Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition _ _____________________
C : That most people don’t perform perfectly at every- thing they try right away. So, I guess the new belief could be that it is realistic to expect that if I want to be good at something, I will have to practice and put in some effort. CORE BELIEFS As described earlier, core beliefs are those that the individual holds most deeply; they are rigid, fixed, generalized, and often difficult to modify. Patterns may emerge through identifying intermediate beliefs, and automatic thoughts that may give the the rapist clues about the client’s underlying core beliefs. The therapist may hypothesize a core belief early in therapy, although typically the therapist will first attend to automatic thoughts and intermediate beliefs. Generally, the therapist helps the client understand that core beliefs are ideas, not facts, and that they can be tested and modified. When the therapist determines it is appropriate, they may share their conceptualization of the client’s core beliefs to make further progress in therapy. Many of the techniques presented above can help the therapist elicit and identify core beliefs, auto- matic thoughts, and intermediate beliefs. Additional techniques could include restructuring early memories, reviewing how the belief was developed and maintained, assisting the client in distancing himself or herself from the belief through the use of metaphor, having the client compare themself to an extreme version of the belief, and constructing a continuum of the extremes of the beliefs through which the client can begin to see the areas between extremes (J. S. Beck, 2020). Modifying core beliefs may often be difficult and takes a much longer than modifying other thoughts and beliefs. Modifying core beliefs can create lasting change for clients, but this approach is not appropriate for everyone. Determining whether targeting and modifying core beliefs is appropri- ate and applying the techniques required to do so can be complex and delicate. Therefore, therapists are advised to seek advanced training and supervision should they wish to pursue this level of intervention. Note that many clients can be assisted in reaching their goals by attending to automatic thoughts and intermediate beliefs. COPING SKILLS TRAINING AND BEHAVIORAL TECHNIQUES Coping skills training and behavioral techniques are often part of cognitive therapy. Coping skills may include problem-
solving, decision-making, social skills, assertiveness skills, relax- ation, time management, mindfulness, and self-management facilitated through bibliotherapy. In cognitive therapy, behavioral techniques are primarily used in the evaluation (e.g., testing the validity), modifying mal- adaptive thought patterns, and learning new skills. A sample of two approaches that use behavioral techniques to evaluate and modify thoughts and beliefs at all three levels is presented subsequently. The therapist tailors the techniques to match the client’s specific issue. Additional techniques may include graded task assignments, activity scheduling, scheduling worry time, behavioral rehearsal, and in vivo exposure. One can also explore possible environmental change to support cognitive and behavioral change. Far more behavioral techniques are available to the cognitive therapist than can be reviewed in this text. Technique: Test It (J. S. Beck, 2020) Once an automatic thought, intermediate belief, or core belief has been identified, a behavioral experiment can be initiated to test the accuracy or validity of that thought or belief. This experiment can occur in the office with the therapist or as an out-of-session exercise. One must exercise caution, however; in assigning such behavioral homework, it will not always work out as planned. Before the client attempts the homework, the therapist discusses preparatory steps (e.g., who, what, where, when, and how) and potential outcomes (e.g., what the client will do if their expected negative outcome does occur). Example: T: We’ve established so far that you believe others view those who ask for help as weak, correct? C: Right. T: Are you willing to test that belief? C: I guess so, but how? T: Any ideas? C: I guess I could ask someone for help and see what happens. T: That’s one way. Other ideas? C: I suppose I could start by asking people what their views are on people asking for support. T: How would you ask them? C: I’d ask, “If you knew someone who just lost their significant other and needed some help with a few things, what would you think of them if they asked for that help?” T : Right, that sounds like a good place to start. Who would you ask? [and so forth]
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