Cognitive Behavioral Therapy (CBT) is one of the most proven psychotherapies for depression and anxiety. It involves identifying, challenging, and replacing irrational thought patterns, also called cognitive distortions, with rational thoughts. However, not everyone is successful in doing so. A key reason for this is when one harbors deeper irrational thoughts, called core beliefs, which are harder to change as they sit at a subconscious level.
While identifying your superficial irrational negative thoughts, also called automatic thoughts, as a part of CBT, you may realize that some of these thoughts can be lumped under common themes. These underlying thinking patterns are called core beliefs or schemas. Whereas automatic thoughts are at the surface of your awareness and more straightforward to recognize, core beliefs are not that readily accessed or easily articulated. Core beliefs or schemas represent a set of attitudes, assumptions, conceptions, preferences, goals, and values acquired by you over several years. They are derived from your culture, past experiences, and idiosyncratic responses to particular events (Beck, 1964). The messages from your parents or authority figures when growing up, your interpretation of events, the rules you learn from others, and traumatic events shape your core beliefs. It is not uncommon for children to internalize repeated parental remarks like, "I wish you could be more like your ... (sibling, cousin, friend)," as a core belief, "I am not good enough."
Core beliefs get activated when you are faced with certain situations that evoke strong emotions and make you respond to those situations in a specific way. With repetition and confirmation bias, these core beliefs get more engrained in your thought processes, and you never question their accuracy or helpfulness. This is particularly true when core beliefs may have served a purpose during one's formative years. For instance, a child growing up with an alcoholic and aggressive parent may assume that "people are dangerous," which may keep them on alert to prevent being hurt. However, the same belief in the future may translate to one misinterpreting everyday interactions as being aggressive (Greenberger & Padesky, 2016). We all have negative and positive core beliefs. In depression, negative core beliefs such as “I am unlovable,” “I am incompetent,” or “I am worthless” become more prominent while the positive ones become dormant.
To identify core beliefs, write your automatic irrational thoughts over two weeks. Then, look for any emerging patterns or themes in those thoughts. For each irrational thought, ask, "If my irrational belief is true, then what does that mean to me or others or my future?” Sometimes, you may have to repeat that question to uncover the deeper core belief. For example, a person afraid of taking a test may have the automatic thought – “I am never good at tests, and I am going to flunk this one too.” In response to the question – “What would it mean to me if I flunked the test?” – their thoughts may be, “That would mean that I am incompetent and a loser.” This is the core belief this person harbors.
Below is a list of some common core beliefs people with depression may have (Beck, 2011; Wright & Basco, 2001). Use it as a guide to identify recurrent themes in your irrational thoughts.
- I am unlovable
- I am unlikeable
- I am incompetent
- I can’t do anything right
- I am so helpless
- I feel trapped
- I am a failure
- I feel out of control
- I am unattractive
- I am not good enough
- I am stupid
- If I make one mistake, I will lose everything
- Without a woman (man), I am nothing
- I must always be in control
- No matter what I do, I won’t succeed
- Others always take advantage of me
- No one is ever fair to me
- Never show your emotions
- I am lazy
- To be accepted, I must always please others
- I am defective
- I am bound to be rejected/abandoned
- The world is too frightening
- I am a fake
- If I choose to do something, I must succeed
- I am unwanted
- I am powerless/weak
As evident, the above themes in depression are negative – finding faults and deficiencies within yourself, blaming yourself or others, subjecting yourself to absolutistic demands of “musts” or “shoulds,” and imposing on yourself the “If – then” rules or conditions. You can challenge irrational core beliefs and replace them with adaptive ones using the same techniques used to challenge and modify automatic irrational beliefs in CBT. It would be helpful to rank your irrational core beliefs according to the level of distress they cause so that you can address the most distressing ones first. Sometimes, when the most distressing core belief is challenged and modified first, the weaker depressing themes may collapse on their own (Knaus, 2012).
While eliminating negative core beliefs may not always be possible, one can identify a companion positive core belief and look for evidence to support it (Greenberger & Padesky, 2016). For instance, a person harboring a negative core belief, "I am unlovable," would find evidence to support the new core belief, "I am lovable." Positive core beliefs don't necessarily have to be the opposite of negative ones. Core beliefs may sometimes be more challenging to change and may require you to seek professional help from a therapist trained in CBT.
HARPREET S. DUGGAL, MD, FAPA
REFERENCES
Beck, A. T. (1964). Thinking and depression. II. Theory and therapy. Archives of General Psychiatry, 10, 561-571.
Greenberger, D., & Padesky, C. A. (2016). Mind over mood (2nd ed.). Oakland, CA: New Harbinger Publications, Inc.
Knaus, W. J. (2012). The cognitive behavioral workbook for depression (2nd ed.). Oakland, CA: New Harbinger Publications, Inc.
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