Lecture 11:Core Beliefs

Transcription

1 Lecture 11:Core Beliefs

2 Learning Outcomes You will learn What Core Beliefs are, when to begin working on them and how to socialize clients to CB work The principles of identifying and challenging negative core beliefs.

3 Core Belief Characteristics Core Beliefs: our most strongly held opinions, points of view and beliefs about ourselves, other people and the world within which we live. At the core of many mental health disorders are distorted core beliefs that fuel and maintain the disorder.

4 The CBT Iceberg Automatic Thoughts Rules for Living Core Beliefs

5 There are certain core beliefs that have certain typical characteristics that include: Core Belief Characteristics 1. Rigid and resistant to change 2. Polarized and over- simplified 3. Formed in childhood 4. Maintained through distortions and biases 5. Not necessarily true 6. Can be tested and evaluated

6 Core belief work should not begin until later in therapy, usually after 6-8 sessions. Core Belief When Should it be done? Core beliefs can be identified early on but shouldn t be challenged until therapeutic rapport has been strengthened. Waiting to challenge core beliefs is beneficial because it gives the therapist enough time to fill out thought records to accurately identify themes throughout that point to the core belief.

7 Core beliefs should not be tackled until clients have been educated on cognitive distortions, the evidence technique and have had some success in creating balanced thoughts. Core Belief When Should it be done? Due to the nature of core beliefs (being rigid, resistant to change, identified as being truth to the client) it is important for there to be a strong therapeutic alliance in order to challenge core beliefs. Generally clinicians strive for an improvement in mood overall before tackling core beliefs because core belief work can be experienced as difficult for the client and result in mood decreases before increases

8 Metaphors for core beliefs are useful tools to educate the client on the concepts of core beliefs. Metaphors for Socializing Clients to Core Beliefs Useful metaphors: All roads lead to Rome (what we want to determine and seek are CBs) Blind men and the elephant (seeing the entire picture once identify CBs) The partially submerged iceberg (iceberg submerged are core beliefs) Comparing the mind to a tree and its component parts to different levels of the mind (tree roots) Metaphor of the magnet (selective attention and processing) Pyschoeducationcan also be used to help clients understand core beliefs.

9 Put Simply Core Beliefs are Distorted Thoughts that have Migrated to Truth

10 Beliefs are how we process information; they act as filters that influence our coding of all our experiences. Semantics and language can trigger identification or support of these beliefs Core Belief Psychoeducation for Clients Genetic predispositions can lead to CBs - predisposition to sadness or anger due to genetic factors and then an onset is created by the right environmental cocktail Neuropsychology: CBs are neural pathways that have established themselves through connections and highways in the brain. They are stored bodies of knowledge or structures that interact with incoming information to influence selected attention and memory search

11 There are three major types of core beliefs: Beliefs about the self: I am worthy/unworthy, good/bad, lovable/unlovable, success/failure, and competence/incompetence. Beliefs about others: others are trustworthy/untrustworthy, others have certain group characteristics. Core Belief Socializing Beliefs about the world: The world is safe/unsafe, beautiful/ugly, just/unjust.

12 Judith Becks List of Negative Core Beliefs Helpless I am inadequate, ineffective, incompetent, can t cope. I am powerless, out of control, trapped. I am vulnerable, weak, needy, a victim, likely to be hurt. I am inferior, a failure, a loser, defective, not good enough, don t measure up. Unlovable I am unlikable, unwanted, will be rejected or abandoned, always be alone. I am undesirable, ugly, unattractive, boring, have nothing to offer I am different, flawed, defective, not good enough to be loved by others. Worthless I am worthless, unacceptable, bad, crazy, broken, nothing, a waste. I am hurtful, dangerous, toxic, evil. I don t deserve to live.

13 Aaron T Beck the Father of CBT - thoughts on Core Beliefs

14 How do we identify and change Core Beliefs?

15 There are many sources of data that a therapist can draw upon to identify key maladaptive core beliefs. Some include: Identifying Core Beliefs 1. Themes in thought records 2. List of core beliefs 3. Client reports 4. Fears 5. Judith Beck s case conceptualization

16 Case Formulation pulling it all together

17 The Downward Arrow Downward arrow: a useful tool for identifying core beliefs. It involves starting with a surface level thought and probing for implications of the thought. If often follows the train of thinking, if that is true... then what does it mean? Clients typically go no deeper than their surface thought but the downward arrow technique prompts them to examine the implications of their surface thoughts until we arrive at the true core belief being masked.

18 The Downward Arrow

19 1. I can t accept that my husband is gone for good. (If that were true what would it mean?) Examples of Using the Downward Arrow Technique 1. It s 11 pm and my wife isn t home yet. (If that were true what would it mean?) 1. The soup I made is terrible. (If that were true what would it mean?) 1. I didn t get a call back from the job I applied to. (If that were true what would it mean?)

20 After educating clients on core beliefs, it s time to begin challenging and restructuring those core beliefs. Restructuring Core Beliefs You can begin challenging core beliefs by generating evidence and identifying distortions. You can ask the client to list any evidence at all that might indicate this belief is not always true. This is called Historical Data Core beliefs form during pivotal events that occur in childhood. Thus, we may need to analyze those pivotal events to allow the client to reprocess them and interpret them from a mature perspective (adult self vs. child self).

21 Historical Review and Modification of Core Belief - Worksheet

22 Restructuring Core Beliefs Positive Data Log: a simple intervention to understand but is often difficult for clients to practice. It involves taking the balanced core belief that you are trying to help the client adopt and having them list evidence every day that supports the new belief.

23 Positive Data Log - Worksheet

24 In summary, core belief work progresses in the following way: Step 1: Educate clients on core beliefs. Restructuring Core Beliefs Step 2: Identify key core beliefs. Step 3: Develop balanced alterations of the core belief using CB techniques. Step 4: Implement new core belief in new situations. Step 5: Pay attention to new evidence and reinforce new balanced belief.

25 Step 1: Educate clients on core beliefs. Step 2: Identify key core beliefs. Through Thought Records, Downward Arrow Technique or the CB List you ve identified the client s CB is I am a Failure Example: I am a Failure You complete a Case Conceputalization worksheet. Automatic thoughts are I did that wrong I can t get it right I m never good enough. Emotions include sadness, fear and guilt Behaviours include striving to get everything perfect, giving up easily when things aren t perfect right away, checking work over and over. Rules for Living are If I get it perfect then I am good enough If I am good enough I will be loved Historical data and evidences are collected of times you have concluded that you are a failure

26 Example: I am a Failure Step 3: Develop balanced alterations of the core belief using CB techniques. Choose what you would like your new balanced belief to be. It could be I am a success or I can be successful or I am not perfect but I am good, anything that resonates and can be truthful and evidence gathered for. Use cognitive continuums to list qualities related to this new core belief Use other techniques like 5 Factor Model and Behavioural Experiments to determine what would look different if you were to begin operating from this new core belief. What would new thoughts and behaviours and emotions look like?

27 Step 4: Implement new core belief in new situations. Step 5: Pay attention to new evidence and reinforce new balanced belief. Example: I am a Failure Begin gathering evidences to support new Core Belief

28 Putting it all Together: Schemas Schema: the schema can simply be thought of as encompassing the entire iceberg and includes all levels of mental life. Thus a singular schema may consist of a core belief, the rules for living and then the automatic thoughts that flow out of that core belief. In cognitive therapy, we seek to identify maladaptive schemas and replace them with adaptive schemas.

29 Here is an example of both an adaptive and maladaptive schema: Situation: A friend doesn t talk to the client at a party. Putting it all Together: Schemas Adaptive Schema CB: I am a generally likable person RFL: If I mingle, I might have a new friend at the end AT: Wow! My friend is busy tonight! Embedded memory: simply of last year s party. Maladaptive Schema CB: Others are more interesting than I am RFL: If I am not interesting, I will be ignored AT: My friend doesn t really like me Embedded memory: Rejection

30 Conclusion: Lesson Summary Core Beliefs are our most strongly held beliefs and opinions about ourselves, others and the world Core Belief work should be done after a strong therapeutic rapport has been built, cognitive behavioural gains have been made and when the client is ready to tackle these rigid and resistant beliefs Core Beliefs can be explained to clients through metaphors or psychoeduation

31 Conclusion: Lesson Summary Core Beliefs can be identified though Thought Records, patterns of client s thoughts, Case Conceptualizations, Downward Arrow technique, Judith Becks list of Core Beliefs or fears Common worksheets to use for identifying and challenging Core Beliefs are: core belief worksheet, historical data log, downward arrow technique, cognitive continuum, positive data log (previous interventions like 5 Factor Model, Behavioural Experiment, RFL worksheets) Steps to changing core beliefs are: Educate clients on core beliefs, Identify key core beliefs, Develop balanced alterations of the core belief using CB techniques, Implement new core belief in new situations, Pay attention to new evidence and reinforce new balanced belief. Schemas are the mental structures that pull all the levels of the CBT model together into one cohesive string. They are important to identify and monitor change within

32 Demo

33 In Class Role play With your partner practice describing what core beliefs are. Then begin identifying a negative core belief you have or a positive core belief you would like to have. Start the 5 steps of Restructuring your Core Belief

34 Quiz!

35 Reminder of HW Go through the 5 Steps of Restructuring Core Beliefs, showing your work for all steps Please homework to cbtassistant@qualiacounselling.com Please label the title of your by your first name, last name, lecture number for homework, and type of course.