Core beliefs, automatic thoughts and conceptualisation in CBT

Core beliefs are central beliefs that people hold about the self, others and the world. Core beliefs are often formed at an early age, and can refer to a cognitive content or construct such as “I am unlovable” or “people can’t be trusted”.

When a person is anxious, the core belief “I am weak” is likely to be activated, whereas in less threatening situations the core belief “I am strong” may be activated. When activated these beliefs are experienced by the person as absolute truths.

Sometimes people with anxiety or clinical depression will develop strongly developed core beliefs that are not balanced by alternative core beliefs. In therapy, one way to detect the evidence of a core belief is to notice thoughts that are accompanied by a strong emotion that do not shift in the face of contradictory evidence.

Automatic thoughts are thoughts that people routinely have during the day as they make sense of their experiences. In therapy clients can be helped to identify their automatic thoughts by asking questions such as:

• What was going through your mind then?
• What does this means for you?

What other people say about this?Some automatic thoughts are more important than others to understand what is going on in the client’s mind. The therapist can ask clients to record their thoughts to have a better understanding of when these automatic thoughts occur.

Case conceptualisation can be defined as a process whereby the therapist and the client work together to describe and explain issues clients present in therapy. If CBT can help clients to build resilience and to alleviate distress, case conceptualisation can help clients to achieve these two goals.

Case conceptualisation can have the following functions:

• To integrate client experiences with relevant CBT theories such as anxiety theory (Beck,1985) or depression (Beck, 1999).
• To help clients to describe their problems in a constructive language and help them to understand how problems are maintained.
• It can help problems to become more manageable for clients and therapists. Also, it can help the therapist to select, focus and plan interventions.

A good conceptualisation offers an understanding of therapeutic difficulties as well as ways to address them. Overall case conceptualisation is viewed as a core aspect of CBT theory and provides an explanatory framework that links triggers, maintenance cycles, and protective/predisposing factors. Conceptualisation incorporates a client's strengths in order to apply exhibiting resources to common issues and to strengthen client awareness to build resilience overtime.