Depression Protocol – Module 4

Phase 4: Core Belief Work

After you are educated on cognitive restructuring tools and themes have been identified in thought records you can shift towards beginning to challenge those core beliefs.  If the therapist has not identified the salient core belief, then ask for a core belief list and try to identify any that resonate with you.  The therapist can also use the downward arrow technique more deliberately to identify core beliefs.

Here are some examples of using the downward arrow to arrive at core beliefs. The initial thought as recorded on a thought record is followed by responses to the therapist promptings.

  1. “My belief that marriage lasts forever has been challenged by my separation.” –>” This means that what I believe about marriage isn’t true.” → “If what I believe about marriage isn’t true, what else am I wrong about?” → “I am a foolish person.”
  2. “My wife wants to go to bed early tonight.”–>”She must not value spending time with me.” → “I am not worthy of her time.” → “I am unlovable.”
  3. “I am a bad cook.” –> “I cannot fulfill my role obligations.” → “I am a failure.”
  4. “I am never going to get a job.” → “I will not be able to provide for my family.” → “I am a failure. “

You will know when you have identified a core belief because that belief will be extremely resistant to change.  Core beliefs are those most strongly held beliefs, opinions and points of view that tend to be very rigid, resistant to change and distorted.  They are often formed in childhood and maintained through systematic information processing biases and distortions.

There are four categories of core beliefs that we are most interested in:

  • Core Beliefs about the Self: I am bad / I am strong / I am sinful / I am perfect / I am unlovable / I am entitled / I deserve bad things
  • Core Beliefs About Others: Others will hurt me / Others are my potential friends / Others are out for themselves only / Others need me, and I need them
  • Core Beliefs About the World: The world is safe / The word is my oyster / The world is mean / The world is beautiful / The world is a palette
  • Core Beliefs About the Future: Terrible things are destined to happen to me/ my future is bright / My future is grim / I believe I can achieve my important goals / I will never achieve my goals.

The most common Core Beliefs that those suffering with depression report are: “I am unlovable”; “I am incompetent”; “I don’t like other people” and “There is no hope for my future.”  Many variations of these themes manifest so that a client may use slightly different language such as: “I am bad” or “I am a failure” or “People suck.”  The overarching theme seems to be believing one is hopeless to have intrinsic needs met.

Core beliefs are identified so that they can be challenged.  There are four general steps for challenging core beliefs:

  1. Step 1: Find evidence that the belief isn’t true ALL the time. Your therapist can help you brainstorm and create a list of exceptions.  For example, if you have a belief that you are a failure then brainstorming successes or helping you recognize past successes can aid in changing the belief.  Remember, that due to the mental filter, this will be a difficult exercise for you to complete and will rely on skillful questioning from the therapist.
  2. Step 2: Develop an alternative core belief and look for evidence that this is true. The new core belief should not be unrealistic but should be a balanced recognition of strengths and weaknesses. For example, the core belief: “I am perfect just the way I am” may be unrealistic so an alternative may be: “I have the capacity to learn, grow and have my needs met.” As with the first step, you can brainstorm with your therapist to find evidence that proves the balanced core belief is true.
  3. Step 3: Finally, for very rigid core beliefs an examination of the past may be necessary. This can be a time-consuming process as it involves analyzing pivotal events in your history that you believe proves the belief is true.   It is important to analyze these pivotal moments, identify how they were interpreted and reframe them using cognitive restructuring techniques.
  4. Step 4: Changing core beliefs is a difficult and time-consuming process that takes a lot of effort and persistence. In order to successfully change a core belief, it is often necessary for you to repeatedly and purposefully look for new evidence to support your  budding new balanced beliefs.  The positive data log is a tool that asks you to record evidence everyday that supports the new belief.  This is a crucial step and ensures gains are maintained and that the brain is slowly rewired over time.

The Main Goals for Phase 4 include:

  • Identifying and determining the most relevant core beliefs to begin changing.
  • Education on what core beliefs are and how they are maintained.
  • Creating a list of exceptions to the problematic core belief.
  • Doing a historical analysis of the core belief, if needed, to reframe pivotal life experiences and reprocess them as an adult.
  • Creating a new balanced core belief to be reinforced over time.
  • Homework: Utilizing positive data logs every day to reinforce the new balanced core belief.
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