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Biomedical subjects

Aaron T Beck

Publications and source records attributed to Aaron T Beck.

At least 19 recordsLinked to original sources
PubMed2007

Characteristics of recent suicide attempters with and without Borderline Personality Disorder.

The present research compared recent suicide attempters with and without a diagnosis of Borderline Personality Disorder (BPD). One hundred and eighty recent suicide attempters, recruited in the Emergency Department, participated in extensive research interviews. Results showed that suicide attempters with BPD displayed greater severity of overall psychopathology, depression, hopelessness, suicidal ideation, past suicide attempts, and had poorer social problem solving skills than those without a BPD diagnosis. No differences were found between the groups regarding the intent to die or lethality associated with the index suicide attempt. These findings highlight the seriousness of BPD and the risk that individuals diagnosed with this disorder will attempt suicide.

Adolescent↗
PubMed2006

Cognition checklist for mania-revised.

The Cognitive Checklist for Mania-Revised (CCL-M-R), which measures the severity of maladaptive beliefs and cognitions associated with mania, was administered to 35 inpatients with a major depressive disorder, 20 inpatients with a schizoaffective disorder, and 45 inpatients with a bipolar I disorder to determine whether cognitions associated with mania differentiate patients who have most recently experienced either manic, mixed, or depressive episodes. The CCL-M-R is composed of four subscales assessing (a) exaggerated beliefs about self-worth (Myself), (b) grandiose beliefs about interpersonal relationships (Relationships), (c) erroneous beliefs about needing excitement from engaging in high risk situations (Pleasure/Excitement), and (d) unrealistic beliefs about having high energy levels for undertaking goal-driven activities (Activity). As hypothesized, the mean CCL-M-R total, Myself, Relationships, and Activity scores of the 26 patients with manic episodes were higher than those for either the 17 patients with mixed episodes or the 57 with depressive episodes. The CCL-M-R was discussed as a reliable and valid instrument for measuring the severity of maladaptive cognitions associated with mania in psychiatric patients.

Adult↗
PubMed2006

Factors of suicide ideation and their relation to clinical and other indicators in older adults.

BACKGROUND: Research on the factor structures of the Scale for Suicidal Ideation (SSI; [Beck, A.T., Kovacs, M., Weissman, M., 1979. Assessment of suicidal intention: the Scale for Suicide Ideation. J. Consult. Clin. Psychol. 47, 343-352]) and the Modified Scale for Suicide Ideation (MSSI; [Miller, I.W., Norman. W.H., Bishop, S.B., and Dow, M.G., 1986. The modified scale for suicidal ideation: reliability and validity. J Consult Clin Psychol, 54, 724-725]) in younger adults have tended to yield two factor solutions. The purpose of the current study was to examine the factor structure of the SSI in an older population in order to determine whether the factor structure was similar and, if so, whether the factors related to other clinical and demographic correlates. METHODS: 199 participants (M age 57, S.D.) were selected from a combined database of psychiatric outpatients and inpatients over the age of 49 currently experiencing suicidal ideation. Principal axis factoring was used in order to determine the factor structure of the SSI. In addition, we ran correlations and regression analyses to determine the relation of each factor with other clinical and demographic correlates. RESULTS: Consistent with prediction, we found a two-factor solution. Also consistent with predictions, clinical and demographic correlates related differentially to each of the factors. LIMITATIONS: The relatively small sample size and the fact that our sample was predominantly Caucasian. CONCLUSION: The current study has provided data on the factor structure of the SSI in an older population, demonstrating that suicidal ideation in this group is similar to younger age groups.

Age Factors↗
PubMed2006

Hypothesized mechanisms of change in cognitive therapy for borderline personality disorder.

Preliminary evidence suggests that cognitive therapy (CT) is effective in treating borderline personality disorder (BPD). According to cognitive theory, BPD patients are characterized by dysfunctional beliefs that are relatively enduring and inflexible and that lead to cognitive distortions such as dichotomous thinking. When these beliefs are activated, they lead to extreme emotional and behavioral reactions, which provide additional confirmation for the beliefs. It is hypothesized that a change in dysfunctional beliefs is the primary mechanism of change associated with CT. However, additional mechanisms of change are likely also at work in CT, including enhancement of skills, reduction in hopelessness, and improvement in attitude toward treatment. Each of these mechanisms is discussed in light of cognitive theory, data from an open clinical CT trial, relevant literature, and therapeutic interventions. Findings from the CT trial support the role of cognitive change during therapy and its continuation after termination.

Attitude to Health↗
PubMed2006

Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders.

Participants were 30 adult outpatients diagnosed with avoidant personality disorder or obsessive-compulsive personality disorder who enrolled in an open trial of cognitive therapy for personality disorders. Treatment consisted of up to 52 weekly sessions. Symptom evaluations were conducted at intake, at Sessions 17 and 34, and at the last session. Alliance variables were patients' first alliance rating and "rupture-repair" episodes, which are disruptions in the therapeutic relationship that can provide corrective experiences and facilitate change. Stronger early alliances and rupture-repair episodes predicted more improvement in symptoms of personality disorder and depression. This work points to potentially important areas to target in treatment development for these personality disorders.

Adult↗
PubMed2006

Attentional fixation in panic disorder.

According to Beck's (1988) clinical observations, patients with panic disorder describe a fixation on their distressing physical and psychological symptoms and an inability to access corrective information during panic attacks. The present study sought to evaluate empirically the notion that attentional fixation is characteristic of these patients. A subset of panic patients participating in 3 cognitive therapy clinical trials completed the Attentional Fixation Questionnaire (AFQ) at intake, during treatment and at termination. The AFQ had adequate internal consistency at all time intervals, and it correlated positively with measures of depression, anxiety and distorted cognitive content. At termination, the AFQ total score and nearly all single items decreased significantly, and patients who continued to meet diagnostic criteria for panic disorder scored higher on most items than patients who no longer met diagnostic criteria for panic disorder. These preliminary data suggest that attentional fixation is an important dimension of cognition relevant to panic disorder.

Adult↗
PubMed2006

Mean Beck Depression Inventory-II total scores by type of bipolar episode.

The 1996 Beck Depression Inventory-II was administered to 120 outpatients diagnosed with DSM-IV-TR bipolar I disorders who had recently experienced manic, mixed, or depressed episodes. A focused contrast supported the hypothesis that the mean Beck-II total score for the 40 patients with depressed episodes (M=34.1, SD = 13.2) was higher than the mean Beck-II total score for the 40 patients with mixed episodes (M=25.9, SD= 13.6) which was, in turn, higher than the mean Beck-II total score for the 40 patients with manic episodes (M= 11.7, SD=7.8, p<.001). The Beck Depression Inventory-II appears to be useful for measuring self-reported depression in patients with bipolar I disorders.

Adolescent↗
PubMed2006

When does the daily hazard rate for committing suicide stabilize in psychiatric outpatients?

To ascertain whether the daily hazard risk rate for committing suicide by psychiatric outpatients stabilizes over time, a parametric survival analysis was calculated for the 6891 outpatients who were followed by Brown, Beck, Steer, and Grisham. Approximately 3 1/4 years after a patient's initial evaluation, the daily hazard rate leveled off and dropped below the hazard rate that would occur if a constant (exponential) daily hazard rate were assumed. The cost-effectiveness of conducting follow-up studies to identify suicidal risk factors in psychiatric outpatients beyond three years was questioned.

Adolescent↗
PubMed2005

Are there any gender differences in frequency of self-reported somatic symptoms of depression?

BACKGROUND: The purpose of this study was to evaluate whether self-reported somatic symptoms of depression, as measured by the Beck Depression Inventory-II (BDI-II), are more frequent in women than in men with major depressive disorder. METHODS: A sample of 105 male and 105 female adult psychiatric outpatients diagnosed with major depressive disorder was classified according to endorsed changes in appetite, changes in sleeping pattern, and fatigue (i.e., "somatic depression") symptoms on the BDI-II. RESULTS: The female to male ratio of somatic symptoms was approximately 2:1. Subsequent analyses found that change in appetite robustly distinguished between women and men and that fatigue partially distinguished between women and men. LIMITATIONS: The sample was largely Caucasian and composed of patients with high rates of comorbidity who presented to a service known for specializing in cognitive therapy. CONCLUSIONS: In outpatients with major depressive disorder, the higher prevalence of "somatic depression" in women is largely attributable to changes in appetite.

Adult↗
PubMed2005

The empirical status of cognitive-behavioral therapy: a review of meta-analyses.

This review summarizes the current meta-analysis literature on treatment outcomes of CBT for a wide range of psychiatric disorders. A search of the literature resulted in a total of 16 methodologically rigorous meta-analyses. Our review focuses on effect sizes that contrast outcomes for CBT with outcomes for various control groups for each disorder, which provides an overview of the effectiveness of cognitive therapy as quantified by meta-analysis. Large effect sizes were found for CBT for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders. Effect sizes for CBT of marital distress, anger, childhood somatic disorders, and chronic pain were in the moderate range. CBT was somewhat superior to antidepressants in the treatment of adult depression. CBT was equally effective as behavior therapy in the treatment of adult depression and obsessive-compulsive disorder. Large uncontrolled effect sizes were found for bulimia nervosa and schizophrenia. The 16 meta-analyses we reviewed support the efficacy of CBT for many disorders. While limitations of the meta-analytic approach need to be considered in interpreting the results of this review, our findings are consistent with other review methodologies that also provide support for the efficacy CBT.

Cognitive Behavioral Therapy↗
PubMed2005

Dysfunctional beliefs in panic disorder: The Panic Belief Inventory.

The Panic Belief Inventory (PBI) was developed to assess beliefs that increase the likelihood of catastrophic reactions to physical and emotional experiences in panic disorder. In the first stage of scale development, 197 panic disorder patients completed the PBI and standard self-report inventories of psychiatric symptomatology. An exploratory factor analysis yielded a 4-factor solution from which a 35-item instrument with 4 scales was constructed. The shortened measure and its scales had good internal consistency and convergent validity and moderate discriminant validity. Subsequently, 22 panic disorder patients who received cognitive therapy completed the PBI and other self-report inventories of dysfunctional cognitions at intake, 4 weeks, 8 weeks, termination, and several follow-up intervals. Results indicated that the PBI decreased significantly across treatment, with the largest decline occurring between intake and 4 weeks into treatment. The PBI correlated more strongly with dysfunctional cognitions associated with anxiety than dysfunctional cognitions associated with depression. These results provide preliminary evidence that the PBI has adequate psychometric characteristics, is useful to assess change in dysfunctional beliefs during treatment, and has the potential to advance cognitive theories of panic.

Adult↗
PubMed2005

Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial.

CONTEXT: Suicide attempts constitute a major risk factor for completed suicide, yet few interventions specifically designed to prevent suicide attempts have been evaluated. OBJECTIVE: To determine the effectiveness of a 10-session cognitive therapy intervention designed to prevent repeat suicide attempts in adults who recently attempted suicide. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of adults (N = 120) who attempted suicide and were evaluated at a hospital emergency department within 48 hours of the attempt. Potential participants (N = 350) were consecutively recruited from October 1999 to September 2002; 66 refused to participate and 164 were ineligible. Participants were followed up for 18 months. INTERVENTION: Cognitive therapy or enhanced usual care with tracking and referral services. MAIN OUTCOME MEASURES: Incidence of repeat suicide attempts and number of days until a repeat suicide attempt. Suicide ideation (dichotomized), hopelessness, and depression severity at 1, 3, 6, 12, and 18 months. RESULTS: From baseline to the 18-month assessment, 13 participants (24.1%) in the cognitive therapy group and 23 participants (41.6%) in the usual care group made at least 1 subsequent suicide attempt (asymptotic z score, 1.97; P = .049). Using the Kaplan-Meier method, the estimated 18-month reattempt-free probability in the cognitive therapy group was 0.76 (95% confidence interval [CI], 0.62-0.85) and in the usual care group was 0.58 (95% CI, 0.44-0.70). Participants in the cognitive therapy group had a significantly lower reattempt rate (Wald chi2(1) = 3.9; P = .049) and were 50% less likely to reattempt suicide than participants in the usual care group (hazard ratio, 0.51; 95% CI, 0.26-0.997). The severity of self-reported depression was significantly lower for the cognitive therapy group than for the usual care group at 6 months (P= .02), 12 months (P = .009), and 18 months (P = .046). The cognitive therapy group reported significantly less hopelessness than the usual care group at 6 months (P = .045). There were no significant differences between groups based on rates of suicide ideation at any assessment point. CONCLUSION: Cognitive therapy was effective in preventing suicide attempts for adults who recently attempted suicide.

Adult↗
PubMed2005

The current state of cognitive therapy: a 40-year retrospective.

The basic framework of the cognitive theory of psychopathology and cognitive therapy of specific psychiatric disorders was developed more than 40 years ago. Since that time, there has been continuing progress in the development of cognitive theory and therapy and in the empirical testing of both. A substantial body of research supports the cognitive model of depression and, to a somewhat lesser extent, the various anxiety disorders. Cognitive therapy (CT), often labeled as the generic term cognitive behavior therapy, has been shown to be effective in reducing symptoms and relapse rates, with or without medication, in a wide variety of psychiatric disorders. Suggestions for future research and applications are presented.

Anxiety Disorders↗
PubMed2005

Screening for obsessive and compulsive symptoms: validation of the Clark-Beck Obsessive-Compulsive Inventory.

The 25-item Clark-Beck Obsessive-Compulsive Inventory (CBOCI) was developed to assess the frequency and severity of obsessive and compulsive symptoms. The measure uses a graded-response format to assess core symptom features of obsessive-compulsive disorder (OCD) based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria and current cognitive-behavioral formulations. Revisions were made to the CBOCI on the basis of psychometric and item analyses of an initial pilot study of clinical and nonclinical participants. The construct validity of the revised CBOCI was supported in a subsequent validation study involving OCD, nonobsessional clinical, and nonclinical samples. A principal-factor analysis of the 25 items found 2 highly correlated factors of Obsessions and Compulsions. OCD patients scored significantly higher on the measure than nonobsessional anxious, depressed, and nonclinical samples. The questionnaire had strong convergent validity with other OCD symptom measures but more modest discriminant validity.

Adult↗
PubMed2005

History of family suicide behaviors and negative problem solving in multiple suicide attempters.

This study examined the relationship between family history of suicide, negative problem solving orientation and suicide attempt status (multiple suicide attempters versus single suicide attempters). Suicide attempters with a family history of suicide were more likely to have multiple suicide attempts when compared to suicide attempters who did not have a family history of suicide. This relationship was consistent with a model in which the relationship between family history and suicide attempt status is mediated by negative problem solving. Results of this study are discussed as they pertain to the theory and treatment of suicide attempters.

Adult↗
PubMed2005

Individual and group cognitive-behavioral therapy for psychotic disorders: a pilot investigation.

The present study is an uncontrolled pilot investigation of individual and group cognitive-behavioral therapy (CBT) for patients with positive symptoms of psychosis (n = 6). While previous studies have utilized either individual or group CBT for schizophrenia, the present investigation is the first to include both components for patients in the chronic phase of a psychotic illness. The results of this pilot study suggest that this approach may be useful for both positive and negative symptoms of psychosis. In addition, depression, anxiety, and hopelessness scores all decreased dramatically. The majority of the gains made during treatment were maintained over an 11-month follow-up period. A combined CBT treatment program may offer benefits in terms of delusional thinking, depression, and anxiety when used as an adjunctive treatment to medication. While the present study demonstrated positive effects from treatment, results are limited by the small sample size.

Adult↗
PubMed2005

Content-specificity of dysfunctional cognitions for patients with bipolar mania versus unipolar depression: a preliminary study.

OBJECTIVE: Dysfunctional beliefs or cognitions are considered to be fundamental to both the phenomenology and pathogenesis of depression. However, the cognitive aspects of mania have not been as thoroughly investigated. We sought to compare the maladaptive beliefs and cognitions of 23 bipolar manic or hypomanic patients, 28 patients with unipolar major depression, and 24 normal adults. METHOD: The Cognition Checklist for Mania (CCL-M) was used to assess the beliefs. This 61-item self-report instrument is scored for seven subscales measuring (a) self-importance, (b) interpersonal grandiosity, (c) inappropriate spending, (d) excitement and risk-taking, (e) interpersonal frustrations, (f) goal-driven activity, and (g) past or future outlooks on life, and also yields a total score. RESULTS: The mean CCL-M total score of the bipolar-manic patients was significantly higher than the mean CCL-M total score of the unipolar-depressed patients, and the patients' mean CCL-M total score was also higher than that of the normal adults. The mean scores of the subscales measuring excitement and past and future memories and expectations were also significantly higher for the bipolar-manic than unipolar-depressed patients. CONCLUSIONS: Bipolar-manic patients endorse with maladaptive beliefs and cognitions that are associated with mania more than do unipolar-depressed patients and normal adults. The implications for the early identification of cognitions associated with prodromal states of mania, and for psychotherapeutic interventions, are discussed.

Adult↗