Erica Russell, Dr. Judith Beck and the workshop participants
I recently attended the Beck Institute’s training on Cognitive Therapy for Depression and Suicidality in San Francisco. The Beck Institute was established by Dr. Aaron Beck, the father of CBT, and his daughter, Dr. Judith Beck. As a world-renowned resource for training in CBT, I felt extremely lucky to attend this event and receive training from some of the CBT field’s most prominent members. The three-day training was host to professionals from all over the world and was led by Dr. Judith Beck and Dr. Daniella Cavanaugh, the Beck Institute’s Director of Education.
The CBT treatment for depression focuses on building awareness of and shifting these negative automatic thoughts and core beliefs, as well as developing a plan to increase a client’s daily activities. The training began by reviewing the basics of the cognitive model and then went on to provide specific information on the conceptualization and treatment of depression and suicidality. The Beck Institute conceptualizes depression as a combination of negative core beliefs (which we formulate early in life based on our experiences), negative automatic thoughts (which are typically linked to our core beliefs, but are activated more immediately), and maladaptive coping behaviors (which may involve social isolation, a lack of physical activity, or avoiding previous activities or interests).
Dr. Beck delved into the most common core beliefs held by depressed individuals and then discussed how these beliefs influence negative automatic thoughts. Common core beliefs center around a negative view of the self, the world, and the future. Clients typically express thoughts about themselves related to being “helpless”, “hopeless” or “worthless”.
Through role plays, Dr. Beck demonstrated how to uncover core beliefs and shift negative automatic thoughts toward more realistic alternative thoughts. She utilized socratic questioning, which involves assisting the client in evaluating and clarifying his or her statements, to uncover and shift negative automatic thoughts. Examples of socratic questions include: “What evidence do I have that this thought is true?” and “what’s an alternative viewpoint?” To assist with uncovering the deeper core beliefs, Dr. Beck utilized the downward arrow technique, which involves asking questions to elicit the meaning behind an automatic thought, such as “what would it mean to you if that was true?” This segment of the training involved time for those in attendance to pair up and practice interventions in role plays together. As a therapist, getting to witness Dr. Beck in action was like getting to watch a favorite rockstar on stage!
Erica and Dr Cavanaugh
After covering cognitive interventions, Dr. Beck spent time discussing the most helpful behavioral strategies for depression, including scheduling pleasant activities, teaching problem solving and interpersonal skills, and encouraging adaptive behaviors, such as exercise and relaxation.
The final day of the training was led by Dr. Cavanaugh and focused on the treatment of suicidal clients. I found the information about practicing coping skills to prevent relapses into suicidal thinking to be particularly helpful. One of my favorite new ideas for coping with suicidal thoughts is a free app called “Virtual Hope Box”. The app includes the ability to add pictures or music that help you to feel hopeful, play games or access relaxation excesses for distraction, and create coping cards with positive responses to your most common negative thoughts. Dr. Beck also recommended creating a physical hope box (an actual collection of photos or items that help you to feel hopeful), but I loved the idea of having this electronic option that you can always carry with you.