Modification of Core Beliefs in Cognitive Therapy

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18 Standard and Innovative Strategies in Cognitive Behavior Therapy. adaptive healthy belief systems develop during childhood and adolescence only to. experience horrific events as an adult that had a profound impact on their core beliefs e g a. young man who joins the military and engages in combat returns home with the belief The. world is cruel Identification of the pathway by which core beliefs develop can provide. multiple points for intervention and evaluation, It is important to understand the core belief construct s place in light of cognitive theory as. this knowledge will allow clinicians to understand and articulate to their patients the. mechanism of change by which they expect therapeutic work on core beliefs to exert its. desired effect Figure 1 displays the central cognitive constructs in cognitive theory The core. belief construct is embedded in the larger construct of the schema According to Clark and. Beck 1999 schemas are relatively enduring internal structures of stored generic or. prototypical features of stimuli ideas or experience that are used to organize new. information in a meaningful way thereby determining how phenomena are perceived and. conceptualized p 79 In other words schemas not only influence what we believe i e. cognitive contents but also how we process information that we encounter in our daily lives. i e information processing Core beliefs then are the cognitive contents that are indicative. of a person s schema When a schema and its corresponding core belief s are activated. people process information in a biased manner such that they attend to assign importance. to encode and retrieve information that is consistent with the schema and they overlook. information that is inconsistent with the schema Thus there is a bidirectional relation. between information processing biases and core beliefs such that information biases. strengthen a person s core beliefs and that core beliefs strengthen information processing. biases It is not difficult to imagine for example that a person with an unhelpful schema. characterized by depressogenic core beliefs e g I m a failure will attend to information. that reinforces those beliefs at the expense of neutral or contrary evidence entrenching that. person further in his or her depression, Schemas and their corresponding core beliefs give rise to what Judith Beck has termed. intermediate beliefs J S Beck 2011 which are defined as conditional rules attitudes and. assumptions often unspoken that play a large role in the manner in which people live their. lives and respond to life s challenges and stressors In many instances they are worded as. if then conditional statements that prescribe certain rules that must be met in order for the. person to protect him or herself from a painful core belief For example a person with an. I m a failure core belief might live by the rule If I get all As then I m successful which. is viewed as a positive intermediate belief because it specifies a path toward a positive. outcome However that same person might also live by a negative intermediate belief If I. get anything less than all As then I m a failure Intermediate beliefs that do not use. conditional language are often expressed as heavily valenced attitudes e g It would be. terrible to get anything less than an A or assumptions about the way the world works. e g Successful people should get all As in their classes The problem with these rules. and assumptions is that they are rigid and inflexible usually prescribing impossible. standards to which one should live his or her life and failing to account for life s unexpected. events and challenges that invariably affect one s ability to achieve these standards As with. core beliefs they exacerbate information processing biases that reinforce unhelpful core. beliefs and conversely information processing biases strengthen the rigidity of these rules. and assumptions,www intechopen com, Modification of Core Beliefs in Cognitive Therapy 19. It is not surprising then that schemas and their associated core beliefs intermediate beliefs. and information processing biases create a context for certain automatic thoughts to arise. under particular circumstances Continuing with the example in the previous paragraph if a. person is characterized by a failure core belief and carries rigid rules about the meaning of. grades he receives in school then receiving a D on a test might be associated with the. automatic thoughts I m never going to get into medical school My life will be. meaningless However consider another person who has the core belief I m unlovable. and who carries rigid rules about the meaning of her accomplishments on the degree to. which others value her In this case receiving a D on a test might be associated with the. automatic thoughts I have nothing to contribute to anyone why should anyone care about. me This comparative illustration demonstrates that two people in similar situations can. report very different automatic thoughts and the explanation for those different thought. patterns is that these people are characterized by different sets of core beliefs and. intermediate beliefs Information processing biases only serve to further increase the. likelihood that patients will experience negative automatic thoughts in stressful or. otherwise challenging situations and when the thoughts are activated they feed back into. those biases, A final cognitive construct in this model is that of the mode captured in the upper right. hand corner of Figure 1 According to A T Beck 1996 a mode is an interrelated set of. schemas Thus several systems of schemas core beliefs intermediate beliefs automatic. thoughts and information processing biases can be assimilated into a larger mode A T. Beck proposed three types of modes a those that are primal in nature which influence. basic and immediate necessities such as preservation and security b those that are. constructive in nature which influence the ability to have effective relationships and build. life satisfaction and c those that are minor in nature which influence daily activities such. as reading writing and driving As anyone who has treated a psychiatric patient has. undoubtedly seen unhelpful belief systems have the potential to severely limit patients. functioning in all three of these modal domains, I propose that core beliefs play a central role in cognitive theory and that modification of.
core beliefs will play a fundamental role in modifying the other layers of cognition in the. cognitive model The adoption of a healthy belief system is hypothesized to add flexibility. and even a sense of kindness to patients rules and assumptions by which they live their. lives which is proposed to in turn decrease the likelihood that unhelpful situational. thoughts will be activated automatically in stressful or challenging situations A healthy. belief system might to decrease the weight that unhelpful schemas carry when people. function in various modes I also hypothesize that the adoption of a healthy belief system. will decrease the extremity of unhelpful information processing biases as patients will. begin to widen the scope of the information to which they attend to and process in their. environment I acknowledge that other cognitive behavioral approaches to treatment focus. primarily on the modification of other constructs in this model such as Nader Amir s. attentional modification program that uses a computer task to train patients attention away. from stimuli that reinforces their pathology Amir Beard Burns Bomyea 2009 Amir. Beard Taylor et al 2009 Nevertheless I believe that an intentional focus on core beliefs. during the course of cognitive therapy has the greatest potential to help patients create a. healthy belief system which will in turn increase functioning in many domains of their lives. www intechopen com, 20 Standard and Innovative Strategies in Cognitive Behavior Therapy. SCHEMA Core Belief,INFORMATION,PROCESSING,INTERMEDIATE BELIEF BIASES. Fig 1 Central Cognitive Constructs in Cognitive Theory. In this chapter I describe strategies for identifying and modifying unhelpful core beliefs. Throughout this chapter I illustrate the application of these strategies with cases that I have. seen or supervised in my practice taking care to remove and modify any identifying. information I conclude the chapter with a discussion of challenges that can arise when. working with core beliefs and directions for future research. 2 Identification of core beliefs, The first step in working with patients core beliefs is for the therapist and patient to. collaboratively identify them Some patients present in the first session with a clear. understanding of their core beliefs for example a patient Karen articulated in her first. session that the main issue she wanted to address was her belief that she is inferior to those. whom she perceives as more accomplished than her It is more common however for. patients to need some time before they can identify and are ready to work with core beliefs. For example some patients have difficulty identifying the cognitions that are related to. aversive mood states so they require practice with the more easily accessible automatic. www intechopen com, Modification of Core Beliefs in Cognitive Therapy 21. thoughts before they have a sense of their underlying core beliefs Other patients early in. therapy find articulation of their core beliefs to be overly threatening and painful and. working with situational automatic thoughts allows them to develop a comfort level in. working with their cognitions before they begin to focus on their most fundamental beliefs. K S Dobson 2012 For these reasons most cognitive therapists work with situational. automatic thoughts earlier in the course of treatment and with core beliefs later in the course. of treatment, When therapists opt to work with patients across several sessions focusing first on.
situational automatic thoughts they can be vigilant for the presence of core beliefs through. several means For example automatic thoughts that provoke a great deal of affect have the. potential to be core beliefs in and of themselves or be a direct manifestation of a core belief. Patients who systematically track their automatic thoughts across several sessions e g. through the use of Dysfunctional Thoughts Record can begin to identify themes in the. thoughts that they identify which may provide a clue about the nature of the underlying. core belief When patients spontaneously report recurrent experiences that remind them of. another experience the therapist can take the opportunity to identify the threads that link. these experiences together and the messages they internalized from them both of which. could reflect their core beliefs D Dobson Dobson 2009. Perhaps the most commonly recognized strategy for identifying core beliefs is the. Downward Arrow Technique first mentioned by A T Beck Rush Shaw and Emery 1979. and subsequently elaborated upon by Burns 1980 Therapists who use this strategy. ask repeatedly about the meaning of situational automatic thoughts until they arrive upon. a core belief whose meaning is so fundamental that there is no additional meaning. associated with it Take for instance a socially anxious patient Gary who was treated. with 12 sessions of cognitive therapy This patient s presenting concern was excessive. blushing and blotchiness for which he perceived that others would judge him negatively. In describing a social situation in which he was convinced that he was becoming red he. identified the automatic thought Others are going to see that I am red Figure 2. displays the application of the downward arrow technique for this case It is evident that. this exercise elicited a pair of powerful core beliefs I am weak and I am less than a. Many therapists administer self report inventories to assess identify cognitions that. have the potential to be core beliefs These questionnaires include a the Dysfunctional. Attitudes Scale DAS Weissman Beck 1980 b the Sociotropy Autonomy Scale. SAS Bieling Beck Brown 2000 D A Clark Beck 1991 c the Personality Belief. Questionnaire PBQ A T Beck Beck 1991 A T Beck et al 2001 and d the Young. Schema Questionnaire YSQ http www schematherapy com id49 htm Advantages of. administering inventories of this nature are that core beliefs can be identified in a. relatively short period of time and that an extensive range of possible beliefs can be. considered This allows the therapist to develop a richer case conceptualization than he or. she might otherwise develop on the basis of interview and observational information. alone However it is important to regard core beliefs identified via self report inventories. as hypotheses to be tested using the data that are obtained by the therapeutic work that. takes place across sessions As stated previously early in the course of treatment many. www intechopen com, 22 Standard and Innovative Strategies in Cognitive Behavior Therapy. patients are not aware of their core beliefs This lack of awareness could influence the. manner in which they respond to these inventories such that they minimize the operation. of one or more beliefs Moreover core beliefs are idiosyncratic to each individual so there. is always the possibility that a salient core belief is not assessed on the inventory that is. administered D Dobson and Dobson 2009 have recommended t. undoubtedly seen unhelpful belief systems have the potential to severely limit patients functioning in all three of these modal domains I propose that core beliefs play a central role in cognitive theory and that modification of core beliefs will play a fundamental role in modifying the other layers of cognition in the cognitive model The

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