I. Core Beliefs in CBT
CBT works with the notion of “core beliefs” which underlie depression and anxiety. The patient in therapy is to identify their damaging core beliefs, consider where they came from, then scrutinize carefully the evidence with respect to them. Ultimately, the aim is to replace the problematic core beliefs not with “positive” ones but with more balanced, realistic ones. So, the person in therapy also takes into consideration what supported the core beliefs, and what functions they played.
The identifying process begins with a taxonomy of malign core beliefs. There are internal ones, about oneself. There are also external ones, about one’s worldly situation. The internal ones are further sub-categorized in terms of beliefs that the patient is unloveable, helpless or worthless; while the external ones are further sub-categorized into deep and abiding beliefs about other people, about the present world, and about the future.
Internal: Unloveable; Worthless; Helpless
External: Other people; the Present; the Future
II. Some of Rob’s Core Beliefs
The above taxonomy is a good departure point for identifying my own troubling core beliefs.
Starting with the Internal, none of the ones listed in CBT’s “unloveable” sub-category apply. Though I didn’t always feel that way, I now know that I am very loved. What applies very much to me are the two other sub-categories. Regarding helplessness, I believe deeply that I am vulnerable, weak, needy, and trapped by my own defective brain. Relatedly, and turning to worthlessness, I believe deeply that I am broken/crazy.
Turning to External Core Beliefs, the “other people” sub-category isn’t problematic in one respect. I value others. I largely trust them. But good people are vulnerable too, and that limits how much trust you can put in them. As for the world and the future, despite the presence of good people who love me, the world and the future are dangerous, unsafe, uncontrollable, and unfair.
Putting these internal and external core beliefs together, I believe that I am vulnerable, weak, broken/crazy and facing a dangerous unfair world. As I like to put it metaphorically, I am soft and getting softer; and the world is hard and getting harder. Eventually, it’s bound to crush me. Therein may lie the main basis of my anxiety and depression.
III. Sources of Rob’s Core Beliefs
Having taxonomized the core beliefs people tend to have and identified some of my own, the next steps in Cognitive Behavioral Therapy are: to ask where the beliefs came from, i.e., the experiences that led to them; to consider their functions (so to arrive ultimately at a more balanced assessment of the core beliefs); and to examine at the same time counterevidence against one’s internal and external core beliefs. A next step after these, the subject of a later post, is trying out new core beliefs which are more realistic. (Again, not “more positive”: CBT isn’t about the power of positive thinking.)
So, what are the sources of my inner and external core beliefs? I’ll approach this biographically. As a small child, I had a violent, highly critical father. He was always telling me that I was helpless and worthless and also showing me that I was, because I couldn’t defend myself. What’s more, my father was very successful and popular, regardless of his abusive behaviors toward his wife and children. This taught me that the world was unfair. (My dad, today in his nineties, is thankfully, a very, very different man now, and I have a strong loving relationship with him.) I was also picked on at school and abused by a predatory pack of older boys. Again, the bad kids seemed to be the popular, successful ones. This too reinforced that the world is dangerous/unfair (external) and that I am the vulnerable/weak one (internal).
My teen years were better. In fact, I now suspect that my first hypomanic episodes were showing up then. I changed from withdrawn to outgoing, academically mediocre to a star student, sad-sack to life of the party. But in my early 20s, my first wife Hamila fell ill with brain cancer. She died after five years of intensive treatments – three surgeries, radiation and many, many rounds of chemotherapy. What could signal more forcefully that the world is dangerous and unfair? And that I can’t control it?
The main source of the worthlessness belief of being broken/crazy is biographically much more recent. It was reinforced in my fifties as my Bipolar got worse. Once you’re 50, there’s also the constant awareness of aging. In my specific case, there were diabetes and high cholesterol diagnoses, which I took as evidence of both my aging body breaking down and of unfair genetics.
IV. The Positive Functions of the Core Beliefs
The final step is to consider the pros and cons of the core beliefs, and the objective evidence with respect to them. It would take too long to do all that in one post, so I’ll end with reflections on how my mostly malign core beliefs have had some positive impacts.
What have been some of the functions of my core belief that I am soft and the world is hard? How did it benefit me? What did it protect me from? Well, those beliefs kept me from taking inappropriate risks. They caused me to always have back up plans and made me attend carefully and constantly to the potential consequences of my actions. They made me try to be prepared for disappointments. Maybe most importantly, believing that the world is dangerous, uncontrollable, and unfair, meant that I do not postpone joy, because joy can disappear tomorrow.
Coming soon: Evidence against these core beliefs and some more balance, new, core beliefs that might replace the above.