How to Identify Core Beliefs in CBT With a Client

What are core beliefs in CBT?

Core beliefs are fundamental, rigid and generalized beliefs that a person holds about themselves, other people, the world or the future. Wenzel uses this definition, drawing on Judith Beck and Keith Dobson. Examples include "I'm worthless," "I'm incompetent" and "I'm trapped."

Core beliefs usually form from messages a person receives over time, often in childhood. Wenzel notes they can also form or change in adulthood after very stressful events. A person tends to treat the belief as a fact rather than an idea, which is part of what makes it hard to examine.

Padesky describes schemas as core beliefs that cognitive therapists think play a central role in maintaining long-term problems. The two terms are often used together. In Wenzel's account, core beliefs are the content of a schema.

How do core beliefs relate to automatic thoughts?

Core beliefs sit underneath automatic thoughts and make certain thoughts more likely in certain situations. Between the two sit intermediate beliefs: the rules, attitudes and assumptions a person lives by, often worded as "if, then" statements.

Wenzel gives an example. A student with the core belief "I'm a failure" might live by the rule "If I get anything less than all As, then I'm a failure." A low grade then triggers the automatic thought "I'm never going to get into medical school." A different student with the core belief "I'm unlovable" might react to the same grade with "Why should anyone care about me?"

Wenzel also describes how core beliefs bias attention and memory. A person notices and remembers information that fits the belief and overlooks information that does not. This keeps the belief in place, even when contrary evidence is available.

When should you work on core beliefs in therapy?

Most cognitive therapists work on core beliefs later in treatment, after the client has practiced with automatic thoughts. Wenzel gives two reasons. Some clients first need practice spotting the thoughts linked to their moods. Others find naming a core belief too painful early on, and working with situational thoughts first lets them get comfortable examining their own thinking.

There are exceptions. Some clients arrive able to name the belief they want to work on in the first session.

James and Barton advise care at this level. Core beliefs shape a client's self-concept and view of the world, and they note that lasting change is hard to achieve. Wenzel adds that sustained attention to core beliefs can raise distress, and clients may feel worse between sessions. Check that the client has coping skills in place before you start, and plan for that possibility together.

How to identify core beliefs with a client

Identify core beliefs collaboratively, starting from material the client has already produced.

1. Collect automatic thoughts. Ask the client to record situations, moods and thoughts between sessions, for example with a thought record.
2. Look for themes. Across several weeks of records, look for ideas that repeat. Repeated themes can point to the belief underneath.
3. Notice the hot thoughts. Pay attention to thoughts that carry the strongest emotion. Wenzel notes that these can be core beliefs themselves, or close to one.
4. Use the downward arrow. Take one automatic thought and ask what it would mean if it were true, and what that says about the client. Repeat until the answer is a basic statement with no further meaning underneath it.
5. Link it to past experiences. When a client says a situation reminds them of something earlier in life, ask what message they took from both. The common thread may reflect the core belief.
6. Treat the result as a hypothesis. Write the belief down in the client's own words and test it against the work you do in later sessions.

Wenzel describes the downward arrow as perhaps the best-known strategy for this. In one of her case examples, a client who feared blushing in social situations started from the thought "Others are going to see that I am red" and arrived at "I am weak" and "I am less than a man."

Some therapists also use self-report questionnaires, which can cover a wide range of beliefs in a short time. Wenzel cautions that clients may not yet be aware of their beliefs and that a questionnaire may miss an individual's belief. So treat questionnaire results as hypotheses too.

What are common core beliefs?

Common negative core beliefs about the self cluster around a few themes: being unlovable, inadequate, helpless or worthless. Wenzel describes three main themes: lovability ("I am undesirable"), adequacy ("I am incompetent") and helplessness ("I am trapped").

Research on measuring core beliefs points in a similar direction. In developing the Negative Core Beliefs Inventory, Osmo and colleagues found that beliefs about the self and beliefs about others fell on separate dimensions. They found preliminary evidence that beliefs about the self split further into helplessness and inferiority, helplessness and vulnerability, unlovability, and worthlessness. Scores were linked with reports of negative childhood experiences, attachment styles, anxiety and depression.

Core beliefs can also be about other people or the world. In one of Wenzel's examples, a man who returned from combat held the belief "The world is cruel." These categories are a guide for listening, not a checklist. Use the client's own wording.

How do you change a core belief once you find it?

Core beliefs change gradually, by lowering how strongly the client holds the old belief and building a new, more balanced one. Wenzel notes they are almost never changed after a single session. Padesky describes several clinical methods for weakening an old schema and building a new one.

• Positive data log. The client writes down, over weeks, experiences that fit the new belief. This works against the bias toward noticing only evidence for the old one.
• Continuum. The client rates themselves on a 0 to 100 line instead of an all-or-nothing label. James and Barton offer practical guidelines for this technique.
• Historical test. The client reviews evidence for and against the belief across periods of their life, such as school years and early adulthood.
• Core belief worksheet. A structured sheet for examining the evidence for the old belief and for a new, healthier one. Wenzel credits Judith Beck with this worksheet.
• Behavioral experiments. Wenzel notes that some clients believe the new view "intellectually" but not "emotionally." An experiment tests a prediction based on the belief in real life, so the client can see the result for themselves.

Most therapists combine several of these methods, chosen to fit the client's formulation.

What does research say about core belief work?

The research on core belief work as a separate step is limited. Wenzel notes that CBT as a whole has been tested in many trials, but that the research has little to say about whether core belief work improves outcomes beyond earlier work on automatic thoughts and behavior.

Schema therapy, which targets similar deep beliefs, has a small evidence base on this question. A systematic review by Taylor and colleagues included 12 studies, and required each one to measure schema change. Schema change and symptom change were both found in 11 of the 12. The authors concluded that schema therapy showed initial significant results for personality disorders, but that formal mediation studies were lacking and rigorous evidence for other disorders was sparse.

In practice, this means core belief work rests mainly on clinical theory and experience. Keep track of how strongly the client holds the old and new beliefs over time, so you can see whether the work is helping.

Using this with clients

Much of the groundwork for core belief work can happen between sessions, so session time can go on the harder conversations.

• Share the Uncover Your Core Beliefs video first. It is a short animated explanation of what core beliefs are, where they come from, and how to start spotting them.
• Assign the Core Beliefs mini course. It explains how core beliefs filter experience and walks the client through the "what does this mean about me?" questions. The client then names a belief that came up in a recent situation, lists evidence that challenges it, and writes a more balanced alternative.
• Keep the client recording automatic thoughts with the Thought Record, and use Examining the Evidence to weigh the evidence for and against a specific thought.

Treat what the client brings back as a starting point for discussion, not a finished formulation. If you need a refresher on the layer above core beliefs, see our guides to automatic thoughts and thought records.

You can assign these tools to a client in Offload in one click and review their responses before the next session. Start your 30-day trial.