6b) Core beliefs

Question 1

Define core beliefs (8)

Answer 1

beliefs that are global, enduring, stable, very rigid, often over inclusive, unrealistic, and very hard to change.
Often outside of immediate awareness
Often multiple core beliefs can be operating

Question 2

How do core beliefs develop (4)

Answer 2

 Developed from an early age
 Develop in response to a genetic predisposition, through interaction with others and/or through interaction with their environment

Question 3

Are negative core beliefs activated all the time? (2)

Answer 3

• For much of their lives, most people maintain relatively helpful and realistic core beliefs. Negative core beliefs may surface only during times of psychological distress.
• However, someone with a personality disorder may have these activated almost continuously.

Question 4

What are the 3 categories of core beliefs?

Answer 4

• Helplessness
  o “I am incompetent”
  o “I am weak”
  o “I am a failure”
• Unlovable
  o “I am unlovable”
  o “I am unwanted”
  o “I am different”
• Worthless
  o “I am bad”
  o “I am a waste”
  o “I am immoral”

Question 5

When do we challenge core beliefs? (3)

Answer 5

• When automatic thoughts have been challenged and further symptom relief is required
• When attempting to reduce the severity of a client’s personality disorder
• When core beliefs are identified/easily accessed when challenging automatic thoughts

Question 6

When don’t we modify core beliefs? (3)

Answer 6

• When you only have a very limited number of sessions with a client
  o Don’t unpack what you cannot contain
• When all symptoms have resolved using other techniques
  o Challenging core beliefs is probably unnecessary
• When there are more pressing issues to manage
  o Remember to prioritise what you do in therapy

Question 7

Identify the 4 steps to challenging core beliefs

Answer 7

• 1) Identifying core belief/s
• 2) Psychoeducation: provide psychoeducation on the core belief and its development
• 3) Identify new core beliefs
• 4) Challenge (evaluate and modify) unhelpful core beliefs

Question 8

What is involved in Step 1 of challenging core beliefs? (4)

Answer 8

o Using specific techniques to identify the core belief
o Present your hypothesis about the presence of a core belief to the client
o Seek confirmatory or dis-confirmatory evidence
o Refine your hypothesis

Question 9

What is involved in Step 2 of challenging core beliefs? (2)

Answer 9

provide psychoeducation on the core belief and its development
Teach clients to monitor the operation of the core belief

Question 10

What is involved in Step 3 of challenging core beliefs? (1)

Answer 10

Specify and strengthen a new, more adaptive core belief

Question 11

What is involved in Step 4 of challenging core beliefs? (4)

Answer 11

Challenge (evaluate and modify) unhelpful core beliefs
o Examine childhood origins
o Examine maintenance over the years
o Examine the contribution of core beliefs to present difficulties
o Monitor activation of the core belief

Question 12

Identify and describe strategies to identify core beliefs (1; 2; 4; 1)

Answer 12

1. Pattern detection / identifying central themes in a client’s negative automatic thoughts or underlying rules and assumptions
2. Downward arrow
3. Socratic questioning
4. Checklists

Pattern detection
* o Patterns will emerge through the systematic monitoring of a client’s automatic thoughts
* o Example:
*  “X people don’t like me”
*  “X person will leave me”
*  “I’m not good enough to be X’s friend”
*  Core belief: Unlovability

Socratic Questioning
* o Sometimes through socratic questioning, core beliefs can be identified
* o The important thing here is to make sure that you are listening very carefully for hints or even clear statements of core beliefs.

Downward arrow/vertical descent
* o The downward arrow technique (or vertical descent) involves asking a series of questions that aim to elicit the underlying core belief
*  “If that were true, then what would that mean?”
*  “What would that mean about you as a person?”
*  “What’s so bad about that?”
*  “What’s the worst part about that?”
* o For the most part, you will be almost repeating the same sentence in an attempt to get to the bottom of a thought.
* o You’ll know that you got to the core belief because the client either says something that fits very nicely in one of into one of six categories, or because the statements in response will start becoming very circular or repetitive.
* o Make sure you are familiar with the categories of core beliefs before embarking on the downward arrow.

Checklists
* o Checklists are available to identify core beliefs:
 Core beliefs checklist (Tolin et al.)
 Negative Core Beliefs Inventory (Osmo et al., 2018)
 Young Schema Questionnaire
 Schema Inventory (Wright et al.)

Question 13

What is involved in step 2 of challenging core beliefs? (5)

Answer 13

No matter what interventions we are providing, clients should always have a really good idea of what we are doing and why.

Psychoeducation on core beliefs should include that core beliefs are (Beck, 2011):
* Developed during childhood
* Maintained through life experiences (biased view)
* Not necessarily true
* Believed very strongly, often with little or no doubt
* Testable
* More realistic core beliefs can be developed and strengthened over time
 Note: be realistic. It takes time, and you are unlikely to finish this work with a client
 Think of your job as giving a client the tools to continue to challenge their thoughts or core beliefs on their own long after therapy ends.
 Our job is purely to see enough symptom reduction

Question 14

Why should we help client identify a new core belief, before we challenge a negative one?

Answer 14

so that clients know what a new one and more adaptive core belief looks like and to start building it up as the negative core belief slowly fades

Question 15

How can we identify a new core belief?

Answer 15

fairly easily done - often by identifying the opposite of the negative core belief

Question 16

How can we strengthen a new core belief? (2)

Answer 16

 By deliberately eliciting positive data
 By examining experiences that further confirms and highlights positive data about themselves

Question 17

Identify techniques to challenge core beliefs (11)

Answer 17

Most of the tools used to challenge an automatic thought can also be used to challenge a core belief.
o Socratic questioning
o Examining the evidence
o Behavioural experiments
o Cognitive continuum
o Core belief worksheets
o Extreme contrasts
o Pros and cons of holding the belief
o Stories and metaphors
o Historical tests
o Restructuring early memories
o Coping cards

Question 18

Describe the ‘Examining the evidence for and against a belief’ core belief challenging technique.

Answer 18

o Can use Socratic questioning with indirect restructuring techniques like this in order to help the client elicit their own responses
o Again, remember that this should never be an interrogation
can use worksheets

Question 19

Describe the ‘behavioural experiments’ core belief challenging technique.

Answer 19

conduct an experiment that involves doing something that challenges the negative core belief - The idea is that the experiment will lead to cognitive change

Can be done by:
*  Taking a poll of friends
*  Videotaping an interaction
*  Doing research online

After doing the experiment, it is important to reflect with the client.
*  “You thought X, but Y happened”

Question 20

Describe the ‘extreme contrasts’ core belief challenging technique. (6)

Answer 20

• Helps the client with black and white thinking to see the areas of grey in their belief
• Requires a client to compare themselves to someone else (either real or imagined) who is at a negative extreme of the quality related to the core belief
• Get client to plot their beliefs on one end of a continuum and then contrast with the opposite (usually positive end).
• The goal is to get the client to describe the extremes in behavioural terms.
• It is useful to ask the client questions like “Can you tell me what someone who is completely incompetent looks like? Can you describe for me their behaviours?”
• Similar technique by Tolin called ‘scaling’

Question 21

Describe the ‘cost-benefits analysis’ core belief challenging technique. (3)

Answer 21

show clients that their core belief is not helpful
“What are the pros and cons of holding on this belief?”
Can be very motivation enhancing if you are having trouble with engaging a client in core belief work.

Question 22

Describe the ‘using stories, movies & metaphors’ core belief challenging technique. (2)

Answer 22

o Encourage clients to reflect on their view of characters or people who share the same negative core belief
o By identifying evidence against someone else’ core belief, clients can begin to reflect on their own beliefs in a more realistic way

Question 23

Describe the ‘historical tests of the core belief’ core belief challenging technique. (3)

What can this technique lead to? (1)

Answer 23

o Examine the experiences that led to the development and maintenance of the core belief
o Encourages clients to reflect on early life experiences that contributed to the development of the core belief and examine these experiences from a more realistic standpoint.
o This technique can lead to:
 Restructuring of the appraisal of early memories
 E.g., if as a child, a client interpreted a parent’s divorce as abandonment by the parent that left the family home, this may be appropriately re-evaluated as an adult

Question 24

Describe the ‘coping cards’ core belief challenging technique. (5)

What should be identified with the client? (5)

Answer 24

• o Good tool that can be used to challenge core beliefs in the moment that they arise for a client outside of the therapy room.
• o In session, identify an alternative, more adaptive thought and/or behaviour
• o Have the client carry a card with this on it to ensure they know how to respond when the core belief is activated
• o By documenting on the card, likely triggers, thoughts, behaviours and alternative beliefs, or even key techniques that the client can use to restructure core beliefs, coping cards can act as a great reminder for what to do when a core belief is activated
• o Early on in treatment, this can be a great tool to remind clients what to do and how to do it.
   With practice, it is likely that this will no longer be required

Identify with the client:
*  Triggers
*  Thoughts
*  Behaviours
*  Alternative beliefs
*  Key techniques that the client can use to restructure core beliefs

Question 25

What is important when doing core belief challenging?

Answer 25

Manage you and your client’s expectations about the time that this work will take - for most clients, core belief challenging takes a long time