1. Pg-Certificate CBT-2017 Dr.Bashir Ahmad (Course Director)

2. Dysfunctional Belief System PgCertrificate CBT Dr Bashir Ahmad

3. Dysfunctional belief system
Core Beliefs Intermediate Beliefs Automatic Thoughts

4. Core Beliefs
The most fundamental level of belief develops in childhood as the child interacts with significant others and encounters a series of situations. For most of their lives, most people may maintain relatively positive core beliefs e.g., I am substantially in control, I can do most things competently, I m worthwhile etc. Negative core beliefs may surface only during times of psychological distress

5. Core Beliefs
Negative core beliefs are usually global and absolute. When activated, patient is easily able to process information that supports it but fails to recognize or distorts information that is contrary to it The degree of identifying and modifying core beliefs varies from patient to patient. It is easier to modify the negative core beliefs of axis 1 patients whose counterbalancing positive core beliefs have been activated through out much of their lives.

6. Core Beliefs
Negative core beliefs of personality disorder patients are much more difficult to modify because they typically have fewer positive core beliefs and they have developed a multitude of negative core beliefs that interconnect, supporting each other like a network.

7. Categories of Core Beliefs
Helpless core beliefs I’m helpless, powerless, out of control, weak, vulnerable, trapped, inadequate, ineffective, incompetent, failure, disrespected, not good enough.

8. Categories of Core Beliefs
Unlovable Core Beliefs
I’m unlovable, unlikeable, undesirable, unattractive, unwanted, unworthy, different, defective, bound to be rejected, bound to be alone.

9. Modifying Negative Core Beliefs(NCB)
Having identified the NCB, the therapist mentally devises a new, more realistic belief and guides the patient toward it.
CBT techniques( Socratic questioning , examining advantages and disadvantages, behavioural experiments) attenuates the old belief.
Collaboratively they develop a new, more adaptive belief.

10. Modified NCB Old Core belief I’m ( completely ) unlovable I’m bad
New Core belief
I’m generally a likeable person
I’m a worthwhile person with positive and negative features
I’m powerless
I’m defective
I have control over my things
I’m normal, with both strengths and weaknesses

11. Intermediate Beliefs
Core beliefs influences the development of an intermediate
class of beliefs consisting of;
Attitudes, Rules and Assumptions.
Assumptions are the intermediate beliefs that exist between core beliefs and Negative Automatic thoughts

12. Intermediate Beliefs
Assumption: “if I work as hard as I can, I may be able to do some things that other people can do easily”.
Rules/expectation: “I must work as hard as I can all the time”
Attitude: it’s terrible to ask for help (be incompetent)

13. Intermediate Beliefs
These are often unarticulated ideas or understandings that patients have about themselves or others and their personal worlds which in turn give rise to Automatic Thoughts.

14. Identifying Intermediate beliefs
Downward arrow technique used to identify int. beliefs
Therapist identifies a key automatic thought which he thinks may be directly stemming from a core or intermediate belief.
Asks patient about meaning of this thought.
Asking about what a thought means to the patient elicits an intermediate belief.
Asking what it means about the patient uncovers the core belief

15. Identifying Intermediate beliefs-cont
Example
P. I didn't’t do a very good job in class
T. Okay, if its true that you didn’t do a very good job in class, what would that mean?
P. I m a lousy student- intermediate belief
T. Okay, if you’re a lousy student , what does that mean about you?
P. I’m not good enough ( I’m inadeqaute) – core belief

16. Other probing questions
“ if that’s true, so what?
“what’s so bad about----”
“what’s the worst part about---”
What does that mean about you?”

17. Modifying intermediate beliefs
Downward arrow technique
Comparing advantages- disadvantages

18. Modified Intermediate beliefs
Old belief
New belief
If I ask for help, it’s a sign of weakness
I should always work hard and do my best
If I don’t work hard all the time, I ‘ll fail.
If I ask help when I need it, I’m showing good problem-solving abilities ( which is a sign of strength)
I need to put in a reasonable amount of effort much of the time.
If I don’t work hard all the time I’ll probably do reasonably well and have a more balanced life.

19. Modifying Automatic Thoughts 8th January 2017

20. Automatic Thoughts
Automatic thoughts are the actual words or images that go through a person’s mind are situation specific and considered the most superficial level of cognition.
“I’m a failure”
“World is an unsafe place”
“ I’m doomed ”

21. Automatic Thoughts Certain events are universally upsetting
Depressed patients often misconstrue neutral or even positive situations and thus their automatic thoughts are biased.
Critically examining their thoughts and correcting their thinking errors make them feel better.

22. Automatic Thoughts
Automatic thoughts are not peculiar to depressed people, they are an experience common to us all.
Most of the time we are barely aware of these thoughts and with just a little training we can bring them into consciousness.
When we become aware of our thoughts, we may automatically do a reality check if we are not suffering from any psychological problem.

23. Automatic Thoughts Example
while focusing on the contents of this workshop, we may have an automatic thought,
“ I don’t understand this” and feel slightly anxious.
However we may spontaneously respond to the thought in a productive way:
“ I do understand some of it; let me pay more attention and ask for clarification where needed.

24. Automatic Thoughts
This kind of automatic reality testing and responding to negative thoughts is a common experience.
People who are distressed, may not engage in this kind of critical examination
Cognitive therapy teaches them tools to evaluate their thoughts in a conscious and structured way.

25. Modifying Automatic Thoughts
Cognitive Restructuring:
Thought Record Diary/ sheet ( DTRS)

26. 20 Minutes exercise
In pairs (patient –therapist)

27. Thought Record Diary