Core beliefs in CBT
We all have central beliefs are about ourselves and our relations to others; they are like short cuts to which we revert, time after time. The problem arises when they become maladaptive, and in which case they often highlight an underlying belief about us being one of three things: unlovable, helpless or worthless.
They often originate in our childhood experiences, and can be related to our personality. For example, a child whose siblings are cruel to them and whose mother does not defend them, may start to believe that they are worthless. If their personality is perhaps more introvert, then they may never speak of their feelings to their mother which means they might never get the ‘your safety and wellbeing is important to me’ response which would quash the thought that they are worthless. So the belief continues.
These beliefs surface during times of psychological distress when they become activated. At times like this we will start to see, in the world around us, only the information which supports the core belief; we almost start to build a case for it being true.
What is hard, particularly when working as a therapist with such clients, is that these beliefs are not often articulated or easily articulated. If this is the case then we can follow the following structure:
- Hypothesise which category of core belief they fall into
- Present this idea to the client
- Educate the client about core beliefs
- Understanding the childhood origin of the belief
- Understand what maintained it through time
- Understand how it contributes to difficulties currently
- Monitor its activation in the present
We would call them ideas at the first stage and explain that there are two options, either they ARE incompetent (or unlovable or worthless) or they BELIEVE they are incompetent (or unlovable or worthless) and thus act incompetently. We would then explain about how core beliefs stop the good stuff getting through and illustrate this by asking them for an example of when this happened in the last week, i.e. when some evidence to the contrary happened but they wrote it off.
We would then help them gather information to strengthen a more accurate core belief by:
- Ask them what their core belief was before they got depressed
- Ask what their strengths are
- Notice data and label that as strengths
- Ask for positive experiences from last week
- Keep a credit list of things that the client is doing ok on or receiving love for
- Ask them for contrary evidence continually
- When they are displaying positive behaviours ask what that means about them and what it is about them which makes this happen
- Give positive feedback about their skills and behaviours
- Ask them to gather evidence too (they might need a reminder to do this; a bracelet, a post it, reminder in phone)
Of course there are ways of doing this and I’d like to explain this in a bit more detail.
We might get the client to fill out a Core Belief worksheet which comprises the evidence supporting the new core belief of (for example) “I’m competent but human” and also the evidence supporting the old core belief of (for example)“I’m incompetent” BUT with a reframe afterwards which allows them to broaden the perspective.
I would also use an extreme example of an incompetent (for example) person that they know and ask what that person is doing. I would then ask how they are different from that person.
I might use a story or an example of someone famous to illustrate similarities between them and elicit how the wouldn’t judge the example unfavourably so illustrating how it is not logical why they should judge themselves in such a way i.e. Cinderella wasn’t bad just because she got abused.
It is also possible to use the emotion a client displays in session. So when the client is emotional, we might explore why and what the core belief is behind it and then ask about where they feel it in the body. Then we might ask them to remember a time when they were younger when they experienced this same feeling. Then we would discuss it and ask about how the other people in the situation were behaving and whether their actions were right. We might also ask why they and others might have acted that way. Then we might role play the situation with you, the therapist, as the young client and the client as the other person in the memory.
We could also do the same as above but using imagery instead. I might interview the younger client, getting them to imagine the scene when they were young, asking for details and ask for thoughts, feelings and behaviours, so that it intensifies the effect. Then I would ask if the older version of them can come into the scene to talk to them. I would get them to choose where they should stand and whether they’re holding hands etc. Then I might get the client to talk to themselves as the old client to young client, talking them through the conversation, i.e. saying older client, ask the younger client what’s wrong, now what would young client say? etc.
I would stop when the client is feeling a bit better and ask them to rate how believable (emotionally and intellectually) the old belief is and now the new belief. I would then take them back to the present day exercise and ask them how the same principle applies.
There are other CBT techniques which can also be used alongside this to help the client both manage real problems,and help them cope with core beliefs and overcome some core beliefs:
- Problem solving
- Making decisions using a decisional matrix
- Asking them how they refocus away from their core beliefs and onto their daily life
- Distraction (such as walk, tv, newspaper, music, call someone, email someone, clean, do finances, go to the shop, bath, prayer)
- Complete thought records
- Measure mood intensity during activities to find patterns and to show that things do fluctuate
- Graded tasks of overcoming fears bit by bit
- Role playing to learn social skills and practice beforehand
- Draw a pie chart to show the imbalance of time spent on things they don’t want to be doing vs ideally what they’d like to be doing (in arenas of fun, social, work, hobbies etc) and then ask how they feel about adjusting, then asking them to test their prediction.
- Determining their responsibility for success, i.e. Get them to identify other reasons for failure (such as luck, other people’s actions, weather, lack of resources and training) and put this in a pie chart and then re-evaluate the core belief after this
- Ask them to compare themself to themself at their worst rather than comparing themselves to others (by explaining that it’s not reasonable to compare to others without depression for example)
- Get them to write a credit list through the week of positive activities or things which were hard but ‘I pushed through anyway’
Clients might not relate to the idea of core beliefs as thoughts but might call them memories, mental pictures, imaginings, fantasies, images, visual ideas.
Techniques which we use with images differ slightly:
- Completion: I would explain that the image normally stops at the worst point, and get the client to imagine what happens next and after that and again and so on and try to guide them to see themselves coping, can say “what do you want to imagine happens next?”. If it ends in catastrophe, then we might ask for the meaning of this and this might highlight another core belief.
- Jumping ahead: I would ask them to jump to the completion of the event they are imagining and imagine the detail of it and ask how it feels once they’ve done this
- Coping: I might ask them to go through the image again and imagine themselves coping the next time
- Changing the image: I would explain they’re the director of the upsetting scene and ask them to imagine how they wish it would happen next. I would then discuss what they could do behaviourally to make this more likely.
- Reality test the image, using evidence to critique it
- Repeat the image and ask how it changes every time
- Substitute the image, as if it was on TV and then change the channel or volume or colour
We can also induce images to help us challenge a thought, for example:
- Imagine a year from now what will you be doing, ask them for details from when they wake up and notice how the thought doesn’t often appear
- Imagine the prediction and then ask them to imagine what they will do to help themselves cope
- Imagine the consequences or what life will be like in 6m, a year, 5 years
- Get them to imagine more encouraging surroundings and faces and equipment around them
Hopefully, this article will have given you more of an understanding of core beliefs within a CBT framework, but more importantly how, as therapists or individuals, we can challenge the unhelpful ones to help us live happier lives.
www.happii.uk is a website providing information about mental health and wellbeing.
Happii.uk is provided by Anna Batho, a therapist working in High Wycombe and providing therapy in Amersham and the wider Buckinghamshire (Bucks) region. You can contact her here.