Topic 6: Automatic Thoughts & Core Beliefs {by 10/21}

[Automatic Thoughts] – Watch MDD-12: Automatic Thoughts – Negative Automatic Thought Record.  Answer the following: (1) How is the client’s response to the outcome (emotionally and cognitively) helpful to understanding his distress? (2) What would be effective Socratic techniques to modify his negative automatic thought?

 

[Core Beliefs] – (1) How do core beliefs develop?  (2) What is it about core beliefs that can make them a challenge to modify in therapy?  (3) What are the therapeutic gains that come from modifying core beliefs?

 

Your original post should be posted by the beginning of class 10/21.  Have your two replies posted no later than 10/23.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

28 Comments (+add yours?)

  1. Jennifer Vear
    Oct 19, 2021 @ 16:01:21

    [Automatic Thoughts]
    1. The client’s response to the outcome is helpful to understanding his distress because the way in which they respond will help the therapist determine the direction for treatment. Depending on how strong the negative automatic thoughts are and the client’s believability of those thoughts will show the direction of the socratic technique that will work best for modifying those thoughts. For example, if a client is most likely to highly believe negative automatic thoughts that have to do with themselves, then they could benefit from separating themselves from the negative core belief. When they separate themselves, they are forced to take an outside perspective of the situation, instead of strictly personalizing every negative situation and negative automatic thought. Furthermore, if a client believes cognitively that they do not believe a negative automatic thought, but emotionally, it feels true to them, they could benefit from looking at the evidence to see if it is truly valid.
    2. There are four socratic techniques that are used to modify negative automatic thoughts. These include examining the evidence, listing the advantages and disadvantages of the negative core belief, separating the self from the negative core belief, and viewing the negative core belief on a continuum. The socratic technique that could work best for Mark would be to separate the self from the negative core belief. Mark continuously blames himself for situations that do not go according to plan. He personalizes these negative interactions to be a negative reflection of his personality. If he focuses on separating himself from these negative automatic thoughts during these situations, it can be helpful for him to see that it does not necessarily have to do with him. It can also be helpful for Mark to see multiple sides to reasons for various outcomes.

    [Core Beliefs]
    1. Core beliefs are an individuals’ beliefs about themself as a person that develops from possibly traumatic experiences, interactions with significant individuals, genetics, and/or continuous automatic thoughts that frequently appear to support the core belief. The more these automatic thoughts occur within various situations, the more likely the individual is to believe that their thoughts are not just situational, but an element of themselves. These core beliefs can either be positive or negative, as the more the interactions occur, the more the individual will come to believe them.
    2. Core beliefs can be very difficult to change and modify in therapy. In order to change a core belief, you have to start by changing the negative automatic thoughts that occur in various situations. Core beliefs and negative automatic thoughts might not always be readily identified for the individual. The first challenge is to identify these negative automatic thoughts to then understand the underlying core belief. Once they are discovered, the individual has to work to change those thoughts, find holes in their reasoning, which will then help to start and crack the foundation that is built under the core beliefs. When an individual no longer believes those negative thoughts, the greater the likelihood of them changing their core belief.
    3. When an individual is able to modify their negative core beliefs through therapy, it can allow them to positively cope when they are faced with difficult situations. The more positive the core belief becomes, the less likely they are to have negative automatic thoughts. Even adaptive individuals can have negative thoughts from time to time, but if they are able to change them and have a positive core belief, then that is what will truly benefit them to living a happier life.

    Reply

    • Valerie Graveline
      Oct 20, 2021 @ 21:41:08

      Hi Jenn,

      I like your point about how Mark would benefit from the socratic technique of separating oneself from the thought. Initially this was one of the socratic techniques I was going to mention…I felt it was hard to decide which technique to choose as it seemed he could truly benefit from so many of them! I agree with you, though, that this technique would prove very valuable considering one of his cognitive patterns surrounds his personalization of the negative experiences he endures. I also think this technique could be effectively combined with exploring alternative explanations if Mark happened to have difficulty identifying what he might say to a friend/family member who was in a similar situation due to his strong level of believability regarding his automatic thoughts.

      Valerie

      Reply

  2. Kaitlyn Tonkin
    Oct 20, 2021 @ 11:29:30

    Automatic Thoughts

    1. When Mark was turned down by his friend he immediately thought it was because he is unlikeable and nobody wants to be friends with him. He then withdrew and went to eat by himself. While sitting alone, he began ruminating on the thoughts and got stuck in a cycle of self-perpetuating those negative feelings. This is something that occurs often in individuals with depression and explains Mark’s diagnosis and symptoms well. He had a negative thought which lead to an intense negative emotion, which he is now perseverating on and finding it difficult to get out of that cycle and feel positive emotions. This cycle also perpetuates his distress because he is ruminating and continuing to think about the event. Had Mark accepted his friend’s answer and asked another friend to lunch, he would be in the company of others and not feel like he was unlikeable. However, he withdrew and indulged in unhealthy food to cope with his negative feelings. It seems like Mark’s symptoms of depression are cyclical and his response to the situation perpetuates these negative feelings. Mark’s therapist can see how his negative automatic thoughts influenced his behavior which then led to him ruminating and having more negative automatic thoughts – there is a clear cycle in Mark’s behavior and thoughts that lead to self-perpetuating distress.

    2. Socratic techniques are used in CBT as a way to question clients about their automatic thoughts and get them to see the truth about the thoughts without explicitly telling them. There are various Socratic techniques that can be used and it is important to note that not all of them are useful or helpful for every client. The different types of Socratic techniques are examine the evidence, decatastrophize perceived negative outcomes, explore possible alternative explanations, assess the impact of believing the negative automatic thought, separate self from negative automatic thought, and shift attributional biases. Using Socratic techniques with Mark would be helpful to get him to dismantle his negative automatic thoughts, however, I think there are particular techniques that would work best for Mark. One Socratic technique that I think would be beneficial for Mark is examining the evidence. Mark believes that his friends do not want to spend time with him, so taking the time to examine the evidence for and against that thought would be helpful for him to see that this thought is not exactly valid. It might even be helpful for Mark to create a physical list to see that there is more evidence against the thought and that could help him better understand that he is not unlikable. Another Socratic technique that I think would be helpful for Mark is to explore possible alternative explanations. When Mark asked his friend to lunch, he said no and Mark assumed that it was because he does not want to spend time with Mark. However, there are several other reasons Mark’s friend might have said no. Giving Mark the opportunity to come up with these various alternative explanations would allow him to see that his friend did not say no because he doesn’t like him, but rather that he had another reason, such as he was busy with work, or having a rough day and wanted to be by himself. Similarly, having Mark shift his attributional bias might also be helpful. This Socratic technique involves having a client assess the attribution of an event as internal or external. If Mark could assess the attribution of the event, he might see that there were other external factors that influenced his friend’s response that had nothing to do with him. This is helpful because it attempts to shift the attribution of an event away from the individual which in turn lessens distress.

    Core Beliefs

    1. Core beliefs typically develop early in childhood and adolescence. However, they can develop in adulthood as well. Core beliefs develop as a result of significant interactions with influential individuals such as parents, teachers, coaches, and peers. Additionally, significant life experiences, like traumatic events or even successes can contribute to the development of core beliefs. Finally, genetics and biological vulnerability such as intelligence, temperament, and lacking or possessing certain skills can influence the development of core beliefs. It is important to note that these three factors (individuals, life events, and genetics) all interact and influence one another, which in turn influences the development of core beliefs. Furthermore, each of these factors can contribute to the development of both positive and negative core beliefs, but negative core beliefs become more salient when one experiences psychological distress.

    2. Core beliefs can be difficult to challenge in therapy because core beliefs are so rigid and concrete. It can be difficult for clients to modify them because they have likely spent a large portion of their lives believing these negative core beliefs. Core beliefs also develop because of interactions with significant people in our lives or significant life events. These people and instances hold a lot of value to an individual, so modifying a belief that stems from that can be difficult because of how much value and validity is placed on that belief. Another reason core beliefs can be difficult to modify is that clients may not be able to identify them right away. Instead, clients might be focusing on specific thoughts or emotions and have trouble pinpointing exactly what their core belief is.

    3. Modifying core beliefs can be beneficial because it can help clients modify their views of themselves, others, and the world. Modifying core beliefs can also influence how individuals interact with other people. Additionally, modifying core beliefs can diminish the amount of psychological distress one experiences by limiting the number and frequency of negative automatic thoughts. As mentioned previously, individuals also have positive core beliefs, so working on modifying negative core beliefs can help uncover those positive core beliefs and strengthen them. Modifying core beliefs also helps build resistance to future stressors because the individual has learned how to recognize and modify their negative automatic thoughts.

    Reply

    • Giana Faia
      Oct 20, 2021 @ 13:53:53

      Hi Kaitlyn,

      I like how you mentioned what if Mark had asked another friend to lunch, then he would not be isolated, eating lunch alone, thinking that he is unlikable. It seems like his automatic thought completely discouraged him from asking someone else to lunch, causing him to shut down and withdraw. Had he done that, he might not have experience the self-perpetuating thoughts that stemmed from his automatic thought. However, the risk of getting turned down yet again could have prevented this from happening. If Mark recognized this automatic thought and modified it, maybe he could’ve asked someone else to lunch. Thanks for sharing!

      Giana

      Reply

    • Jennifer Vear
      Oct 20, 2021 @ 19:16:11

      Hi Kaitlyn!

      You did a really great job with your description on Socratic techniques that Mark would most benefit from. I like how you first mentioned how he could benefit from examining the evidence. He does seem to jump to conclusions and then when he works through them later with Dr. V, he starts to think of things that he did not notice before. Even when he weighs his past and current believability of most of his thoughts, he realizes that they are not the same. He could definitely benefit from working on this type of technique on his own. Understanding other alternatives for those experiences are also tied in here, as you mentioned. Overall, really great job.

      Reply

    • Katie O'Brien
      Oct 21, 2021 @ 12:00:56

      Kaitlyn,

      I like the idea of shifting Mark’s attributional bias. We do see a pattern of personalization and internalization with Mark in various settings – personal life with friends, at work, with coworkers, etc. and so it is definitely a theme he struggles with quite a bit. Learning to not take negative outcomes so personally would certainly alleviate a good amount of his distress, as that is so often his first reaction: I must be the problem, people don’t like me, they don’t want to spend time with me. He is pretty insightful, and like you mentioned, can often come up with alternatives when prompted. However, that knee-jerk reaction is to blame himself. Practice shifting the focus to other factors, maybe they were busy, maybe they themselves were feeling down and didn’t want to socialize, would be a big help to Mark so he does not feel so personally let down when he doesn’t get the desired outcome. Great point!

      – Katie

      Reply

  3. Giana Faia
    Oct 20, 2021 @ 13:44:44

    [Automatic Thoughts] –
    (1) After Mark’s friend said no to getting lunch with Mark, he went to get lunch by himself where he sat isolated and ruminated on his automatic thoughts that he is unlikable and no one wants to be his friend. Relating to the outcome, Mark said he felt bad, sad, and guilty because he believes he is hard to like. This negative automatic thought of feeling unlikable caused Mark to feel these unpleasant and negative emotion toward himself and how he perceives others to think about him. It is because of this response to the outcome that is helpful to understanding his distress because it demonstrates Mark’s coping skills when it comes to distressing situations. By ruminating on the automatic thought, isolating himself, letting it create other negative automatic thoughts, it shows how he let the distress impact both his perception of himself and how others view him.

    (2) Socratic techniques are used as a way to help guide the client to certain conclusions rather than tell them specifically. Effective Socratic techniques to modify negative automatic thoughts for Mark could be to examine the evidence and explore possible alternative explanations. He could examining the evidence by thinking “what is the evidence to support that I am unlikable? And what is the evidence that shows I am likable?”. This may help Mark see that just because of this one experience does not mean he is unlikable. It could help Mark see that just because of experience of his coworker not wanting to get lunch, does not mean Mark specifically is unlikable. For exploring alternative explanations, he could go through other reasons for why his friend said no to getting lunch. His friend could have actually been busy, or maybe experiencing his own distress about a situation, or wasn’t hungry at the time causing him to decline getting lunch with Mark. These are some Socratic techniques that could be used to help modify Mark’s negative automatic thought.

    [Core Beliefs] –
    (1) Core beliefs develop early in life, usually in childhood/ adolescence. Core beliefs stem from significant interactions with influential people, such as teachers, parents, or peers. Core beliefs can also develop from significant life events, such as both traumatic experiences or successes. Another contributor to the development of core beliefs is both biological and genetic factors such as intelligence, temperament, and skill set. It is because of the reciprocal interaction between all three factors that core beliefs are enhanced and validated. People can experience both negative and positive core beliefs, however, negative core beliefs usually occur when experiencing psychological distress. These negative core beliefs can ultimately negatively impact thoughts and behaviors.

    (2) Core beliefs are deeply ingrained due to the development of them starting in early life, causing them to be difficult to modify. The main challenge that comes with modifying core beliefs in therapy is first being able to identify and evaluate them. Since they are so deeply rooted, the client may not even be able to recognize them. This can be difficult and requires recognizing automatic thoughts as a way to help facilitate identifying and evaluating core beliefs as they relate to the clients distress. It is also important to integrate new, more positive core beliefs once modification of core beliefs occurs.

    (3) By modifying negative core beliefs, it paves the way for changes in how the client views themselves, interact with others, and views the world. Along with this, modification can reduce the frequency and intensity of them, ultimately eliminating overall distress. Another therapeutic gain that comes from modifying negative automatic thoughts is that it helps resist future stressors due to the new ability of recognizing and identifying automatic thoughts. While trying to modify negative core beliefs, positive core beliefs can be uncovered and enhanced which can help in the modification of negative core beliefs.

    Reply

    • Jennifer Vear
      Oct 20, 2021 @ 19:12:36

      Hi Giana!

      I really like how you mentioned that core beliefs are really difficult to modify and they can stem from influential people. I think it is interesting to think about the fact that many people can have similar core beliefs about themselves even with very different experiences. However, with modification, you can change these core beliefs to become more positive. One technique will not work for everyone, but I believe that is what makes our field so interesting. We have to really learn about who these individuals are and their experiences in order to work with them and see what works best for them. It makes our job really interesting and makes me even more excited to get started.

      Great job!

      Reply

    • Valerie Graveline
      Oct 20, 2021 @ 21:49:13

      Hi Giana,

      I appreciate how you articulated how Mark’s behavioral responses to the outcome of his experience demonstrates his coping skills in distressing situations. It seems as though what you identified, being his rumination, isolation, and perpetuation of the negative automatic thoughts is a continuous pattern he utilizes when in stressful situations. It is very valuable that the clinician is able to recognize Mark’s behavioral patterns in response to such outcomes so that it is clear what he and Mark should address moving forward in treatment. I also noticed that Mark is proving to be effective so far in recognizing his negative automatic thoughts, so hopefully this will help him modify such maladaptive behavioral patterns as well.

      Valerie

      Reply

    • Sergio Rodriguez
      Oct 21, 2021 @ 06:58:38

      Hi Giana,

      I like how you presented the importance of modifying negative core beliefs as an opportunity for the client to change the way they see the world. I consider this is a crucial element and many times overlooked because when new paths are a possibility for a client, new ways of thinking, perception, and behaviors are developed and that’s a core element of therapy. I also agreed with the fact that using the “positive” adaptive core belief will facilitate navigating future stressor situations for the client.

      Thanks,

      Sergio R.

      Reply

  4. Valerie Graveline
    Oct 20, 2021 @ 21:31:55

    Automatic Thoughts
    1) Mark’s response to the outcome of his behaviors, both emotionally and cognitively, provides the clinician with valuable information in understanding his distress. When Mark was turned down by a friend when asking to go to lunch, Mark withdrew from further social interaction by instead eating alone in his car while continuing to think about the event. Mark described the outcome of his withdrawal behaviors as causing him to feel isolated, lonely, and guilty. Mark’s response to the outcome of his behaviors allowed the clinician to notice that Mark was ruminating about the event and his negative automatic thoughts. Further, Mark’s emotional and cognitive responses to the outcome showcased the areas he and the clinician should particularly address when working toward restructuring his negative automatic thoughts, such as his perceived guilt, isolation and loneliness. By understanding Mark’s responses to his behaviors and negative automatic thoughts, the clinician is able to effectively adapt the treatment plan and address what issues are most salient to Mark. With this, it is also helpful that Mark rates the believability and intensity of the emotions he experienced so that the extent of his distress is especially clear to the clinician.

    2) There are six socratic techniques that could potentially be used to modify Mark’s negative automatic thoughts, including examining the evidence, decatastrophizing perceived negative outcomes, exploring alternative explanations, assessing the impact of believing the thought, separating oneself from the thought, and shifting attributional bias. Though there are many different techniques that can be utilized, it is important to note that the various techniques are only useful when contextually relevant to the particular automatic thought. With this in mind, Mark would especially benefit from socratic techniques such as examining the evidence and exploring alternative explanations. With examining the evidence related to his negative automatic thought, this technique is especially useful when the client’s thought is strongly believed and is accompanied by intense emotions, which is seen with Mark’s negative automatic thoughts. In this technique, Mark would be able to compare his negative automatic thought with evidence, and if the thought is invalid, he and the clinician can work toward modifying the thought. On the other hand, if the negative automatic thought had some validity, he and the clinician should instead focus on how to cope with the thought. Regarding exploring alternative explanations, this technique is useful when the client may jump to conclusions about various events or personalize situations, just as Mark does. In this technique, the clinician may ask Mark what possible alternative explanations may be associated with why his friend turned him down for lunch. This technique could help Mark realize that the alternative explanation(s) is more likely or valid than his negative automatic thought.

    Core Beliefs
    1) Core beliefs typically develop during an individual’s childhood or adolescence, but have the potential of developing during adulthood depending on their experiences. When developed in childhood or adolescence, the influence often results from the individual’s interactions with family, friends, significant others, coaches and/or peers. With this, significant life events that the individual experiences, whether it is perceived as a positive or traumatic event, can also have an influence on one’s developing core beliefs. Finally, there are biological factors that affect the development of core beliefs, such as one’s level of intelligence, skills they do or do not possess, or even their temperament as a child. It should be noted that these factors also interact with one another, rather than acting independently when influencing the development of one’s core beliefs. Individuals develop both positive and negative core beliefs, but negative beliefs are frequently more recognizable in comparison to positive beliefs due to the level of distress they cause one to experience.

    2) It can be challenging to modify core beliefs due to the fact that such beliefs have likely been a significant part of an individual’s thinking processes for most of their lives. Due to this, it can be very difficult for individuals to even recognize their negative core beliefs if such beliefs are perceived to be ‘normal’ by the individual. Negative core beliefs can often be difficult to modify in therapy because one’s beliefs about themselves, others or the world have been continuously reinforced by their experiences over the years. Not only this, but one’s negative core beliefs may have possibly had some level of validity in the past, which causes the individual to continue to believe such ideas to be accurate, even if they do not prove to be valid anymore.

    3) Therapeutic gains that come from modifying core beliefs include diminishing a client’s overall distress, preventing future stressors, and changing the way they view themselves, others or the world into a more positive, adaptive lens. By modifying a client’s negative core beliefs, their distress will diminish considering they will likely have less negative automatic thoughts related to such beliefs. The individual will likely experience related automatic thoughts much less frequently, and with this, will be able to recognize and modify such negative thoughts as they arise in the future. Thus, the client will have the ability to prevent future related stressors. Also, individuals can modify their negative core beliefs in order to have a more adaptive approach to their own thoughts, interacting with others, and their ideas about the world, which will ultimately allow them to function more effectively in their daily lives.

    Reply

    • Sergio Rodriguez
      Oct 21, 2021 @ 06:50:31

      Hi Valerie,

      I agree with you that it was essential that Mark rated the believability and intensity of the emotions he was experiencing when he received the response from his coworker, but also when he was displaying his behavioral response to that (eating by himself in the car), ruminating about all the situation and perpetuating these negative automatic thoughts. For a therapist that knows his patient will be easier to assess and intervene in a situation when a precise scale of gravity is provided.

      Thanks,

      Sergio R.

      Reply

    • Giana Faia
      Oct 21, 2021 @ 10:04:57

      Hi Valerie,

      I also agree that examining the evidence and exploring alternative explanations are both beneficial Socratic techniques that Mark could use. By examining the evidence, it can help Mark visualize the evidence either support or against his automatic thought. If he finds evidence that supports it, this will then allow him and his therapist to explore coping strategies to handle it. Along with this, exploring alternative explanations, it allows Mark to come up with other ideas as to why his friend did not get lunch with him rather than it being because he is unlikable. Thanks for sharing!

      Giana

      Reply

    • Katie O'Brien
      Oct 21, 2021 @ 12:06:39

      Valerie,

      I think it is important to note the significant impact of Mark’s emotional and cognitive reactions to the outcome on his overall well-being. We’ve talked about how not all negative automatic thoughts or core beliefs are suited for modification, particularly when we want to make the most of our time in therapy. As this pattern of thinking clearly has a pretty substantial impact on Mark – feeling lonely, isolated, even guilty, it seems these thinking patterns are definitely worth evaluating and modifying. Not only do his reactions give us something to work with in terms of modification, such as which behaviors to modify, the reactions themselves prove that the thoughts are worth modifying to begin with.

      Really good point!

      – Katie

      Reply

    • Kaitlyn Tonkin
      Oct 21, 2021 @ 15:00:49

      Hi Valerie,

      You make a really good point about how this brief example of Mark’s behavior can give the clinician a better idea about Mark’s coping skills and how he manages his emotions. You also mention how the clinician can use this example to create a treatment plan for Mark and address his thoughts, emotions, and behaviors. I think it is important to remember that clinicians are also learning when their clients are completing certain homework assignments, like a negative automatic thought record. Your comment allowed me to start thinking more about how beneficial these activities really are for both the client and the therapist.

      Great post!

      -Kaitlyn

      Reply

  5. Lisa Andrianopoulos
    Oct 20, 2021 @ 22:21:30

    In MDD-12, Mark’s behavioral response to Jeff declining the lunch invitation is to go to McDonald’s instead of his original restaurant choice and sit alone in the park. The outcome of this, as identified by Mark together with is therapist, is feeling lonely and isolated and ruminating about the event. This led to further feeling sad, bad, and guilty, and became self-perpetuating. It is important for Mark and his therapist to examine this because it helps pinpoint where the distress is coming from and identifies the maladaptive responses that intensify and reinforce the automatic thoughts. Identifying maladaptive patterns in Mark’s responses to distressing events is an opportunity for Mark to gain insight into how his emotional and behavioral responses impact different areas of his life. Additionally, it is a real-life example of the cognitive model, meaning it gives Mark context to understand how his thoughts, emotions and behaviors all influence each other. With this insight, Mark’s motivation to change may increase. A useful Socratic technique to modify Mark’s negative automatic thought is to first examine the evidence that it is actually true. This can be done by eliciting from Mark what evidence he has both for and against the thought. Next, ask Mark to come up with other more plausible scenarios for Jeff’s decline (i.e., elicit alternative explanations). It was also identified that Mark tends to over personalize. Therefore, it could be helpful to encourage Mark to separate himself from it so he can look at it more objectively. This can be done by asking Mark what he would say to a family member or friend who had a similar thought.

    Core beliefs typically develop in childhood or adolescence. They are based on the interactions one has with significant others and/or those influential in their lives. Along the way, significant life events, both positive and traumatic, contribute to further shaping the core belief. Personal characteristics related to genetics and biology also interact with experiences with significant others and life events in the core belief development. Examples of personal characteristics include temperament, skill sets, cognitive ability, etc. When an individual is under psychological distress, core beliefs become more prominent. Generally, core beliefs are deeply ingrained and have likely been there for a long time. This can make it tricky to modify them. However, since automatic thoughts stem from core beliefs, effectively modifying core beliefs reduces both the frequency and intensity of the automatic thoughts, which in turn can be of significant help in reducing overall psychological distress. Furthermore, it provides the client with an opportunity to develop an ability to recognize and modify their automatic thoughts in the future before they become problematic.

    Reply

  6. Sergio Rodriguez
    Oct 21, 2021 @ 06:39:37

    [Automatic Thoughts]
    (1) The client’s response to the outcome expressing his emotion qualitative (hurt) and quantitative (8 out of 10) provides to the therapist a baseline (knowing his client beforehand is essential too) to understand the distress of a specific situation that can be challenging for the patient. That response can often be overlooked if the therapist is unaware of the client’s emotional arousal, usual responses, or common negative automatic thoughts. Another crucial factor was that the therapist walked the patient through the whole process of stressing the differentiation between feeling (lonely, isolated felt bad, sad, guilty) and the rumination where he was circling with thoughts like “people don’t want to be with me” or “I’m unlikeable.”

    (2) Two Socratic techniques would help to modify the client’s automatic thoughts. The first one is “Explore possible alternative explanations.” Starting with a simple question about other possible explanations will lead the client to open up to a different perspective for the same situation. Once he has these new perspectives, he might recognize valid alternative explanations that help him reevaluate how others feel or their thoughts about the same situation. The second technique is “Decatastrophize perceived negative outcome.” First, the therapist should check with the client what is the worst that could happen if his automatic thoughts were true, then what would be the consequence if the worst thing happened and how he would cope with it. That extreme (less likely) scenario would provide the client the certainty that, even in that case, there will be ways to cope with it. Thus, once the therapist helps the client connect with a more realistic scenario, the client would utilize different solutions recognizing that sometimes you can’t control other people’s feelings or actions (e.g., coworker).

    [Core Beliefs]
    (1) Negative core beliefs develop in a process that is comparable to the stress-diathesis theory in many aspects. When psychological distress is minimal or controllable, the predisposition and existence of negative core beliefs may not have any significant negative consequences. However, when distress is extreme and difficult to handle, negative core beliefs can become prominent and have profound adverse implications on thinking and behavior. Core beliefs develop from childhood to adolescence (even adulthood) as of three crucial elements: interactions with significant and influential individuals, significant life events and genetics, and biological vulnerability.

    (2) Early in life, our core beliefs are created and molded by our upbringing and experiences. Therefore, it is pretty challenging to change them because they are so deeply rooted and established.
    Core beliefs might be difficult to modify since they are typically unconscious, instinctive beliefs that have been ingrained in our personality. Nevertheless, learning to recognize, challenge, and reframe self-defeating ideas and basic beliefs is a crucial step toward emotional well-being.

    (3)An essential piece of modifying negative core beliefs is that is more than just minimizing or reducing the current distress, is also about creating a “shield” for the person to face future stressors. It is noteworthy to highlight that adaptative core beliefs are crucial and valuable to modifying non-adaptive “negative” core beliefs. In other words, the client will not just be changing a “negative” core belief; the client will be learning new ways to face stressful situations and strengthening their adaptative “positive” core beliefs.

    Reply

    • Francesca Bellizzi
      Oct 21, 2021 @ 11:33:35

      Hi Sergio!

      Great post and awesome explanations of the key concepts we have been learning about. I like that you mentioned the Socratic technique of decatastrophizing for Mark’s automatic thinking. When I was thinking about my answer to this question, I thought hard about including that technique in my own response because my mind was hesitant in asking Mark to continue to think the worst of the situation. Do you think that someone who has extreme negative thinking and self-blame like Mark would benefit from this? I do agree that this technique could be beneficial as it brings the client awareness around a particular situation and gives them the ability to adaptively cope with the outcome later on.

      Awesome job, and thanks for sharing!!

      Francesca

      Reply

  7. Francesca Bellizzi
    Oct 21, 2021 @ 11:23:29

    [Automatic Thoughts]

    1. When completing the automatic thought record with Mark, the focus was placed on the incident when he asked his coworker Jeff out to lunch and he said no. While working through the different steps, Mark was mentioning a handful of negative thoughts and emotions that resulted from his exchange with Jeff. Particularly, when asked how he was feeling and what he was thinking during the outcome “stage” of the event he mentioned that he felt sad and thought that he was unlikeable. This is helpful in understanding Mark’s distress because his thinking patterns tie into his core beliefs. If a clinician can understand/identify a client’s core beliefs, then it is easier to understand the client’s distress as our core beliefs have a significant impact on our way of thinking and interpreting certain situations. Likewise, the emotions that are felt during the outcome of the event can help uncover fundamental patterns of emotional and cognitive responses. This is evidenced by the matching of a client’s core beliefs to the emotions that are felt. By having a client name the emotion they feel during a particular situation can help the therapist dive into the roots of emotional distress, and help the client regulate these emotions (and thoughts) more appropriately.

    2. In the CBT process, there is a type of questioning that clinicians can use to modify a client’s automatic thoughts – called Socratic techniques. Socratic techniques involve directly asking the client questions about their negative automatic thoughts in order to raise their awareness and come to conclusions by guiding, instead of telling. These techniques include asking questions that: examine the evidence, decatastrophize perceived negative outcomes, explore possible alternative explanations, assess the impact of believing the negative automatic thought, separate self from negative automatic thought, and shift attributional biases. While there are a handful of Socratic techniques that can be used to modify a client’s automatic thought, not one technique works for every situation. One technique that would be helpful to modify his automatic thought in this situation would be to examine the evidence. In this situation, Mark thinks he is unlikeable and that nobody wants to spend time with him or that he doesn’t have any friends. By examining the evidence, the idea that he has no friends and that nobody likes him can be challenged. Here, the clinician would ask the client what evidence there is that both supports and goes against his automatic thought. Another technique is to explore possible alternative explanations. What other explanation could there be for what happened in this particular situation? Does Jeff really not like you, or could he just be busy and have a deadline to meet? By asking for alternative explanations you can directly challenge the thought without completely invalidating what the client is saying. Lastly, it would be helpful to separate Mark from his negative automatic thought. Asking these questions are beneficial as Mark constantly blames himself for every negative outcome that occurs. By separating him from his negative automatic thought, it could normalize the situation and help him come to the conclusion that there is nothing wrong with him as a person, but rather there are other variables at play that determine someone’s response or the situational outcome.

    [Core Beliefs]

    1. Core beliefs, or templates that provide rules for an individual’s information processing, typically develop at an early age. During early childhood to adolescence, there are three factors that may contribute to the development of an individual’s core beliefs including, significant life events (success and traumatic experienced), interactions with significant and influential individuals (such as teachers, parents and peers), and biological and genetic vulnerability (i.e. presence or lack of certain skills, intelligence, and temperament). These factors all interact with each other and it is through the reinforcement and validation of specific mechanisms that a core belief becomes increasingly concrete. While most core beliefs trend in the positive direction, negative core beliefs arise when an individual is undergoing high levels of psychological distress.

    2. Modifying core beliefs during the therapeutic process can be highly challenging due to their fundamental characteristics. Core beliefs tend to be concrete and rigid, which makes it difficult to modify them. Similarly, because they are so concrete and rigid, some individuals may not be able to identify their own core beliefs as they tie into automatic thoughts. Moreover, individuals may regard this thinking as normal as they have been subjected to this way of thinking their whole lives – making it difficult to identify and modify.

    3. By modifying core beliefs, the most significant therapeutic outcome is that the client’s level of distress will be reduced. In challenging any negative cognitions (whether core beliefs and/or automatic thoughts) the client and clinician are able to make modifications by working collaboratively with the therapeutic goal of psychological distress reduction. Similarly, by seeking to modify negative core beliefs you can draw attention to those that are positive. Increasing a client’s awareness of their own positive core beliefs can act as a “defense” and give clients strength and increase their optimistic outlook. From a clinician’s standpoint, modifying core beliefs is beneficial to the therapeutic process as it allows you to understand your client on a deeper level. By thoroughly examining their thoughts, emotions, and the patterns they exhibit you are better able to adapt your treatment plan and use of interventions to more appropriately address the individual’s distress.

    Reply

    • Kaitlyn Tonkin
      Oct 21, 2021 @ 15:05:57

      Francesca,

      I agree that a variety of Socratic questioning techniques could be used to help Mark when he has negative automatic thoughts. I like that you gave the idea of separating Mark from his automatic thoughts. There are many reasons why Jeff said no to going out to lunch with Mark, but allowing Mark to remove himself from the situation and get him to realize that he is not a horrible person that nobody wants to be around would likely help him realize his automatic thoughts do not have as much validity. I had not considered this Socratic questioning technique previously, so thank you for bringing it up.

      Great job!

      -Kaitlyn

      Reply

    • Frayah Wilkey
      Oct 22, 2021 @ 13:25:53

      Francesca,
      I think you did a great job of explaining Socratic questioning and what techniques would best apply to Mark‘s situation. I also think that examining the evidence would be helpful and that was seen in the videos. You could tell that there was a change in Mark‘s demeanor when he began stating the evidence for each side and started understanding the situation from a more objective view. Thanks for sharing your thoughts.

      Frayah

      Reply

  8. Katie O'Brien
    Oct 21, 2021 @ 11:53:41

    Automatic Thoughts:

    1.) Understanding the client’s emotional and cognitive response is important in understanding their distress and the patterns of behavior that might either reinforce their distress or help to alleviate it, if they do use healthy coping mechanisms. For example, in Mark’s case, he has a pattern of withdrawal, isolation, and rumination when he encounters an unpleasant experience. When his coworker said no to lunch, Mark withdrew and went to lunch by himself, where his automatic thoughts cycled and reinforced one another. He went into the encounter with some initial doubts: maybe Jeff will say no because he does not like me. When Jeff did in fact say no, Mark ruminated over it, allowing the “evidence” to confirm that he is unlikable. As this is a pattern for Mark in various situations, it is important to identify this pattern so that we are able to modify it. Had he maybe asked someone else to lunch, or still gotten some better food, he might not have withdrawn and ruminated so much on those thoughts, which in turn made him feel even worse. By looking at this response, we can see how Mark’s thinking and behavior patterns exacerbate his distress, like in many cases of depressed individuals, which will be helpful in reducing his stress as there is now a good starting point for modification.

    2.) We have seen how examining the evidence for and against a thought is helpful for Mark. He is pretty insightful and able to recall evidence that might work against this thought, such as “Well, we have gone to lunch a bunch of times before so maybe he does like me at least somewhat.” Something that also might help for Mark is to separate himself from the thought: he has a very close relationship with Melissa and when asked if the thought would apply to her in the same situation, he pretty readily disregards the thought and can come up with alternatives when it is her facing the situation and not himself. And then it almost becomes “obvious” to him – it’s just when he is thinking of himself that he has these negative automatic thoughts and that they seem valid. When thinking of someone he cares about, like Melissa, he can see that they are not always valid or accurate. Coming up with alternative explanations for Melissa might help him realize that those alternatives might also apply to himself and his thoughts as well.

    Core Beliefs:

    1.) Core beliefs normally develop during childhood and adolescence based on interactions with significant individuals, such as parents, coaches, teachers and peers, and significant life events, including both trauma and successes, as well as genetic vulnerabilities and biological factors, such as intelligence and temperament. As these reciprocal factors interact, they also reinforce and validate one another. Particularly in times of high psychological distress, negative core beliefs become more prominent and reinforced. Underlying negative core beliefs may not be as distressing during times of manageable stress, but when under more extreme stress, they can become more prominent and have a significant impact on the individual.

    2.) Core beliefs can be difficult to modify. As they are very deeply rooted and likely developed during childhood, the pattern of thinking is relatively ingrained and enduring in the individual. Sometimes, these core beliefs were also valid or helpful at one point in time, making it difficult for the individual to realize that they are no longer helpful or adaptive in their present circumstances. Because they are so deeply rooted, it is also difficult for individuals to even be aware of these prevailing patterns of beliefs. While the automatic thoughts are more readily available and identifiable to the client, it can be difficult for them to identify broader patterns of where these thoughts come from. Many times, the individual has also had experiences that do reinforce those negative core beliefs and by doing so, continue to perpetuate the belief and its validity in the eyes of the individual. Because of this, it can be harder to identify and modify these beliefs.

    3.) Sometimes evaluating and modifying negative automatic thoughts is not enough to lessen an individual’s distress. When negative core beliefs are this prevalent, it can be immensely helpful to the individual to modify these beliefs and replace them with new, more adaptive beliefs. By doing this, they are able to use a more adaptive lens in how they view themselves, other people, and the world, which in turn will result in less negative automatic thoughts. As the old patterns of beliefs and thinking are replaced with these newer, more helpful patterns, the individual will begin to feel less distress. By becoming more aware of these core beliefs, individuals also become more readily able to identify their negative automatic thoughts, allowing them to modify these thoughts themselves when they arise in the future and use the tools they have learned in therapy to continue to make modifications, again, lessening their overall psychological distress even once therapy is over.

    Reply

    • Lindsay O'Meara
      Oct 21, 2021 @ 19:25:53

      Hi Katie,

      It is true that there were many other ways for Mark to cope with being declined for lunch that would’ve helped him to feel better. Ruminating on his thoughts made him feel so much more sad. The negative automatic thought of “Jeff doesn’t want to spend time with me,” helps to shed light on what Mark is struggling with. It also gives the therapist a solid foundation to work off of. Modifying the ways that Mark thinks about his interactions with others will help him to change his behaviors and feel better.

      Thanks,
      Lindsay

      Reply

    • Frayah Wilkey
      Oct 22, 2021 @ 12:30:52

      Katie,
      I really like how you explained the origins of core beliefs. It’s important to note that they may have been valid or adaptive at one time when considering why they are so ingrained. Many times, maladaptive beliefs begin as something that can be viewed as ‘helpful’ by the individual but it grows into something else. This can help us better understand why the client hold onto them so tightly.

      Frayah

      Reply

  9. Frayah Wilkey
    Oct 21, 2021 @ 12:31:34

    Automatic Thoughts]
    1. In the video, Mark was turned down by a coworker when asked to join him for lunch. This had a really negative effect on Mark and caused him to have negative automatic thoughts and emotions. Mark was able to articulate how much the interaction effected him and his subsequent thoughts and behaviors which helped us better understand his distress. Mark was able to describe his perception of his coworkers response and the thoughts that followed, especially those that reinforce his ‘unlikeable/unloveable’ core beliefs. This explains why he went to such a negative place a chose to eat at McDonald’s by himself after the interaction.

    2. Mark sometimes has trouble with assuming other people’s motivational factors and responses. I think it would be useful for the clinician to begin a line of questioning so that Mark can change his own conclusions instead of allowing him to be steadfast in this automatic thoughts. Examining the evidence together could help Mark form different conclusions and help him understand that he may have misinterpreted the situation. He may be able to shift his thinking which will benefit future situations. It could also be helpful to first explore and possible alternative explanations. The clinician could ask Mark if it was possible that the coworker was tasked with a project or had a personal matter, both very common explanations of why a person may turn down lunch. This will be helpful because there will be many situations in life where he feels rejected but he can learn to restructure his thinking and consider that there are external factors driving others responses.

    [Core Beliefs]
    1. Core beliefs develop over the first few years of life as an accumulation of our personal experiences. They are based on the interactions of the individual with their environment and can be positive or negative in nature. Those who are important to the individual will have major impact, such as caregivers, siblings, and teachers. Core beliefs can change over time though, even well into adulthood, through significant life events. They are reinforced and even can be self-perpetuating over time.

    2. Core beliefs can be difficult to shift because they are frequently reinforced and based on the individual’s personal experiences. They are often deeply rooted, stemming from childhood experiences that shaped the person into who they are now. Challenging these beliefs is necessary for growth and change in therapy however. The clinician will have to work on this for multiple sessions in order to break down the core beliefs after years of reinforcement.

    3. Modifying our core beliefs can be useful to creating a more happy, fulfilled life. The person will be able to shift their automatic thoughts more easily and can reduce the frequency of negative thoughts and emotions. They may also experience less distress on a daily basis and may reduce or eliminate symptoms of depression, anxiety, and other illnesses. Shifting core beliefs is a huge gain in therapy and will create an overall more positive path for the client and their health.

    Reply

    • Lindsay O'Meara
      Oct 21, 2021 @ 19:30:01

      Hi Frayah,

      It is so important to identify and effectively modify negative core beliefs when we are able to. We want our clients to be as healthy as possible and positive core beliefs are a great first step. Strengthening a client’s existing positive core beliefs can help them shift away from the negative. Like you said, this is great because it will result in a less distressed client and positively affect their mental health.

      Reply

  10. Morgan Rafferty
    Oct 21, 2021 @ 12:38:18

    1.The clients response to the outcome (emotionally and cognitively) is helpful to understanding his distress. When Mark was turned down after inviting his co-worker to join him for lunch, Mark reacted be not going to the sandwich place he had hoped for and instead going to a place (McDonald’s) he describes as being less than desirable. Mark had negative automatic thoughts that included being unlikeable. It is helpful for Mark’s therapist to get a sense of how strongly Mark feels about his negative automatic thoughts and also how believably they are to Mark. By gaining a sense of these things, the therapist becomes more aware of what negative thoughts need to be addressed and also how ingrained the thoughts are; influencing the level of difficulty for the client to alter them.

    2.Socratic techniques are used to encourage a sense of inquiry within the therapeutic relationship. It is helpful to lead clients to an awareness of the contradictions/inconsistencies in their thought patterns.

    Examining the evidence would be a helpful technique to use with Mark. He points out that his co-worked has gone out to lunch with him on other days and did pop his head into Mark’s office to chat later that day. There clearly is evidence that Mark’s co-worker has interactions with Mark. Mark’s co-worker also was busy working. It is helpful for Mark to think about the difficulty everyone can sometimes have with breaking away from work for lunch. Examining evidence in other areas of Mark’s life (ie., his girlfriend enjoying his company, as well as other friends), can help chip away at Mark’s core belief that he is unlikeable. Separating Mark from this negative core belief would prove to be useful. If you were to describe to Mark his life as if it were someone else, it might help him to realize there is indeed evidence that he is likeable.

    1.Core beliefs are concrete, specific patterns in thinking about oneself. They develop in childhood and adolescence and might continue to emerge in adulthood. They form as a result of interactions with significant people in our lives; parents, relatives, teachers, peers. Traumatic events can contribute to our core beliefs, as well as triumphs. They are pervasive and deeply ingrained. Biological and genetic factors play a role in the development of core beliefs as well.
    2.Core beliefs can be a challenge to modify in therapy depending upon how deeply embedded they are in a client’s belief system. The first step is identifying and evaluating specific core beliefs that contribute to the client’s distress. Changing automatic negative thoughts is required in order to modify one’s core beliefs. It takes hard work to change automatic thoughts. If a client has high believability in their negative automatic thoughts, it is even more challenging.
    Once core beliefs are being modified, new, more adaptive/positive core beliefs need to be integrated. If this were not challenging, people could do it on their own and there would be less need for LMHCs for sure!
    3. The therapeutic gains that come with modifying core beliefs are: alleviating client’s distress and preventing distress moving forward. The client will have more positive, accurate automatic thoughts as a result. An altered, improved set of core beliefs will lead to overall more adaptive functioning. A person will feel better about themselves which attracts others to them as well. A more positive cycle of thoughts and behaviors and emotions is the end result.

    Reply

  11. Lindsay O'Meara
    Oct 21, 2021 @ 19:19:38

    [Automatic Thoughts]
    1. The clients response to the event that occurred, led him to eat lunch alone and dwell on the situation. The negative thought of “Jeff doesn’t want to spend time with me,” led Mark to feel sad. Mark then went to lunch alone and continued to think this same thought which led to more distress. These thoughts perpetuated the thought that Mark is unlikeable. This is helpful to understanding Mark’s distress because it makes it clear that he feels unlikeable, and therefore gives direction to sessions moving forward.
    2. Starting with examining the evidence of Mark’s negative automatic thoughts would be the first technique that should be used. In this case, Mark’s negative automatic thought was that, “Jeff doesn’t want to spend time with me.” We have already determined that this thought is not valid, so we would continue with modification techniques. We would then ask Mark what his evidence is that supports this thought, and then what is the evidence against his thought. We would then decastrophize perceived negative outcomes. We would then compare worst-case and best-case scenarios. In this case, the worst-case scenario is that Jeff doesn’t want to spend time with Mark, whereas the best-case scenario would be that Jeff does want to spend time with Mark and he was just busy on that given day. We would continue to explore possible alternative explanations. There may be another reason why Jeff was unable to have lunch with Mark. Then, we would assess the impact of believing the negative automatic thought. In this case, Mark felt isolated and ruminated on the event.

    [Core Beliefs]
    1. Core beliefs are central beliefs that a client has about themselves. People develop core beliefs at an early age. This can begin in childhood, with genetic predisposition, with significant others, or in a variety of situations. Contributing factors such as interactions with significant and influential individuals, significant life events and genetics and biological vulnerability can create core beliefs. The more that a belief is validated, the stronger it becomes. Everyone has core beliefs, some are positive and realistic, whereas others are negative and can lead to psychological distress. Extreme and unmanageable distress can have more negative impacts on thinking and behaving. There are three categories of core beliefs, and these are helplessness, worthlessness, and unloveability.
    2. Core beliefs can be difficult to modify in therapy because they are deeply ingrained in the individual. These beliefs have stuck with the client since childhood, and the client may not recognize that they have these beliefs about themselves. Identifying the core belief can be difficult since the client is unable to articulate exactly the root thought. Helping the client to identify negative automatic thoughts can lead to the unearthing of core beliefs.
    3. Modifying negative core beliefs can help a client to reduce their distress. It can also help the client resist future stressors. Strengthening a client’s positive core beliefs can lead to helpful coping. The more time that you spend with a client and gain understanding of their core beliefs, the more likely you’ll be to help modify the negative, and reinforce the positive.

    Reply

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Adam M. Volungis, PhD, LMHC

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