Topic 8: Core Beliefs & Behavioral Exposure {by 3/23}

[Core Beliefs] – Watch MDD-17: Core Beliefs – Modifying – Evidence and Advantages/Disadvantages -AND- Modifying 2 – Core Belief Flowchart-Part B.  Answer the following: (1) What information or themes obtained from both techniques will be helpful in developing a new core belief? (2) What could be a possible new (positive/realistic) core belief to test with the Core Belief Flowchart (Part B) and a Behavioral Experiment?

 

[Behavioral Exposure] – There is one reading due this week (Volungis – 1 Chapter).  For this discussion, share at least two main thoughts: (1) Why is behavioral exposure very effective for certain disorders/types of distress?  (2) What are some cautions to consider when implementing behavioral exposure interventions?

 

Your original post should be posted by the beginning of class 3/23.  Have your two replies posted no later than 3/25.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

61 Comments (+add yours?)

  1. Tiana Faulkner
    Mar 18, 2023 @ 10:41:48

    When working through the disadvantages and disadvantages of the core belief, Mark was unable to find many advantages for having the negative core belief he has and found plenty disadvantages. It gave him the ability to really see how the core belief can negatively impact his life and reasons why he needs or should want to create a new more positive belief. This technique puts all of the negative part of his original core belief right out in the open and he came up with all of them.
    As for the flowchart, he was able to work through all of the good things in his life. That there are in fact people in his life that like him and that not every needs to like him. He was able to sit through many different situations that supported his original core belief and find alternative explanations for them that support his new core belief. This technique allows the client to work through his original feelings, thoughts, and behaviors when he feels left out, like his example with work friends, and find new more positive ways to handle these things.
    I am likeable is a good core belief for Mark to use, as he did in the video. Other core beliefs such as I am worthless or unlovable are also some good ones that could be used. They work with the present, unlike, I will eventually be rejected, or I will always be alone. You are able to work with these core beliefs and find a new one the same way Mark was able to. Then working with the believability experiment, create a believability rating for the new and old core beliefs, finding advantages for the new core belief, and thinking of how the new core belief will benefit the client when working through situations that would negatively impact them in the past.
    Behavioral exposure helps clients address their triggers in real and imagined ways. This can help the client explore and understand the source of their distress, increase self-efficacy, and gives the client a safe environment to succeed. For example, anxiety or other disorders can prompt you to overestimate the threat of danger or discomfort and underestimate your ability to cope with the danger or discomfort. Behavioral exposure works to address these challenges so that the client can realize their distress will naturally fade over time when facing an uncomfortable or scary situation.
    Being put into these difficult situations can be very uncomfortable and challenging leading clients to avoid the option. It also is simulated and monitored situations; it can be easier to get used to it in these instances but in reality, it may be difficult to translate. If the therapist moves too quickly it can do more harm than good. In some situations, it can be very intensive and very difficult to put into practice.

    Reply

    • Magdalen Paul
      Mar 19, 2023 @ 10:21:04

      Hi Tiana! I like your point that behavioral exposure can help increase a client’s sense of self-efficacy. By creating a safe environment for a client to explore their distress and gradually become more comfortable facing threatening situations, confidence in their ability to persevere through and overcome stressors will grow. Belief in oneself will develop as more situations are confronted and successfully navigated–or, as more evidence is obtained that he or she has the means to reach desired goals. Therefore, behavioral exposure can help yield byproducts of enhanced self-efficacy, heightened self-concept, and overall improved confidence in oneself. These benefits will likely prove useful in various circumstances beyond those addressed in therapy.

      Reply

  2. Magdalen Paul
    Mar 18, 2023 @ 16:34:53

    Mark was able to identify various instances that provide evidence for likability (Melissa and friends from the past), but also those in support of his core belief of unlikability (how friends have responded to him in various contexts). Thus, Mark was ultimately able to determine evidence both for and against his core belief. He eventually shared that he could see himself as a “good guy” who has had friends and is generally likable (such that not everyone loves him but not everyone hates him, either). Therefore, a new workable core belief to test with Mark could be “I am generally a likable person.” While he was already starting to believe this core belief as he continued to speak it aloud, working through a flowchart and “putting it to the test” with a behavioral experiment could help push the believability ranking even higher—as more evidence is obtained through lived experience.

    Behavioral exposure is very effective for a variety of anxiety and anxiety-related disorders, any disorder that accompanies bouts of anxiety, as well as concerns such as poor coping skills, poor social skills, trouble relaxing, and so on. It is effective because exposure has the opposite effect of avoidance—eventually, clients learn that a situation is no longer life-threatening (even though the initial confrontations will likely result in anxiety/fear). This process involves the acquisition of new adaptive coping skills and thought patterns that can be used to address future stressors. Though, it’s important to note that not all exposure techniques will be useful for every client. For example, research on diaphragmatic breathing indicates mixed levels of effectiveness for individuals with panic disorder. As such, it’s important to be aware that some diagnoses (such as panic disorder and agoraphobia) may yield benefits from exposure techniques alone—sometimes even without negative automatic thought or coping skill modification. In order to produce the best results more efficiently for a client, it is crucial to understand how different diagnoses respond to particular techniques so that more or less “unnecessary” methods are not implemented. Therefore, applying various techniques requires clinical judgment on a case-by-case basis in alignment with relevant research. Additionally, it is important to start slow with exposure techniques, by striking a balance between challenging the client but not harming them. Identifying levels of fear and ranking perceived threat before undergoing exposure techniques will be important to ensure that we select a technique that is appropriate for where the client is at. We want the client to be uncomfortable to the extent that change can occur, but not harmed or unwilling to partake.

    Reply

    • Tiana Faulkner
      Mar 20, 2023 @ 21:10:12

      Hi Maggie! I agree with your response. This new core belief of being generally likeable was a great one and was realistic. Like you stated, not everyone is going to like him or love him but not everyone hates him either. I also like how you mentioned that through lived experience, he will learn more and put his new core belief to the test.
      I also like how you mentioned in the second part of the blog that exposure has the opposite effect of avoidance. It is true, it works best for anxiety and disorders that are accompanied by anxiety. The client is able to learn more adaptive coping skill and positive thought patterns. I also liked your specification about applying various techniques requires clinical judgment on a case-by-case basis in alignment with relevant research, this is very important to keep in mind.

      Reply

  3. Ashley Millett
    Mar 20, 2023 @ 19:13:02

    In the video, Mark gave out valuable information to the therapist that helped them both develop a new core belief. He talked about certain situations that happened in the past while also talking about the present. The two common themes that were said was Mark feeling both unlike and liked by the people in his life. Mark talked about his girlfriend, Melissa, being very supportive in their long term relationship. Mark also talked about how though the situation with Jeff hurt his feelings, he generally feels that Jeff is a friend at work. He also talked about certain situations where he did not feel that he was liked by others. A few examples of this are his old friends Brian and Dave. Dave decided he did not want to be friends with Mark anymore. Brian was Mark’s college roommate freshman year and grew apart during the second semester. These two examples can leave a imprint on Mark thinking that something is wrong with him. Due to this and other situations, this left a mark on Mark to think that he is unlikable. While doing the flowchart and going through the advantages and disadvantages, it started to change Mark’s mindset from unlikeable to “I am likable.” During the reframing of the core belief, Mark started to realize that he does have redeeming qualities. While examining his evidence and looking at the disadvantages/advantages, it allowed Mark to see that he is likable and that he has a good group of friends around him. Having him see it layed out, allowed him to see the good behind the negative automatic thought. A possible new core belief that Mark can test out is “I’m generally a likable person.” While stating how to reframe his negative core belief, Mark listed out multiple different beliefs. Some can include that he has redeeming qualities, he is a good guy, and more. However when he said “I’m generally a likable person”, his body posture and demeanor seemed to change. The core belief “I’m generally a likable person” would fit best to test with the Flowchart and a Behavioral Experiment.

    Behavioral exposure is used for a variety of anxiety and anxiety-related disorders. This technique is usually initiated during the early or middle phase of therapy. Some of the techniques used in behavioral exposure helps clients relieve their anxiety-related distress. It also allows them to cope with life stressors. Behavioral exposure is very effective for certain disorders/types of distress. It allows the client to face their distress head on rather than trying to avoid it. Clients who do behavioral exposure will be confronted with what makes them distressed. With this, it will break their avoidance pattern. As the textbook talked about, the exposure to their fears/anxiety will be increased. However, their physiological arousal will not last forever. The clients will soon learn that their situation would not be threatening anymore. With the new found confidence, the clients will then develop behavioral and coping skills to help manage their fears/anxiety in future situations. A caution to consider is how well the client will respond to the situation if exposure is there. Yes the physiological arousal will decrease over time, but the anxiety/fear is still there. Clients may have difficulty assessing their anxious and fearful patterns. Though they can realize they have anxiety/fear during a specific situation, it may be difficult understanding why it happens. With behavioral exposure, techniques that can be used are muscle relaxation, diaphragm breathing, and in vivo exposure techniques. Clients, however, might hesitate doing these techniques. Overall, behavioral exposure might be new to clients. It will be difficult for the client to engage due to the overconsumption of fear/anxiety in them. They can be hesitant with the techniques because it may seem new or difficult to them. It may take time for them to come to terms with the idea of behavioral exposure. It will also take baby steps with the client to help them cope with their anxiety/fear in their situations.

    Reply

    • Tiana Faulkner
      Mar 20, 2023 @ 21:16:05

      Hi Ashley! I definitely agree with your response and love how thorough you were. I like how you had mentioned that the two common themes that were said was Mark feeling both unlike and liked by the people in his life. There were many points given about both of these in Mark’s life that validated both ends of the spectrum. Having all of these examples that Mark gave made him come to a really great realization as you had mentioned about having redeemable qualities.
      I also agree with your point of behavioral exposure techniques being used to relieve “anxiety-related distress”. Using these techniques will help the client no longer avoid these situations and learn better ways to cope. It can also be a very hard tool to use and some clients may be too uncomfortable. I like how you had stated it, it is about taking baby steps and being patient with them.

      Reply

  4. Abby Sproles
    Mar 20, 2023 @ 23:09:04

    Both techniques (evaluating the advantages/disadvantages and core belief flowchart) helped Mark arrive at a new, more realistic core belief. After both exercises, Mark concluded that the old core belief (“I am unlikeable”) leads to negative, maladaptive emotions and behaviors. On the other hand, a more realistic belief like, “ I am a generally likable person” is more objective, and does not produce negative reactions nearly as strong as the old core belief. In addition to “I am generally a likable person”, Mark could explore the result of believing “I do have value to others, and sometimes I am able to value myself”. Mark repeatedly discusses his preoccupation that his coworkers or friends do not value him as a person. Therefore, Mark may benefit from visualizing the positive results of believing this new core belief in a flowchart. In addition, Mark can gain more evidence for this thought through behavioral experiments between sessions.
    Behavioral exposure is very effective for anxiety-related disorders and phobias because it can break the pattern of avoidance. Individuals may be stuck in a pattern of avoiding the feared/anxiety-provoking event because avoidance saves the person from experiencing the stressor (negative reinforcement). In addition, physiological arousal and negative thoughts/emotions can reinforce avoidance. The most effective way to break this cycle is to demonstrate to the client that the situation does not pose a threat, or as much as a threat. When implementing behavioral exposure, one should consider if the fearful event can be or should be exposed in vivo. Some fearful situations, like exposing the client to a traumatic event, should not be replicated through in vivo due to ethical considerations. Instead, a therapist may consider imaginal exposure. In addition, the therapist should be cautious of the client’s degree of anxiety before exposure procedures. If the client is extremely anxious, the therapist may consider beginning with low-ranked imaginal exposures, and working the client up to in vivo.

    Reply

    • Magdalen Paul
      Mar 21, 2023 @ 12:04:19

      Hi Abby! I really like your additional “new” core belief of “I do have value to others, and sometimes I am able to value myself.” This seems like a very realistic belief to work with, and one that would likely resonate with Mark. I would be interested to scaffold Mark toward this belief and maybe even compare it with the “I am a generally likable person” belief. I wonder if he may resonate moreso with one over the other, or if there is a way to tie the two beliefs together. Either way, I really like the idea of incorporating Mark’s sense of value into a testable core belief and would be interested to get his reaction on it.

      Reply

    • mikayladebois
      Mar 21, 2023 @ 15:31:30

      Hi Abby! I had not thought too much about the ethical questions of putting a client in a situation that we know will have a negative impact on them. It requires a huge reliance on the trust between the client and therapist to do any kind of exposure treatment, but we don’t want to take advantage of it either. You raised really good points in your post!

      Reply

    • Megan VanDyke
      Mar 25, 2023 @ 18:11:07

      Hey, Abby! I love that your new core belief for Mark is centered around finding value within himself. Since the beginning of the semester, we’ve seen that Mark is preoccupied with others’ feelings toward him, which may indicate a decrease in or lack of self-confidence. Finding value within oneself may help Mark see his likable qualities, which in turn can help him realize that his friends and loved ones most likely see the same qualities. I also like how you noted beginning the behavior exposure process with imaginal exposure. This can be a good beginning step for clients with severe traumas as it helps them warm up to in vivo.

      Reply

  5. mikayladebois
    Mar 21, 2023 @ 15:22:46

    A new core belief for Mark to employ would be that he is a generally likable person. By examining the evidence for both his new and old beliefs, Mark was able to gain a more realistic understanding of his situation. It would be helpful for his new core belief to be based on reality and Mark did a good job of finding evidence both for an against his old core belief. He should also be able to do just that when looking at the new belief of his general likability.
    Exposure techniques are effective for specific disorders because it brings the client into direct contact with the event or object they are avoiding. A lot of times it is the unknown factor that is scary or difficult for an individual to cope with, the possibilities of a situation are endless and it could always turn ugly. Direct exposure eliminates that unknown piece because they are put in that situation, what they experience is then known. Hopefully, it is not a negative experience and the individual can start to change their perceptions and thoughts of the event and then their behaviors will change as well.
    These techniques are scary for the individual as you are literally asking them to face their fear. As a counselor, we have to be cautious when using exposure techniques for a few reasons. If the client’s coping skills are not at a level where they would be able to deal with their feared situation it may devolve into making their fear worse. If the client avoids interactions with strangers and then they are suddenly put in a social situation without knowing how to deal with their physiological reaction, it is unlikely to be a positive experience. Similarly, if the client or counselor doesn’t know what the fear or anxiety is about, it will be difficult for progress to be made because it cannot be addressed. If the client is worried about having an anxiety attack while on a bus but the clinician thinks their fear is about talking to people, the treatment likely won’t be effective.

    Reply

    • Abby Sproles
      Mar 22, 2023 @ 13:28:43

      Hi Mikayla! You bring up really good points! Specifically, I liked your point that exposure helps fill in the wholes of unknown information regarding the feared stimuli. If an individual never faces their fear, they will not understand realistic results. Exposure can demonstrate how unrealistic and impractical their negative thoughts, behaviors, and physiological arousal are. In addition, it is important that the therapist is present for the first few exposure procedures to ensure that the results will be positive and that the client utilizes effective coping skills if needed. If the client attempts to face their fear, and the negative result actually happens, this will only reinforce avoidance.

      Reply

    • Stephanie Lugo
      Mar 25, 2023 @ 23:50:37

      Hi Mikayla,

      You made some great points about exposure therapy and its benefits. The biggest benefit of exposure therapy is the fact that it is easily adjustable given the type of disorder. If a client has OCD they may need to start out slowly and work their way up to more exposure as they go on in therapy. Being able to adjust the level of exposure each client receives allows exposure therapy to be more attainable for each client as well as the clinician administering it.

      Reply

  6. Esther Konadu
    Mar 21, 2023 @ 17:38:24

    The first piece of information that Mark obtained was that there was proof for and against his core belief, “I am unlikeable.” He examined his relationships with various people, discussing what he got from each relationship. Some relationships seemed to fit both columns, while others were strictly in one. Through it, he realized that proof against his core belief was stronger, which showed him that he could develop a new core belief. Mark could test this with a behavioral experiment and the Flowchart to see how much this core belief is true in situations in between sessions. That new core belief could become “I am a generally likable person.”

    Behavioral exposure is effective for certain disorders and distress because it provides structure to navigate uncontrollable situations. Learning to respond to triggers or environments effectively can reduce distress and make those environments less threatening. Without behavioral exposure, someone might respond to their fears in a “life or death” manner, and that could disrupt other bodily systems from being in a panicked state frequently. Behavioral exposures should be done carefully and with a lot of consideration beforehand. Ensuring the client is open to exposure is necessary to earn their trust with what you ask them to do. It is also essential to stay prepared and address any questions and offer support throughout the process. Even thinking about facing a fear or stressor can be difficult, so clients understanding that they are not alone is helpful. Also, reminding the client that overcoming their stressor is not an overnight process, can reassure them if they feel like they are not progressing on their goals.

    Reply

    • Whitney Andrew
      Mar 21, 2023 @ 21:11:54

      Hi Esther!

      I really like how you emphasized the structure aspect of behavioral exposure, especially since that can be a comforting aspect to clients that are apprehensive about engaging in behavioral exposure. I also think it’s important to circumvent having to confront anxiety inducing situations in a life or death manner, and behavioral exposure seems to be a great strategy for that. Super great points!

      Reply

    • Emily Forde
      Mar 22, 2023 @ 17:09:47

      Hi Esther! I really like your point that behavior exposure can provide structure to uncontrollable situations. I think this point is so important and is why behavior exposure is successful. Because the client is able to feel comfortable regarding the structure, they may feel comfortable in taking the leap to be exposed to whatever causes them distress. Great response!

      Reply

    • Stephanie Lugo
      Mar 25, 2023 @ 23:01:44

      Hi Esther,

      You make a great point about how most individuals who experience anxiety tend to view situations as life and death. These individuals will not be able to realize that the situation is less severe than they think it is. They will build up one situation in their mind until they develop severe stress around it. This excess stress may be considered uncalled for when it comes to the situation, but for that individual, it doesn’t feel that way. When this consistent anxiety happens often it can really disrupt the individual’s daily life as well as their nervous system. That is why it is essential to use CBT techniques to help decrease anxiety levels.

      Reply

    • Lucy Rising
      Mar 28, 2023 @ 09:58:14

      Esther, You made really good points about the counselor’s role in supporting a client while undergoing exposure. It is important that the counselor takes time to consistently check in and talk with the client about the distress they are feeling as a result of being exposed to their feared/anxious stimuli. This is very distressing work and we do not want the client to become overwhelmed with their exposure. Consistent feedback, debriefing, and monitoring of symptoms is important to make sure the client isn’t taking on more than they should.

      Reply

  7. Melissa Elder
    Mar 21, 2023 @ 19:40:51

    When developing a new core belief it is important for the client to come up with advantages and disadvantages for their core belief, with the support of their clinician. When a client is challenged to list advantages and disadvantages for their own belief with techniques like a flowchart or a behavioral experiment, this allows the client to approach the belief in a different light then they normally would as prior they had no reason to believe it was not true. Mark seemed to realize the negative impact his core belief had on him once he was unable to identify many advantages to the belief, yet was able to identify plenty disadvantages. It became apparent to Mark that in order for him to have more positive experiences, he had to change this negative core belief of himself to be positive. In the process of reframing his core belief, Mark started to talk about how he is a good guy and that he does in fact have friends and began to see that he really is a likable person. With this discovery he was able to form a new core belief as he held evidence towards being a generally likable person.
    Behavioral exposure is very effective for anxiety and anxiety related disorders because of the exposure aspect, typically clients with anxiety or anxiety related disorders tend to avoid the anxiety driven situation which helps in validating their fear. Using behavioral exposure helps relieve anxiety related distress and assists in coping with related life stressor. After a positive experience with direct exposure the client can begin to reshape their core belief after having the experience they never thought they would or could have had. Once the client and clinician have identified the anxiety driven fear It is important to consider the level of which the client is ready to be challenged before implementing behavioral interventions. Direct exposure for someone who has been avoiding for a length of time can be extremely scary. It is important to meet the client where they are at and not too put them to the challenge to soon. It is important that the exposure go well or else the client could backtrack and we as clinicians never want that, this would slow down their progress or even could push the client away.

    Reply

    • Whitney Andrew
      Mar 21, 2023 @ 21:17:35

      Hi Melissa!

      I totally agree that challenging the client to identify advantages and disadvantages of a core belief really helps them to see a new side to the belief and potentially breaks down their point of view in the process. I also liked your point in discussing behavioral exposure that the level at which the client is ready to face their fear is super important. If a client is not ready to confront any aspect of their fear, it is not wise to introduce behavioral exposure as they may never be open to trying this technique again.

      Reply

    • Abby Sproles
      Mar 22, 2023 @ 13:38:32

      Hi Melissa! I liked your point that the therapist needs to consider the anxiety levels surrounding a feared situation before implementing behavioral exposure. After rating various feared situations, the therapist can help ease the client into behavioral exposure by having the client face “lower-ranked” fears first. If the client is able to overcome these situations, they may have greater confidence and willingness to face their “high-ranked” fears. In addition, the client can begin to practice and integrate learned coping strategies, so that by the time they face their greatest fear, they may respond more effectively.

      Reply

  8. Whitney Andrew
    Mar 21, 2023 @ 21:04:33

    The process of working through whether or not the core belief was supported helped Mark to see that the evidence supporting his core belief was minimal in comparison to evidence contradicting his core belief that he is unlikeable. In completing the flow chart along with examining the evidence, Mark was able to reach the conclusion that he is liked by most, as it is not realistic to go to the opposite extreme that he is liked by everyone. He was able to support this new core belief by stating scenarios in which his friends Jeff and George are still in contact with him and his girlfriend Melissa has been with him for a couple of years, meaning she must like him to continue to be together. A new core belief to test through the flowchart or behavioral experiment could be “I am amiable and pleasant to be around”.

    Behavioral exposure is very effective in addressing the situations that make them uncomfortable head-on rather than avoiding these situations and continuing the vicious cycle. The confrontation breaks the reinforcement by the avoidance There is also the opportunity to modify the negative automatic thoughts that present themselves with the anxiety surrounding certain situations. One of the more imminent cautions to consider is the heightening of the individual’s anxiety and fear when confronting the situation head on.

    Reply

    • mikayladebois
      Mar 22, 2023 @ 11:11:40

      Hi Whitney! I really like your comment about exposure treatments breaking the reinforcement of avoidance. Behaviorism isn’t the most prominent influence in a lot of the work we do at this point, but it does give an underlying explanation for some of the things we will see. The reinforcement and punishment routines in our clients’ daily lives would be helpful when treating anxiety, trauma, and phobias. Great post!

      Reply

    • Emily Forde
      Mar 22, 2023 @ 17:07:10

      Hi Whitney! I agree with your point that examining the evidence helped Mark realize there was more evidence against his core belief than for it. Because Mark realized this, I feel like he would be more likely to remember the evidence against his core belief in the moment. I love how you worded your point that “confrontation breaks the reinforcement of avoidance”. As a behavior therapist, I am constantly looking for the reinforcer behind behaviors and understand the behavior will not stop if the reinforcer continues. Great response!

      Reply

    • Jack Halliday
      Mar 22, 2023 @ 17:44:29

      Hey Whitney, I really liked your new core belief for Mark. Instead of focusing heavily on how other feel about him, it rests more on how people feel when they’re around him instead or directly how people feel about him. It’s also very important to keep in mind when doing behavioral exposure is the heightened anxiety the individual will feel when confronting their feared situation head on.

      Reply

    • Rena yaghmour
      Mar 26, 2023 @ 10:25:49

      Hi Whitney,

      I think behavioral exposure can be very effective especially in breaking the vicious cycle as you said! Exposing clients to certain stressors or anxiety inducing situations little by little will help them in the future and help them eliminate certain barriers which could be their core belief. By slowly exposing themselves to these situations can later allow them to face these fears head on with no hesitation. However, it is important to note that sometimes exposure therapy can go south if it is not done correctly or at the correct pace for the client. It can potentially harm them if they are just thrown into w situation with no coping skills or other skills to help them in their feared situation.

      Reply

  9. Emily Forde
    Mar 22, 2023 @ 16:54:04

    When using the techniques to modify core beliefs, Mark was able to identify specific situations that he could observe his core belief being involved in. With Melissa, he was able to identify that he was likeable, or else she would likely not still be with him. Looking at both sides of his core belief allowed Mark to see that his core belief was extreme and was not as accurate as he sometimes feels it may be. With that being said, Mark was able to come up with a new core belief that was realistic and based on evidence. Testing a new core belief is essential for Mark to change his maladaptive thinking patterns. I really like the new core belief of “I am generally likeable” that he came up with on his own. I think this core belief is perfectly in the middle of the spectrum and is realistic. Another potential new core belief could be “I am liked by others and typically like myself”.
    Behavioral exposure is effective for certain disorders, such as anxiety and phobias, because it is able to increase the individual’s comfort level and provides the individual with the opportunity to use their coping skills. When an individual is able to engage in behavioral exposure, they are able to better understand their triggers, responses, and how they cope with the situation. When doing behavioral exposures, the client needs to be open-minded. The clinician should start the behavioral exposure at a lower level and work their way up, so the client feels they can trust their clinician.

    Reply

    • Jack Halliday
      Mar 22, 2023 @ 17:35:20

      Hey Emily, I totally agree that a reasonable new core belief for Mark is that he is generally likeable. Additionally, I really liked your addition of a secondary one, because it is important to keep in mind that how Mark feels about himself is also highly relevant when doing core belief work. I also definitely agree then when doing behavioral exposure it is important to start at a lower level and then work your way up, as to avoid any adverse consequences from the technique.

      Reply

    • Ashley Millett
      Mar 24, 2023 @ 09:42:52

      Hi Emily,

      I agree with what you said about looking at both sides of his core belief. You could tell from the video that Mark was examining his thoughts once they were written down. Before looking, he could just say the thoughts. However, once written down, he was able to thoroughly examine them. I feel that it is important to do that because saying something can be one thing. However, reading them and being able to examine the thought, is another. I like the new core belief for Mark. I also agree with you that it is a middle ground from his old core belief. I agree that behavioral exposure allows us to understand our triggers, responses, and how to cope. It can give us a better understanding of the situation or fear. Then it can also help us understand what to do for the next time the situation occurs.

      Reply

    • Melissa Elder
      Mar 24, 2023 @ 18:57:19

      Hi Emily, I really like the second core belief of “I am liked by others and typically like myself”, I did not even think about that. That core belief allows Mark to think more positively around himself as well as how he thinks others feel about him. I also agree that behavioral exposure helps to increase comfort especially when the clinician meets the client where they are at and never pushes them over their limits.

      Reply

  10. Jack Halliday
    Mar 22, 2023 @ 17:29:08

    Through the exercise, Mark was able to identify contradictory evidence towards his core belief of being unlovable. He was also able to identify evidence that supported it, but through the process of the exercise he was able to weigh the pieces of evidence against each other and ultimately realize that there was more evidence to contradict it than there was to support it. He identified his relationship with Melissa as a driving force of the evidence against that belief. He identified that his relationship with her is very supportive, and that it is clear that she does in fact love him. He also cited interactions with other friends or colleagues that could provide evidence in favor of his core belief. I think that a realistic new core belief for mark would be “generally, I am a likeable person”. This would leave room for the unavoidable people he encounters in his life that do not like him, but it also will change his mental framework about how he is perceived in a majority of his relationships.
    Behavioral exposure is very effective for anxiety and anxiety related disorders because those disorders involve a significant amount of avoidance. The technique of behavioral exposure counteracts that avoidance head on by, in some cases, forcing the individual to re-experience the times in which they felt distressed. Overtime, this will help the individual to realize that the feared situation is not worth the high degree of fear they were giving it, and eventually be able to experience it with minimal, or at least a manageable level) of distress. This technique can help break the reinforcing cycle of feeling afraid of a situation, avoiding it, and then being reinforced by not experiencing the fear and this continuing to avoid it. The fac this this technique involves facing the feared situation head on means that the therapist should proceed with caution. For example, if the individual has a trauma history, then that way the situation is approached should be delicate. In these situations, it can be more helpful to start with imaginary exposure to the feared event and then potentially working up to real time exposure. This can help to monitor your client’s general well-being, and doing too much too fast with them could lead to significant distress.

    Reply

    • Becca Boucher
      Mar 23, 2023 @ 16:18:31

      Hi Jack, I like your explanation of behavioral exposure. I agree that behavioral exposure is great for tacking avoidant behaviors head-on. However, I also agree that a therapist should be cautious because you do not want to expose your client to extremely high levels of distress that they are unable to cope with. This could make their fears worse, and even really hurt their progress and willingness to complete treatment.

      Reply

    • Grace Ling
      Mar 28, 2023 @ 19:50:37

      Hi Jack, allowing clients to confront their anxieties with behavioral exposure does tackle the issue of avoidance. Though it is important to do these exposures with a great deal of care and consideration for the client. Some clients may need a gradual reintroduction to certain situations to prevent clients from completely shutting down. I agree with your response of incorporating imaginary exposure before working up to in vivo exposure.

      Reply

  11. Gitte Lenaerts
    Mar 22, 2023 @ 17:43:28

    The techniques, evaluating the evidence/advantages/disadvantages and the core belief flowchart, allowed both Dr. V and Mark to dive deeper into his core belief and allowed the process to start modifying this belief. These techniques allowed both Mark and Dr. V to get the full scope of his beliefs while pulling in valid points on either side. This not only looked at his reasons to believe this core belief but also reasons against his core belief. The common theme and information that was found through these techniques were reasons he is liked by others and reasons he is not liked by others. Having this information is helpful to modify his core belief as there is evidence against his belief and for his belief. Seeing opposing sides allows for further insight and can in a way ground Mark to see what is true and what isn’t true. Which can aid in developing a more realistic and positive core belief that pertains to where he is currently at. With that, a possible new positive core belief that Mark could test with the Core Belief Flowchart and a Behavioral Experiment could be “I am appreciated and valued by the people around me”, “I am a likable person to be around”, “People enjoy me for who I am”, etc.
    Behavioral exposure is an effective technique for anxiety disorders as a key component of anxiety is avoidance. With behavioral exposure techniques, puts clients in front of their anxiety triggers to help break the avoidance pattern and work through negative automatic thoughts. Sometimes with anxiety disorders, it is better to confront the stressor head-on to then work further to modify core beliefs and negative automatic thoughts. Through this technique it is also done in a therapeutic way, to allow the client to feel as comfortable as possible to face the trigger. However, some cautions to consider when implementing behavioral exposure interventions is doing it too soon into therapy. We want to make sure the client is comfortable and trusts the therapist. Building a strong therapeutic alliance will help the client understand the meaning behind behavioral exposure as well.

    Reply

    • Esther Konadu
      Mar 25, 2023 @ 13:47:00

      Hi Gitte,

      Your thoughts on behavioral exposure raise a great point! If the therapist pushes the client to go ahead with behavioral exposure even though they are not ready yet could turn them away from the therapeutic process. Checking that the client agrees with the therapist before starting behavioral exposure is a great way to have a trusting, respectful therapeutic relationship.

      Reply

    • Alysha Benoit
      Mar 25, 2023 @ 19:07:30

      Hi Gitte! I agree with you that it is important for clients to develop new core beliefs that are realistic and reflect themselves more accurately. It could be counterproductive for a client to form a core belief that is overly optimistic and positive as it would most likely set their expectations too high and reinforce negative automatic thoughts. In Mark’s case, for example, developing a new belief that he is liked by everyone would only let him down when he learns that it is impossible for everyone to like him. Understanding that there is nothing “wrong” with having experiences in which others do not necessarily like or agree with him is a part of life and a much more realistic belief about himself and his environment/peers. Nice work!

      Reply

    • Lucy Rising
      Mar 28, 2023 @ 10:09:49

      Gitte, You bring up a good point about making sure that there is a good therapeutic relationship with the client before conducting exposure techniques. This is an exercise that requires a good level of trust and understanding with one’s therapist. Especially knowing that a client will likely begin to feel worse at the beginning of exposure treatment due to an aggravation of their symptoms, it can been seen why a client needs to have that strong rapport with their clinician before beginning exposure.

      Reply

  12. Megan VanDyke
    Mar 22, 2023 @ 18:18:11

    Mark was able to work on developing a new core belief by finding information or themes that worked against the initial core belief. For instance, Mark firmly believed he was unlikeable, yet recognized that Jeff and George spend time with him regularly, and he is in a long-term relationship with Melissa. If Mark were truly unlikeable, none of those people would be in his life. Once Mark better understood that he was “generally likeable,” he began problem-solving ways to engage with those who like him, so Mark is invited to places more often, thus showing his friends that he likes them and wants them around. Although Mark could identify evidence that both supports and contradicts his initial core belief, he identified ways the contradictory evidence outweighed the supporting evidence, thus recognizing the invalidity of his initial core belief. Aside from “I am a generally likeable person,” another realistic core belief Mark could explore might be “my friends and loved ones care about me.” Mark identified that, at times, his friends or his girlfriend might say or do things that make him question how much they like him. Like his previous core belief flowchart, Mark can examine instances where he felt like he wasn’t cared for, such as when Jeff went out for lunch with everyone in the office except him or when Melissa does things without him, and compare those events to times his friends went out of their way to invite him. An example of a behavioral experiment may be Mark inserting himself into conversations with his coworkers or friends to allow them more chances to invite him to events, thus allowing opportunities for people to show him they care.

    Behavioral exposure is effective for disorders like obsessive-compulsive disorder and anxiety-related disorders because it helps the client confront the stressor instead of “running away” from it. By avoiding the stressor, the client does not learn to cope, making it more and more stressful over time. However, facing the stressor through behavioral exposure makes the event less threatening. It is helpful for behavioral exposure to be completed in increments, so the client does not feel overwhelmed on the first attempt. One caution to consider when implementing behavioral exposure interventions is recognizing how far a client can go in the beginning stages. Pushing the client to expose themselves to stressors too early can delay the treatment process and potentially damage the client’s well-being. Thus, the therapist should consider the client’s diagnosis, the stressor, and how the client may physiologically and emotionally respond when exposed to said stressor. Another caution to consider is recognizing when a client is ready to transition to the next phase of behavioral exposure. For example, a client may have the necessary coping skills to increase their exposure to the stressor but is too anxious to do so. In this case, it is important to understand why the client feels unprepared and meets their needs so they feel more confident in moving on with the intervention.

    Reply

    • Jonas Horan
      Mar 25, 2023 @ 11:03:48

      I totally agree that behavior exposure should be done in a careful, step by step process. I think that if I needed exposure therapy I would find it very stressful, and I would keep that in mind when working with clients. I do think that it might be difficult to judge exactly how much someone can handle. Obviously we can ask them what their willing to do, but pushing them can require a lot of clinical judgement.

      Reply

  13. Stephanie Lugo
    Mar 23, 2023 @ 13:28:31

    One of the biggest pieces of information that we learned from Mark’s therapy sessions was the fact that he felt very unliked by some of his friends and co-workers. This belief of Mark has really been impactful to Mark’s life, but it shows that using the proper techniques can help reshape previous negative core beliefs and develop new more positive beliefs. Both the elevating advantages and disadvantages techniques as well as the core beliefs flow chart technique can drastically help an individual form more realistic core beliefs. During the therapy session, both techniques allowed Mark to reevaluate his previous “I am unlikeable” belief and realize how it was causing him maladaptive emotions and leading to negative behaviors. The technique of evaluating the advantages and disadvantages allowed Mark to realize having more positive core beliefs such as “I am a very likable person” can lead him to have more positive thoughts and behaviors. Having a positive/realistic core belief like the one mentioned above allows Mark to actually be able to find supporting evidence for this belief when using the core belief flow chart. It also allows him to compare the new positive core belief with the old negative belief which will allow him to better understand how our beliefs and thoughts affect our reality and our behavior.

    Behavioral exposure is a very effective technique when used with certain disorders, but it is not effective for every disorder out there. The reason for this is that for some disorders it can provide the individual suffering with the structure needed to help them understand and navigate situations that are very overwhelming to them. Using effective behavioral exposure can greatly help the individual reduce their distress when engaging in situations that are stressful to them. With that being said, some disorders cause extremely overwhelming stress which can cause severe anxiety about their fears. If their fear and anxiety of certain situations cause them to have panic attacks then this exposure technique could cause these individuals to develop even more of a negative response to those situations. That is why it is essential for the clinician to consider and weigh the positives and negatives of exposure therapy before they attempt it with the client. It’s also essential to consider the client’s feelings about exposure theory and discuss the pros and cons with them as well. As a clinician, we should never do anything that goes against what the client wants for their therapeutic experience. If the client agrees to exposure therapy then the clinician will need to decide the best way to go about it. Overall it is essential for the client and clinician to take their time during the process as it is extremely stressful. Exposure therapy is not an overnight process, it can take weeks or months depending on the level of fear and anxiety surrounding the disorder.

    Reply

    • Taylor Poland
      Mar 24, 2023 @ 22:00:04

      Hi Stephanie,
      Thanks for sharing your thoughts on behavioral exposure. I agree that it is helpful for the individual to experience the stressful stimuli in manageable doses to reduce their overall distress. As clinicians, we must listen to our clients and never push them too far too quickly. If a client puts up a stop sign or shows apprehension about the behavioral activition, we must do our best to listen to them and gain insight into why they are feeling this way.

      Reply

  14. Grace Ling
    Mar 23, 2023 @ 15:18:12

    From practicing both techniques, Mark was able to observe evidence that supports and contradicts his negative core belief. In this practice, he discovered that there was more evidence against his negative core belief rather than evidence that supports it. He realized that his core belief made him view his relationship in extremes and that in general, he is indeed a likable person. A possible new core belief to test would be “I am generally a likable person” or “I am valued by my loved ones.” Mark seems to have trouble believing these two things and would perhaps have more evidence supporting these core beliefs. He can evaluate instances where people have rejected his invitation to spend time together and reflect on instances where he was intentionally invited to events with friends or those he cares about. A behavioral experiment Mark could participate in could be attempting to invite other coworkers he is friends with to lunch. Whether this invitation is accepted or rejected, he can evaluate his automatic thoughts and further observe more evidence that supports or contradicts his negative core belief of being “unlikable.”

    Behavioral exposure can be effective for anxiety-related disorders, especially for phobias. Behavioral exposure allows clients to confront distressing stimuli to further reduce the level of distress certain stimuli. People tend to use avoidance to prevent interaction with or experiencing stressful stimuli. Thus, behavioral exposure works to decrease their patterns of avoidance and modify automatic thoughts and core beliefs surrounding the distressing object or setting. A caution to consider for behavioral exposure is not to do too much exposure in the beginning. Clinicians should assess the client’s level of distress before building upon more exposure. It is also important to consider the client’s ability to participate in exposure. For those with phobias, confronting the phobic object or situation takes time. Beginning with thoughts and images before direct contact with the object allows for a gradual increase in tolerance for the object.

    Reply

    • Becca Boucher
      Mar 23, 2023 @ 16:15:15

      Hi Grace! I love your recommendation that Mark could invite other coworkers to lunch so that whether he is reject or accepted he will have the chance to evaluate his automatic thoughts and he will be also adding evidence to his repertoire either for or against his negative core belief of being “unlikeable”. I agree that this would be a good way for Mark to start, as he has done this in the past, so it may not be as scary. Additionally, considering his history of asking coworkers to lunch, I think he would probably get a good response which would help his core belief.

      Reply

    • Taylor Poland
      Mar 24, 2023 @ 21:43:44

      Hi Grace! Your entire blog post was spot on! I really like how you emphasize the importance of accurately assessing the client’s level of distress before adding more exposure to stressful stimuli. Doing too much too quickly can cause a lot of anxiety thus halting the client’s progress. As you said, it may be helpful to engage in imaginal exposure before moving into in vivo exposure.

      Reply

  15. Becca Boucher
    Mar 23, 2023 @ 16:09:45

    Mark obtained evidence that contradicted his “old” core belief as well as evidence that supported a new, more adaptive core belief through the techniques in session. I think a good new core belief to test with the flow chart and a behavioral experiment could be that he is valued by others. This is not a grandiose statement that brings him from a very negative, unrealistic core belief to a very positive, unrealistic core belief. Rather, this is a good middle ground that is overall more adaptive, but not unrealistically so. He seems to really enjoy seeing his thoughts on paper and is more able to recognize thought patterns when he discusses them in session than when it is just in his head. Therefore, I think he could benefit from the visualization of his thoughts in a flowchart.
    Behavioral exposure is effective for certain disorders because some types of distress such as anxiety result in avoidant behaviors and behavioral exposure is a way to tackling/countering that avoidant behavior. Upon breaking the habit of avoidance, an individual can learn to cope with things that distress them and face them head-on. This can help to decrease their distress when faced with those stressors and helps them to cope with the distress they do still experience.

    Reply

    • Ashley Millett
      Mar 24, 2023 @ 09:29:53

      Hi Becca,

      I definitely agree with what you said about visuals helping Mark. I also witnessed that too. When Mark was listing his thoughts out, you can tell by his demeanor that his attitude was more negative. However, when Mark started to read and look at them, his demeanor changed. He was able to understand his thoughts rather than just saying them. I also agree that behavioral exposure has clients break the avoidance. We try to avoid things that can cause us distress. However, behavioral exposure lets us almost tackle it head on. It can help us cope with the situation and helps us for the near future.

      Reply

    • Megan VanDyke
      Mar 25, 2023 @ 16:50:57

      Hey, Becca! I like your example of a new core belief Mark can work on. As you said, it’s not grandiose or unrealistic. Instead, it’s more of a “next step” toward Mark developing a positive, adaptive mindset toward his relationships. Mark strikes me as a visual learner, so it makes sense that using worksheets has been effective. However, completing flowcharts in the moment may not always be possible. For example, Mark might see the best results from a behavioral experiment if he takes mental notes of significant events when he is with someone he values and uses the flowchart afterward to reflect on how well the event went. That way, Mark can look back on his most recent experiences to feel valued.

      Reply

  16. Rena Yaghmour
    Mar 23, 2023 @ 16:23:08

    Information and themes that were obtained that are helpful for Mark in developing a new core belief is the proof and evidence that was put towards his original core belief. This allowed Mark to Examine his negative core belief of “ I am unlikeable” and was really able to put evidence towards it and reflect on the people in his life and who he knows values and likes him. By putting evidence towards his core belief and reflecting he could change the negative idea that he is unlikeable into a more positive one. With the flowchart this also helped Mark put evidence towards his core belief and helped him realize that he needs to change his negative core belief into a positive one as the old one negatively impacted him and the way he went about things. By noticing he needs to alter his core belief he was able to think about who he is and all the people he has in his life that like him and value him. Although not everyone is going to like him he was able to identify the ones who do and enjoy being around him.
    Behavioral exposure is effective for certain disorders/types of distress because it allows the client to experience and learn how to handle the situation. It exposes them to a point where it drives them to learn skills to help them manage their anxiety and fear around what they are avoiding. With the exposure it can allow the client to hopefully realize that nothing bad will happen to them and will help them shift their core belief allowing them to accept and continue to practice this exposure technique which will eventually allow them to not avoid the specific situation. However, there are many things a counselor should be cautious of when implementing this technique. The individual is facing their fear head on which can cause them to shut down, experience a panic attack etc. if the client has yet learned how to cope correctly throwing them into a situation like this can negatively impact them and most likely making things worse for them and creating more fear.

    Reply

    • Gitte Lenaerts
      Mar 25, 2023 @ 11:22:08

      Hi Rena, I like how you mentioned that through examining Mark’s core beliefs, he and Dr. V were able to modify the belief into a more realistic and positive belief. We want to examine all aspects of the core belief to see if there is validity behind it, which lays the foundations for modifying the belief. Doing the flowchart is helpful as everything is written down and is a way to visualize the modifying thought process. Nice post!

      Reply

  17. Jonas Horan
    Mar 23, 2023 @ 17:26:23

    Mark seems to have some coping abilities to draw on. Although he struggles when he’s depressed, he came up with a good adaptive belief with a little support. The theme of withdrawal might be something to work on, since it could be an obstacle in overcoming his negative belief and establishing his new belief. Getting him to put himself out there might give him opportunities to affirm his new belief instead of withdrawing and personalizing his limited data.

    I think that Dr V and Mark might have already formed a good new belief. I would phrase it something like “not everyone likes me all the time, but I’m a generally likable person.” This new belief is much more realistic and can stand up in the real world, but it is also positive enough to influence his mood and behavior for the better.

    Certain types of disorders, specifically anxiety disorders, involve avoidance, and a lack of self efficacy when it comes to other coping strategies. Behavioral exposure cuts of access to the avoidance strategy, which will be unpleasant in the short term, but beneficial in the long term. By avoiding, individuals with anxiety don’t develop robust coping mechanisms for stressful events and situations, and often become anxious in the face of less and less obviously stressful scenarios. Behavioral exposure can reverse the direction of that trend, allowing the individual to cope better in more and more situations.

    When exposing clients to stressful situations, it is important to get their complete consent and to brief them beforehand. Clients must be motivated to engage with the exposure and be warned of what will be happening. The avoidance strategies that clients use often feel safe and appropriate, so it is also a good idea to get them on the same page about how avoidance influences anxiety. What you really want to avoid is confirming to them that they need the safety measures by overwhelming them or moving too quickly without explaining the rationale.

    Reply

    • Gitte Lenaerts
      Mar 25, 2023 @ 11:15:21

      Hi Jonah, I agree with your new core belief for Mark, “not everyone likes me all the time, but I am generally a likable person”. When developing a new core belief, we want to start slow and make it more realistic as modifying core beliefs takes time. Whereas with behavioral exposure techniques, we want to face those anxiety triggers head-on to break the avoidance pattern as you mentioned. You made a good point on how behavioral exposure can reverse the direction of avoidance and allows the individual to cope better over time with different situations. Great post!

      Reply

    • Alysha Benoit
      Mar 25, 2023 @ 18:11:23

      Jonah, I appreciate that you mention the components of different disorders regarding coping skills and avoidance behaviors. This is important as each client is unique and will most likely present with symptoms different from another individual with the same disorder. Behavioral exposure is a great way to help clients gain insight into their behaviors and their specific triggers. Additionally, keeping these differences in mind is beneficial in determining if a client is actually ready for what behavioral exposure entails. Nice job!

      Reply

  18. taylor poland
    Mar 23, 2023 @ 18:10:43

    The two techniques can provide Mark with a more realistic and positive view of himself, thus a new core belief. Mark’s new core belief can be that he is a generally likable person, instead of the old core belief “I am unlikeable.” The old core belief caused Mark to attribute a situation negatively despite contradictory evidence. Mark did a good job identifying evidence for and against his old core belief- this activity revealed that there is more evidence against his core belief. Having this listed on paper may be helpful for the client to visually see the evidence.

    Behavioral exposure is very effective for anxiety disorders because it is a safe way to expose the client to stressful stimuli. Individuals with anxiety-related disorders tend to completely avoid or limit interactions with stressful stimuli to reduce their anxiety. This isolation can be harmful as it may affect them socially, emotionally, and occupationally. An individual may struggle if they quickly introduce themselves to the stressful event as they may not have the appropriate coping mechanisms to handle the stress and anxiety. Slowly reintroducing oneself to the stressful stimuli is better for long-term progress. When implementing behavioral exposure with a client, it is important to meet them where they are at. The client and clinician should be in agreement with the next steps or else the treatment will not be effective.

    Reply

    • Melissa Elder
      Mar 24, 2023 @ 19:09:26

      Hey Taylor
      I like that you point out how Marks old core belief cause him to attribute situations negatively even with contradictory evidence. I agree that this technique is especially helpful due to the visual aspect as it can really provide the clients with a different view. I thought it was really great you mentioned how isolation can be very harmful to an individual in many ways, that it a really important factor.

      Reply

    • Rena yaghmour
      Mar 26, 2023 @ 10:30:00

      Hi Taylor,

      I like how you mention that the client may struggle if they are quickly introduced to their stressor. I think it’s really important to note that they need to be introduced slowly and learn skills to help them cope in these situations. Learning these skills will eventually allow them to test out exposure therapy slowly and see how they do with their coping skills they’ve learned. It will also help working on their core belief as it may have some impact on it.

      Reply

  19. Alysha Benoit
    Mar 23, 2023 @ 21:39:11

    With regard to information and themes that could be obtained to help form a new core belief, there are a few that come to mind. In Mark’s case, he is able to distinguish between his negative thoughts about himself and the more positive ones. For example, we notice in the role-play that Mark understands more about himself than he realizes. He talks about how he is unlikeable yet appreciates that Melissa is someone who makes him feel as though he actually is likable. In this instance, Mark was able to differentiate which belief had more evidence to support it. Thus, Mark could potentially develop a new core belief that he is a “generally likable person”. Although we explicitly hear Mark say this, his belief could extend beyond just being generally likable, so maybe “it is okay if not everyone likes me and it’s actually normal to not be liked by everyone”.
    Behavioral exposure is very effective for certain disorders and different types of distress through the mechanisms involved. For example, the use of behavioral exposure helps to desensitize an individual to a specific triggering event or memory. A client with panic disorder, for example, may experience thinking about the worst-case scenario or that something very bad will happen to them unless they avoid the triggering situation and eventually learn that they were still “okay” and “survived” the event after the exposure. Over a period of time, an individual is able to understand that the level of fear and/or anxiety they experience regarding a particular situation does not actually constitute that level of fear/anxiety. Through this, a client continues to learn more not only about the anxious/feared situation but about themselves as well. For example, an individual who experiences panic attacks may not fully understand the identifiable triggers involved, but rather just recall they experience them. Although this technique is extremely effective, counselors should be wary of the types of clients and disorders they use it for. If a client presents with having experienced severe trauma and a counselor uses behavioral exposure within the first few sessions, it may come off as too strong of an intervention for the client and reinforce their fears. It is important that counselors are mindful of how “ready” a client is for these types of techniques.

    Reply

    • Esther Konadu
      Mar 25, 2023 @ 14:29:57

      Hi Alysha,

      Your description of Mark’s new core belief is a great conclusion. As you said, not being liked by everyone is a typical thing that all of us experience. Learning that it is okay to be unlikable by everyone could help with some negative automatic thoughts. And utilizing the core belief Flowchart to reach these conclusions is a great place to start.

      Reply

  20. Olgena Pano
    Mar 23, 2023 @ 22:34:29

    When watching the video of Mark and Dr.V using the flowchart exploration, was helpful to understand the importance of the whole process of modifying core beliefs starting with their identification, challenge, modification and the development of new core beliefs. Maybe, a new potential core belif for Mark would be: “I am a valuable and amiable person”. It is important that Mark is taught to use the techniques applied previously in therapy to support these beliefs with evidence. In addition, is important for Mark to be aware that there are complex situations where he is not the only person who contributes to a particular occurrence and consider the other external factors.

    Moreover, watching this stage of Mark’s therapy his progress is obvious starting with the way how he is able to analyze his behavior and the evidence when applying the advantages and disadvantages/ evidence technique. The client is aware of identifying the situations where his prior core beliefs could affect his behavior, and the techniques/evidence he could us use against these beliefs. The client is able to view his personal and social relationships more positively, by challenging his negative thoughts, and therefore feeling better emotionally.

    Volungis’ readings empathized the important role of behavioral exposure as an important part of CBT especially among anxiety related disorders. The chapter highlighted the importance of using this technique to encounter the feared trigger that causes the distress and the negative automatic thoughts. This technique is important to challenge maladaptive coping behaviors that individuals could develop such as avoidance. While these coping techniques could decrease the short-term disturbances, in the long-term aspects could turn into new problematic behaviors and serve as negative reinforcement. The readings highlighted the idea that is important for the therapist (newbies) to develop certain set of skills, and carefully consider the disturbances how these techniques could affect client’s, based on the nature of their problem. Therefore, is important that this process is planned by priorly informing the client about the challenging aspects and the realistic/expected outcomes.

    Reply

    • Jonas Horan
      Mar 25, 2023 @ 11:13:09

      I like that you said that we were teaching Mark a new technique. Even though we would do the flowcharts an other worksheets in session, I think we’re also doing psychoeducation and helping Mark learn new ways of coping with his thoughts on his own.

      Reply

  21. Lucy Rising
    Mar 28, 2023 @ 09:41:31

    I think the best information that Mark obtained from the evidence and advantages worksheets for aiding him to develop a new core belief is seeing the evidence for and against as well as the advantages and disadvantages side by side and seeing that his evidence against and disadvantages outweigh and contradict his evidence for and advantages. By coming up with this list he is at the same time actively refuting it and proving it wrong. Simply the act of struggling to find examples of advantages to his negative core belief and coming up with disadvantages so easily shows him how this pattern of thought is non-beneficial and actively harmful to him. Especially the fact that he is the one who is working through these examples and not the therapist telling him “this is why these thoughts are bad” helps him formulate reasons that mean something to himself. This formulation also helps for himself to break down some of these cognitive links from his automatic thoughts to his core beliefs, making it easier for him to shift his cognition to a different core belief. The more adaptive core belief that Mark suggests “I am a generally likable person” is a really good example of a more positive and realistic core belief that we would want to help instill. Like Prof. V said to Mark in session it is a statement that is not overly positive and therefore less realistic (like “everyone likes me”) and as a result can be more likely to take effect because it more falls in line with Mark’s values and beliefs. As he said, he knows not everyone is going to like him, but he knows that he does have friends and loved ones who do care for him and do genuinely like him. So shifting his core belief to reflect that acknowledgement can help change some of his distressing feelings and avoidant behaviors that come from his negative core belief that he is beginning to see as maladaptive and false (through the use of the first two worksheets).
    Exposure works well at reducing stress from certain disorders (especially anxiety centric issues) for a few reasons. One is that it shows the client that their catastrophizing is not grounded in reality, that is, when they are forced to experience their feared stimulus they can see that the result of interacting with it is not the worst case scenario they had been ruminating about. In this way the exposure acts as an experiment to show the client that their expectations of the event are not going to come true. Some distress will probably occur, but that leads to another positive of exposure which is desensitization. While the worst case scenario did not happen, the client most likely experienced some level of distress due to the anticipation of their fear. With repeated exposure and experience the client will no longer feel that level of distress when engaging with the stimulus because it has been desensitized from that repetition. When doing exposure with a client the clinician must make sure that they are not making the client engage in a behavior that is too distressing for where they currently are in their treatment progress. A good way to measure this is by creating an anxiety/fear hierarchy chart and having the client work on some of the lower distressing steps first. This can provide a sense of positive reinforcement and encouragement and instillation of hope for when you begin to work on some of the things higher up on the chart.

    Reply

    • Grace Ling
      Mar 28, 2023 @ 20:27:42

      Hi Lucy, I like your point in having Mark realize these maladaptive thoughts are not helpful himself rather than having the therapist point them out to him. Using some of these techniques gives the autonomy back to the client in coming to these realizations themselves. I agree with your points about behavioral exposure and its effectiveness in reducing stress and anxiety. Exposure to a feared stimulus can eventually result in desensitization of distress towards the feared stimulus. Using a hierarchy chart to cater to a client’s needs and comfort levels can further build rapport and trust between the therapist and client.

      Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

Adam M. Volungis, PhD, LMHC

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 88 other subscribers
%d bloggers like this: