1. Core Beliefs: Identifying & Modifying8a
Core Beliefs: Identifying & Modifying
708: Cognitive Assessment & Psychotherapy

2. What are Core Beliefs?
Typically all-or-nothing statements that are rigid, global, and overgeneralized view about the self, others, and how the world “works”
If patterns of thinking are pervasive in nature, then there is a good chance the negative automatic thoughts are an “external” representation of “internal” negative core beliefs
Schemas vs. Core Beliefs (pretty much the same, but…)

3. What are Core Beliefs? Three Categories Viewed through Three Lenses
Helplessness
Ineffective, vulnerable, low achievement
Worthlessness
Bad, unworthy, dangerous to other people
Unloveability
Defective in character so as to preclude gaining the sustained love and caring of others
Viewed through Three Lenses
Self
Others
World

4. What are Core Beliefs?

5. Core Belief Development
Generally develop at an early age, from childhood to adolescence
Contributing factors
Interactions with significant and influential individuals
e.g., parents/guardians, teachers, coaches, peers
Significant life events
Both traumatic experiences and successes
Genetics and biological vulnerability
e.g., intelligence, temperament, specific skills or lack thereof

6. Core Belief Development
The overall interaction of the key three contributing factors (i.e., significant others, significant events, genetics) are reciprocal in nature, where different mechanisms are reinforced/validated
The more so, the more concrete the belief
Beck (2011) states that most people tend to have core beliefs that are relatively positive and realistic, but negative beliefs become more prominent when experiencing psychological distress
In many ways, the development of negative core beliefs follows a pattern similar to a stress-diathesis hypothesis
In other words, when there is minimal or manageable psychological distress the predisposition and existence of negative core beliefs may not have any significant negative effects, but when there is excessive and unmanageable distress they can become salient with profound negative impacts on thinking and behaving

8. Benefits of Changing Core Beliefs
Effective modifying of negative core beliefs will not only reduce current distress, but also act as an “immunization” to resist future stressors
It is important to not forget that although your clients will have profoundly negative core beliefs, they will also have some positive/adaptive core beliefs that contribute to helpful coping
Can be increasingly uncovered and strengthened while working on negative core beliefs
The more you have a comprehensive understanding of your clients’ core beliefs and associated maintaining negative automatic thoughts and reinforcing behaviors…
The more accurate/comprehesive your CBT case formulation...
And the more effective your interventions for reducing distress and enhancing strengths

10. Psychoeducation of Core Beliefs
VV 8.1 – MDD – 14 – Core Beliefs – Psychoeducation
DQ 8.1
Over time, determine the categories and lenses of the core beliefs…
and related automatic thoughts…
and emotional and behavioral reactions
When you do present to your clients your conceptualization of their core beliefs and automatic thoughts it is best done in a tentative manner
At this point you should have already identified and worked on at least a few negative automatic thoughts
It is often helpful to present your hypothesized core beliefs within the context of supportive/related negative automatic thoughts they have had across multiple situations
You may have even already grouped some negative automatic thoughts as specific cognitive distortions

11. Psychoeducation of Core Beliefs
Reviewing the key elements of core beliefs does not necessarily have to be as extensive as reviewing automatic thoughts
Explain development of core beliefs by focusing on significant past events and individuals
Highlight the three categories of core beliefs
Discuss the self-perpetuating nature of core beliefs
Emphasis on reinforcing nature of core beliefs on negative automatic thoughts
Provide hope – core beliefs can be modified, which can result in significant distress reduction
Can also note that positive core beliefs are also present and can assist in modifying

13. Identifying Core Beliefs
Core Beliefs Expressed as Automatic Thoughts
Clients state it themselves
Can point out the core belief “in the moment” or take note of it and return to it in a future session when more therapeutically appropriate
Provide supportive evidence by way of related negative automatic thoughts
Core Beliefs Embedded in Patterns of Automatic Thoughts
Look for patterns in the way clients perceive themselves, others, and the world
Cognitive distortions and themes how thoughts cluster together across a variety of situations

14. Identifying Core Beliefs
Be Direct: Ask Client for the Core Belief
“We have been discussing your pattern of [negative automatic thoughts/cognitive distortions]. I wonder if you can think of a core belief that represents this particular style of thinking?”
Formal Core Belief Assessments
Sometimes seeing a list can stimulate recognizing patterns
Dysfunctional Attitude Scale (Weissman & Beck, 1978)
The Personality Belief Questionnaire (Beck & Beck, 1991)
Young Schema Questionnaire – Short Form (Young, 2005)
Automatic Thoughts Questionnaire (Hollon & Kendall, 1980)

15. Identifying Core Beliefs
Guided Discovery
From emotions to automatic thoughts to core beliefs
Downward Arrow Technique
Digging deeper for core beliefs
Core Belief Flowchart – Part A
Historical Events and Present Patterns

16. Guided Discovery (From Emotions to Automatic Thoughts to Core Beliefs)
Process is nearly identical to what was discuss for Automatic Thoughts
Eliciting strong emotions; identifying the triggering event; recognizing relationship between thoughts, emotions, physiological arousal, and behaviors
Instead of stopping at automatic thoughts, you can continue by summarizing any possible themes and asking further follow-up questions
“Do you think you a have rule in your mind about…?”
“Do you find that these types of thoughts about… have a pattern that come from a deeper source?”
“I wonder if these thoughts about… come from a fundamental belief?”
Guided imagery can also be used

17. Downward Arrow Technique (Digging Deeper for Core Beliefs)
VV 8.2 – MDD – 15 – Core Beliefs – Identifying – Downward Arrow Technique
DQ 8.2
“Showing” has more long-term therapeutic effectiveness than “telling”
Be sure that you have a good therapeutic rapport and provide a rationale in order to prepare client for what to expect
Style is important – there is an “art” to this technique
(1) – Identify a relevant negative automatic thought
Ideally, one that still elicits strong emotions and is believed to be true
Already relevant – have a hypothesis of possible core belief

18. Downward Arrow Technique (Digging Deeper for Core Beliefs)
(2) – Ask client meaning of the negative automatic thought
“If that’s true, so what?”
“If what you say is true, what does that mean about you?”
“What is so bad about...?”
“If what you say is really bad, what is the worst part about it?”
(3) – Stop asking questions at core belief
Negative shift in affect
“look of insight”
Verbally confirm belief
Restating belief in same or similar words

19. Downward Arrow Technique (Digging Deeper for Core Beliefs)
(4) – Process client’s response to core belief
Sometimes coming face-to-face with one’s negative core belief can provide such feelings as sadness, hurtfulness, and/or frustration
Other times it can provide relief or satisfaction
Any other thoughts or feelings about the process?
(5) – Consider options to modify core belief
Is this a core belief that is largely invalid?
Is this core belief relevant/believed?
Is this core belief causing significant distress?
Are additional identification techniques necessary?
Does the core belief warrant modification? If so, what techniques?

21. Core Belief Flowchart – Part A (Historical Events and Present Patterns)
VV 8.3 – MDD – 16 – Core Beliefs – Identifying 2 – Core Belief Flowchart – Part A
DQ 8.3
For some core beliefs it is helpful to explore key historical individuals, events, and contextual factors that may have lead to its development
(1) – Category and lens
Category: helpless, worthless, unloveable
Lens: self, others, world

22. Core Belief Flowchart – Part A (Historical Events and Present Patterns)
(2) – Significant Individuals
“Which people have influenced your life the most?”
“Which family members have influenced the way you think?” “Besides family members, who has influenced the way you think?”
“Has anyone ever given you great support or inspiration?”
“Has anyone ever caused you harm or belittled you?”
(3) – Significant Life Events
“Have you experienced any (positive or negative) life events that you believe shaped/influenced/transformed who you are today?”
“Did you learn anything about yourself during/after this experience?”
“Is it possible that you experienced an event that changed/transformed your view of how the world/others works?”
“What negative messages did you get about yourself from all of the arguments with your family?”
“Can you think of any attitudes or beliefs that you have that may be a result of that experience?”

23. Core Belief Flowchart – Part A (Historical Events and Present Patterns)
(4) – Recent Contributing Stressors
“Has anything recently happened in your life that has been especially stressful?”
“Has anything recently been on your mind that you can’t stop thinking about?”
(5) – Temperament and Coping Skills
“What quality about yourself do you like (dislike) about yourself the most?”
“How would others describe you as a person?”
“Is there any characteristic/quality about yourself that could probably never be changed (or you don't want to change?)?”
“How do you cope with day-to-day stressors?”
“How do you handle situations that are out of your control?”

24. Core Belief Flowchart – Part A (Historical Events and Present Patterns)
(6) – Contributing Socio-Cultural Factors
“How does your socio-cultural background (or race/ethnicity, gender, sexual orientation, socioeconomic status, immigration status) influence how you view and interact with the world?”
“How does your socio-cultural background influence your self- concept?”
“Have you ever been treated differently (for better or worse) by others because of your socio-cultural background?”
“Is there anything about your socio-cultural background (or how others respond) that is currently contributing to your current distress?”

25. Core Belief Flowchart – Part A (Historical Events and Present Patterns)
(7) – Relevant Activities or Life Accomplishments
“What personal accomplishments are you most proud of?”
“How do your interests/abilities reflect who you are as a person?”
“Is there any activity or life accomplishment that best defines how you see yourself?”
“How has your job (or schooling, education) influenced your view of the world and yourself?”
“Have you had any “life learning” events or opportunities that have changed the way you approach life?”

28. Evaluating & Modifying Core Beliefs
Just like identified negative automatic thoughts, you will first need to determine if your clients’ negative core beliefs have therapeutic relevance and are appropriate for modification
Not all negative core beliefs are worth exploring
Keep in mind that it is not possible nor practical to fully reduce the believability of a core belief to nothing

29. The Evaluation Process: Focusing on Relevant Automatic Thoughts
Core beliefs that elicit the strongest emotions and appear to be associated with multiple negative automatic thoughts patterns should receive the most initial attention
There is a good chance that by the time you get to this point in therapy you most likely already have a good idea for what core beliefs deserve the most attention
Knowledge of the “deeper” meaning of a core belief will allow for a more comprehensive case formulation and purposeful modification techniques

30. Socratic Techniques: Evaluating to Modifying Core Beliefs
Examine the evidence: Determine if the negative core belief is invalid
List the advantages and disadvantages of the negative core belief
Separate self fro the negative core belief
View the negative core belief on a continuum

31. Examine the Evidence This technique should always be used first
One significant difference from automatic thoughts is that there is a greater chance that your clients’ core beliefs have at least some validity in the past, and may still have some validity in the present
Additionally, many core beliefs have been part of the clients’ thinking for a significant portion of their lives and reinforced by multiple negative life events and corresponding outcomes
Thus, it is not unusual if clients are able to provide substantial evidence that the core belief is true

32. Examine the Evidence 1. What is some evidence that
supports your core belief?
2. What is some evidence that
is, at least in part, against
your core belief?
3. Based on the modification
techniques and behavioral
experiments, what evidence
supports your new core belief?
4. How much do you now believe your old core belief?
5. How much do you now believe your new core belief?
6. What do you think about the difference in believability between your old core belief and new core belief?

33. List the advantages and disadvantages of the negative core belief
The reason why some negative core beliefs maintain their strength (i.e., believability) over time is because there may be some benefit from its resulting thoughts and reinforcing behaviors
Your goal here is to obviously minimize the advantages while still being validating and indicate and emphasize the disadvantages
The goal is for clients to naturally recognize that the new core belief can still provide the similar advantages that the old core belief provided, and at the same time reduce the disadvantages resulting from the old core belief
Keep the “good” and lose the “bad”

34. List the advantages and disadvantages of the negative core belief
1. How have you found this core belief helpful in your life?
2. Can you think of any ways this core belief may have caused you harm/pain?
3. Based on the modification techniques and behavioral experiments, how has this new core belief been helpful in your life?

35. Separate self from the negative core belief
Sometimes clients can be more objective in assessing the validity and benefits of thoughts and behaviors when they can distance themselves from their own core beliefs
The most common method is to ask clients to consider what they would tell other individuals if they had similar core beliefs
“What would you tell your [family member/friend] if they had a similar core belief as you?”
If your clients are able to provide an alternative response from their own core belief, you can then suggest trying to apply it to themselves
“I wonder if it would make a difference in your psychological distress if you thought the same way about yourself as you do your [family member/friend]? What do you think?”

36. View the negative core belief on a continuum
Most negative core beliefs are expressed in extremes and are dichotomous in nature
Viewing oneself from a negative lens and only acknowledging the existence of the ideal (opposite) lens of the continuum (e.g., “I’m a great success,” “I’m fully competent,” “Everybody loves me”) essentially sets up clients for persistent distress because there is no recognition of the wide area between the two continuum end points
By viewing their core beliefs on a continuum, instead of two opposite poles, clients can moderate their thoughts and at least shift their core beliefs towards the middle
Any shift from the negative extreme of the continuum towards the middle will provide clients some relief

37. 1. How much does this negative core belief apply to you on a 0-100% scale?
2a. Think of a few people, real or hypothetical, that have the same or similar negative core belief. How much does this negative core belief apply to them?
2b. How do these people think and behave that makes them so close to 100%?
3a. Think of a few people that do not have this core belief and fall on the other side of the scale. How much does this negative core belief apply to them?
3b. The people you just mentioned here are not at 0%, which means they are not perfect. What are some flaws that these people have?
4. Now that you have provided some examples of people that fall on both sides of the scale, where do you put yourself on the scale?
5. Although you may not feel it now, where would you like to be on this scale in the future?

38. VV 8.4 – MDD – 17 – Core Beliefs – Modifying – Evidence & Advantages and Disadvantages DQ. 8.4

39. Core Belief Flowchart – Part B (Modifying Old Core Beliefs and Developing New Core Beliefs)
VV 8.5 – MDD – 17 – Core Beliefs – Modifying – Core Belief Flowchart – Part B
DQ 8.5
Focus is on synthesizing information form the previous modification techniques of the negative core belief in order to eventually develop a new, more adaptive core belief
The primary focus should be on information that supports the new core belief (in the past or present) and reframing any “old evidence” that supports the negative core belief
The new core belief does not have to be the polar opposite of the old cold belief
An appropriate new core belief is less extreme and may acknowledge imperfections

40. Core Belief Flowchart – Part B (Modifying Old Core Beliefs and Developing New Core Beliefs)

41. Core Belief Flowchart – Part B (Modifying Old Core Beliefs and Developing New Core Beliefs)
Once a new core belief has been chosen, practice at least one of the events used for the “old” core belief
However, this time develop a possible new automatic thought that might result from the new core belief
Thereafter, consider what emotions and behaviors that can develop from these new thinking patterns
The purpose here is to demonstrate if the new core belief can result in new adaptive cognitive and behavioral patterns that can reduce distress
For some clients the cognitive processes associated with these worksheets is still not quite enough evidence that the new core belief can reduce distress
Behavioral experiments of actual life experiences is necessary

43. Behavioral Experiments (Testing Old Core Beliefs and Applying New Core Beliefs)
VV 8.6 – MDD – 18 – Early Session Stage – Late Phase – Reviewing Behavioral Experiment
DQ 8.6
Similar with automatic thoughts, you can develop experiments with your clients to test the validity of a particular belief
Sometimes behavioral experiments can have a stronger influence on modifying an old core belief and reinforcing a new core belief than verbal dialogue and techniques
These experiments create experiences that clients can “see” and “feel” for themselves in the moment; a change in behavior can result in a change in thinking
Ultimately, all clients should eventually practice their new core belief “in action” outside of session; this is where to long-term change occurs