How Your Past Affects Your Present (CBT)

Levels of cognition

Aaron Beck’s cognitive model describes three levels of cognition (Beck, 1995). Alongside life experiences, these can affect how events are perceived:

• At the top level are automatic thoughts. These are thoughts which arise automatically and involuntarily, often taking the form of internal statements or mental images. Because of the speed at which they occur, automatic thoughts are often accepted uncritically (even when they are objectively inaccurate). While people are usually aware of their emotional responses, they are generally less conscious of the thoughts and images associated with them.
• At the intermediate level are underlying assumptions. They are also known as intermediate beliefs, associated beliefs, conditional assumptions, or rules for living. These develop in response to how individuals make sense of their experiences, and they vary in their accuracy and functionality (Beck, 1995). Often, they shape behavioral strategies for preventing or coping with the activation of core beliefs (e.g., “If I make a mistake, then it means I am stupid, so I must strive to be perfect”). Assumptions maintain core beliefs by explaining life experiences that might otherwise contradict them, as well as generating negative automatic thoughts and problematic behaviors (e.g., avoidance and safety behaviors; Fennell et al., 1998; Kuyken et al., 2009).
• At the bottom level are core beliefs, also known as unconditional beliefs and central assumptions. These are deep-rooted, global, and overgeneralized judgments about oneself, other people, and the world. They are usually phrased as all-or-nothing, absolute truths (e.g., “I am good”, “I am bad”) and experienced by individuals as “just the way things are” (Dowd, 2002). Core beliefs usually arise in pairs (e.g., “I am worthwhile”; “I am worthless”), although only one core belief is active at a time, depending on the clients mood (Beck, 1967).
• Finally, life experiences including interpersonal, environmental, and sociocultural factors (e.g., childhood trauma, parenting styles, chronic illness, social isolation, discrimination) can predispose, precipitate, and perpetuate dysfunctional patterns of thinking and the maladaptive beliefs and assumptions that underlie them (Padesky, 2020).

The cognitive model proposes that the way a person feels about an event follows from how they interpret it (i.e., their automatic thoughts). These perceptions of events or ‘best guesses’ are influenced by underlying beliefs and assumptions. Importantly, negative core beliefs that are inaccurate or dysfunctional cause individuals to process information in a biased way, resulting in cognitive distortions such as overgeneralizing, catastrophizing, or disqualifying some kinds of evidence. Distressing feelings associated with psychological disorders can therefore be a direct result of biased thinking at different levels.

Addressing each level of cognition

Clinicians who practice CBT will be familiar with working at the level of automatic thoughts. Standard texts recommend that the “usual course of treatment in cognitive behavior therapy … involves an initial emphasis on identifying and modifying automatic thoughts that derive from the core beliefs” (Beck, 1995). Clinicians usually choose to work at this level for good reason – cognitive restructuring can be relatively quick and is often sufficient to bring about emotional change. Furthermore, once the client’s primary difficulty has improved (by re-evaluating and testing their negative automatic thoughts) their negative core beliefs often become less active and positive core beliefs emerge (Padesky & Kennerley, 2023).

Nonetheless, there may be times when it is necessary to work with deeper levels of cognition. Indicators for targeting dysfunctional assumptions and core beliefs may include:

• The client displays only a limited response to standard interventions such as cognitive restructuring.
• The positive effects of treatment are not maintained or generalized (e.g., the client frequently relapses).
• The client maintains a fixed, negative view irrespective of their mood, life events, or circumstances (e.g., they have a chronic mood disorder).
• Maladaptive assumptions or beliefs affect the client’s ability to engage in therapy, form a therapeutic alliance, or recognize progress (Clark & Beck, 2010; Padesky & Greenberger, 2020).

It is usually recommended that assumptions and core beliefs are addressed in the later stages of therapy, once less intensive interventions have been trialled and the client is familiar with identifying and re-evaluating their interpretations (Tolin, 2016).

Irrespective of the level at which clinicians intervene, therapists should be aware of the client’s relevant life experiences, including their developmental history and current situation. This can help identify factors that may have increased the client’s vulnerability to their current difficulties, provoked their onset, or perpetuated the maladaptive cognitions associated with them (Macneil et al., 2012). Furthermore, communicating this understanding can help contextualize and normalize these issues, supporting client engagement and guiding the use of appropriate interventions (Kuyken et al., 2009).

"A key idea in CBT is that what you think impacts how you feel. However, our thoughts don’t just come out of nowhere: our underlying beliefs and life experiences influence the way we think. Can we use this handout to explore how these ideas fit together?"

• Beck, A. T. (1967). Depression: Clinical, experimental, and theoretic aspects. Harper and Row.
• Beck, J. S. (1995). Cognitive therapy: Basics and beyond. Guilford Press.
• Clark, D. A., & Beck, A. T. (2010). Cognitive therapy of anxiety disorders: Science and practice. Guilford Press.
• Dowd, E. T. (2002). History and recent developments in cognitive psychotherapy. In R. L. Leahy & E. T. Dowd (Eds.), Clinical advances in cognitive psychotherapy: Theory and application (pp.15-28). Springer.
• Fennell, M. J. V. (1998). Cognitive therapy in the treatment of low self-esteem. Advances in Psychiatric Treatment, 4, 296-304. DOI: 10.1192/apt.4.5.296.
• Kuyken, W., Padesky, C. A., & Dudley, R. (2009). Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. Guilford Press.
• Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice. BMC Medicine, 10, 1-3. DOI: 10.1186/1741-7015-10-111.
• Padesky, C. A., & Greenberger, D. (2020). The clinician’s guide to using mind over mood (2nd ed.). Guilford Press.
• Padesky, C. A., & Kennerley, H. (2023). Dialogues for discovery: Improving psychotherapy’s effectiveness. Oxford University Press.
• Tolin, D. F. (2016). Doing CBT: A comprehensive guide to working with behaviors, thoughts, and emotions. Guilford Press.