. The best time to work with someone who has mania, that's what you're describing someone who might be up for five or six days in a row and getting no sleep and having grandiose ideas and engaging in very risky behavior, having very, very rapid thinking thoughts, that run through their mind. The best time to work with them on it is when they're either in a neutral mood or a slightly depressed mood. And then you're really doing relapse prevention, you're saying let's talk about what are the early warning signs of mania, your early warning signs? Let's get down to writing a plan of what you can do when you notice these early warning signs happening. So you want all of that in writing. You also want to ask the client to predict what kinds of thoughts or what kind of situations might the client get involved with, when they're manic, which would then lead to some disruptive behavior that they're going to be sorry for later. So they can look back at their history and see what's going on. And then we help them identify what kind of manic thinking they may have in those situations, and what they want to be able to tell themselves the next time they have these kinds of bad thoughts and we make sure that that's all down in writing. And we very likely will have a family member or a friend come to at least one or more sessions, if the client is willing so that that person knows what to say.

Steve Martorano 
And of course, the the tricky. The tricky thing here is applying all of those CBT techniques at the moment when the mania has subsided. Yes. And the deep depression that often follows has not kicked in. As you know, it's very difficult to be in that sweet spot. Because of all of the questions and responses you as a clinician want to elicit from that person, you may be getting wrong information, they may be lying to you, they may be telling you things that aren't true, or I don't have any triggers or what are you talking about? So...

Dr. Judith S. Beck 
That's why it's helpful to have another person if the client is willing to come to treatment to...

Steve Martorano 
Someone close...somebody who understands the situation?

Dr. Judith S. Beck 
Yeah, yeah. A close family member, a close friend, and so forth.

Steve Martorano 
So, that's tricky I think that that schizophrenia and things like that would be the most extreme examples of this. But as you mentioned at the beginning of CBT, has been very effective over many years over such a wide range of behaviors from anxiety, to depression, and certainly, phobias, right I mean, phobias must, must be the perfect case. When people have irrational fears having grown up with some family members who weren't debilitated by some of these things, but you know, didn't like getting in an elevator and were a little shaky going across the bridge in a car. Those sorts of things are really right in your wheelhouse, right?

Dr. Judith S. Beck 
That's why in order to test their fears, we need to do what we call exposure, having them get into the situation and not try to do anything to make their anxiety last, not try to do anything to make the situation better. But they need to find out once and for all, whether their fears really come true. You can talk about it intellectually with them, and they may have an intellectual understanding that spiders are most spiders are not harmful. But it's not until they actually are in a situation and allow themselves to stay in that situation till the anxiety comes down, that they find out that their fears really are...I mean, they understand it at an intellectual level, but then they start to believe it at an emotional level once they've gone through the experience.

Steve Martorano 
It's so real world, and I correct myself if I'm wrong, but in the CV area. It's less a question of well, what the childhood trauma is causing this stuff and that's part of it, for sure. But it seems to be CBT says to people, Look, I know you're afraid of flying. Why don't you take a short flight someplace and notice that everything will be fine? And when the plane lands, you go well, gee, that was that was okay. In other words, real-world... real-world effects. Yes, works better.

Dr. Judith S. Beck 
You have to sometimes build up to it. Right? Start by just talking about taking the airline flight, then we might start watching videos of what it's like to sit inside an airplane. And so when we're doing exposure, sometimes people are willing to just go for it. And sometimes we have to do it a little bit more gradually.

Steve Martorano 
Yeah, you have to meet them where they are. Jude is back. Dr. Judith Beck is our guest from the Beck Institute for Cognitive Behavioral Therapy. It's mission is to spread the gospel of CBT training. And I take it that you in addition to the institute, you take private patients, we do

Dr. Judith S. Beck 
We do and we actually are now treating many patients via Zoom. So we find and the research shows that CBT can be just about as effective with distance therapy as it is face-to-face therapy. Yeah.

Steve Martorano 
Are you up for your private pay? How does it work?

Dr. Judith S. Beck  
We are. We are located in Bala Cynwyd, right across City Line.

Steve Martorano  
Yeah, yeah, we're neighbors. We do this from suburban Philadelphia and Chestnut Hill. Anyway, more information about the institute, as I said, Beckinstitute.org. For those of you who are in the area that has some direct interest and others who just want to know more about cognitive behavioral therapy, I think, at the very least, we found out that, you know, this is the kind of skill you can pick up yourself. Wouldn't be a bad thing to have a handle on. And if you need help, there are professionals like Dr. Beck out there that can who can help you, Judy, right? I can call you Judy

Dr. Judith S. Beck 
Of course.

Steve Martorano 
Thank you. I appreciate your time. We'd love to have you back. It's a big topic. And there are all kinds of different tangents that we could get into. We appreciate your expertise your time and your work.

Dr. Judith S. Beck 
Well, thank you. This is one of my favorite topics to talk about.

Steve Martorano 
I'll bet thank you guys for your time as well. Don't forget to look for us wherever you find your podcasts which are everywhere lying around. And when you find us listen, like subscribe to the whole thing. The Behavioral Corner we will catch you next time bye bye.

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