Positive Core Belief Evidence Record

Core beliefs are the most fundamental level of cognition and are embedded in schemas. Schemas are an important cognitive structure in the cognitive theory of psychopathology and are believed to contribute to both the development and maintenance of psychological disorders, as well as their recurrence and relapse (Arntz, 2018; Riso & McBride, 2007). Beck (1967) defines schemas as structures “for screening, coding, and evaluating the stimuli that impinge on the organism” (p.283). In this context, core beliefs comprise the verbal representation or ‘content’ of a schema (Beck, 2011; Wills, 2022).

Core beliefs are global, unconditional, and overgeneralized beliefs about the self, other people, and the world. Also referred to as ‘unconditional beliefs’ or ‘central assumptions’, they are usually phrased as all-or-nothing, absolute truths (e.g., “I am good”, “I am bad”) and are experienced by individuals as “just the way things are” (Dowd, 2002).

Core beliefs are also strongly held and difficult to modify through experience (Wenzel et al., 2009). Morse (2002) describes them as like the roots of a tree:

The lowest level of cognition is the… core belief. These thoughts are like the roots of the tree. You cannot see the size or the shape. You do not know the number. They filter all the information and nutrients to the upper levels. They are as old as the tree and have grown and modified over the life of the tree… They “hold” the personality together and all information is filtered through them.

According to the cognitive model, core beliefs influence the selection and interpretation of incoming information, and so contribute to information processing biases (Riso & McBride, 2007). They also impact memory recall, since individuals tend to remember congruent experiences (Clark & Beck, 2010). As a result, they exert a powerful influence – usually below the threshold of awareness – on how people think, feel, and behave across situations, as well as what they pay attention to.

Other key features of core beliefs include:

• Core beliefs are often paired. They usually arise as pairs (e.g., “I am good”, “I am bad”), but depending on the individual’s mood and current circumstances, only one core belief is active at a time (Beck, 1967). During an intense mood (e.g., depression), negative core beliefs are activated (e.g., “I am worthless”). When this mood lifts, the paired belief (e.g., “I am worthwhile”) is likely to return (Padesky & Greenberger, 2020). However, some clients (such as those with chronic mood disorders or who have experienced developmental trauma) may hold negative core beliefs that are not counterbalanced by a positive alternative (Kuyken et al., 2009: Padesky & Kennerley, 2023).
• Core beliefs can be adaptive or maladaptive. Maladaptive core beliefs tend to be negative, rigid, and extreme, resulting in distorted interpretations of events and negative emotional reactions. Adaptive core beliefs tend to be more stable and relativistic, and so do not result in negative interpretations or responses (Beck, 2011; Tolin, 2016).
• Core beliefs vary in their prepotence and activation. Like schemas, core beliefs have different thresholds for activation (Riso & McBride, 2007). For instance, negative core beliefs will have a low threshold for activation when individuals are depressed. Furthermore, they will usually inhibit other (i.e., positive) core beliefs that might be more appropriate to the situation (Beck et al., 1990).
• Core beliefs can be categorized. Negative core beliefs tend to center on themes relating to unlovability (e.g., “I am unattractive/different/not good enough”), helplessness (e.g., “I am weak/incompetent/a failure”), or worthlessness (e.g., “I am bad/unacceptable/toxic”) (Beck, 1999; Beck, 2011). Individuals may hold beliefs in one or several categories.
• Disorders can be associated with specific core beliefs. For instance, susceptibility to anxiety disorders is believed to arise from core beliefs relating to vulnerability and the salience of threat (Clark & Beck, 2010). In addition, Beck and colleagues (1990) associate each personality disorder with a specific set of beliefs (such as “I am special” in narcissistic personality disorder; Beck et al., 1990).

Core beliefs are usually acquired early on in life, sometimes pre-verbally (Arntz, 2018). Factors that shape the core beliefs people develop may include their genetics (e.g., temperament, predisposition to certain personality traits), developmental experiences (e.g., early attachments, traumatic events, relationships with others), modeling (e.g., observation, interactions with significant others), and verbal communication (e.g., familial judgments, instructions, stories). Arntz (2018) notes that, because people actively make sense of their experiences, core beliefs can also be influenced by the way they reason. As such, one’s culture, education, and developmental phase may play a role. Finally, Young (1999) has observed that people tend to behave in ways that strengthen their core beliefs. For instance, an individual who holds the belief, “I am different to others” might avoid social interactions, resulting in isolation. These behavioral responses cause individuals to experience their environment in ways that confirm their beliefs (Tolin, 2016). Most importantly, people rarely stop to question the longstanding beliefs that helped make sense of their early experiences. As a result, they tend to go through their adult lives believing their core beliefs are still entirely accurate (Greenberger & Padesky, 2016).

When to work with core beliefs

Opinion varies as to when therapists should work with core beliefs in CBT. For instance, Beck (2011) recommends addressing core beliefs early on in treatment to improve clients’ mood and support adaptive thinking. However, Padesky and Kennerley (2023) caution against working with core beliefs prematurely, noting that this can be exposing, distressing, and potentially unnecessary. For instance, negative core beliefs are likely to become less active and positive core beliefs often emerge spontaneously once the client’s primary mood issue has improved using other interventions (e.g., re-evaluating automatic thoughts and behavioral experimentation). Finally, some research with depressed clients suggests that working with core beliefs in the early stages of therapy may make some difficulties worse (Hawley et al., 2017). In summary, it is clear that:

Although there are some clear benefits associated with the greater emphasis on underlying structures, it is essential to remember that care must always be taken when working at the level of schemata, whatever form of CBT one is engaging in.

(James, 2001, p.403)

Accordingly, it is often recommended that CBT therapists work with clients’ automatic thoughts and dysfunctional assumptions first, as these can be tested more quickly and will often lead to improvements in mood, thereby helping activate associated adaptive core beliefs (Padesky & Greenberg, 2020). If therapists do decide to work at the level of core beliefs, this is usually best introduced 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). 

Potential indicators for intervening at the level of core beliefs include:

• The client has a limited response to ‘standard’ interventions, such as cognitive restructuring or behavioral experiments (Greenberger & Padesky, 2016).
• The client maintains a fixed, negative view irrespective of their mood, life events, or circumstances (e.g., they have a chronic mood disorder or diagnosis of personality disorders) – this often reflects a weak or absent positive core belief in the belief pairing (Padesky & Greenberger, 2020).
• The client struggles to maintain or generalize the positive effects of treatment (e.g., they experience frequent relapses; Clark & Beck, 2010).
• The client describes numerous diffuse difficulties that are best collated under a common theme, such as ‘personal failure’ or ‘defectiveness’ (Young et al., 2003).
• The client struggles to identify their thoughts or changes in mood, which makes work with automatic thoughts unproductive (Young, 1999). 
• The client’s negative core beliefs affect their ability to form a therapeutic alliance, recognize progress, or learn from setbacks (Padesky & Greenberger, 2016).

Developing positive core beliefs

Core beliefs can be addressed in different ways. One common approach involves the identification, re-evaluation, and empirical testing of negative core beliefs (e.g., Arntz, 2018; Young, 1999). Alternatively, therapists may focus on creating and strengthening clients’ positive core beliefs (e.g., Padesky, 1994; Greenberger & Padesky, 2016). Both approaches are sometimes combined (e.g., Beck, 2011; Moore & Garland, 2003). Padesky (Greenberger & Padesky, 2016; Mooney & Padesky, 2000; Padesky, 1994) argues that strengthening positive core beliefs is often most beneficial for several reasons:

• Without a positive core belief, evidence that contradicts the client’s negative core belief will be overlooked, discounted, or distorted.  
• Counterbalancing negative core beliefs with positive core beliefs helps clients accept a wider range of life experiences and interpret situations more flexibly.
• Positive core beliefs allow clients to appreciate and remember positive events more readily.
• Clients can use the positive data they have collected to reactivate positive core beliefs when negative beliefs get triggered.
• Strengthening new beliefs is a more creative, motivating, and interesting therapeutic process for clients.

The value of bolstering positive core beliefs is also consistent with modern cognitive theory. Brewin’s (2006) retrieval competition account suggests that, rather than seeking to modify negative representations, the purpose of therapy is to increase the activation and accessibility of positive internal representations. Crucially, these new representations need to be sufficiently salient, memorable, and attention-grabbing to outcompete negative representations for retrieval from long-term memory.

Research suggests that targeting positive core beliefs has therapeutic potential. For example, positive schemas are associated with reduced emotional distress and symptomatology, as well as increased wellbeing, resilience, and life satisfaction (e.g., Chi et al., 2022; Cooper & Proudfoot, 2013; Louis et al., 2018). In addition, interventions focused on strengthening and enhancing the retrieval of positive self-representations (i.e., competitive memory training or ‘COMET’; Korrelboom et al., 2008) have proved effective in treating several difficulties including low self-esteem, depression, and rumination (e.g., Ekkers et al., 2011; Korrelboom et al., 2012).

Therapists can help clients strengthen their positive core beliefs using a range of interventions (Beck, 2011; Bennett-Levy et al., 2015; Korrelboom et al., 2012; Padesky, 1994; Padesky & Greenberger, 2020). They include:

• Recording evidence (or ‘positive data’) that supports the positive core belief.
• Rating positive core beliefs on unidimensional or multidimensional continuums.
• Testing the accuracy of positive core beliefs using behavioral experiments.
• Engaging in kindness- and gratitude-focused tasks that activate positive beliefs.
• Using imagery to ‘live out’ positive core beliefs in imagination.
• Writing stories about instances when positive core beliefs were manifest.
• Behaving ‘as if’ the positive core belief is true.
• Symbolizing positive core beliefs and associated positive qualities using images, drawings, music, or objects.

The Positive Core Belief Evidence Record is designed to help clients identify and strengthen new, positive core beliefs. Clients are trained to notice and collect evidence (‘positive data’) on an ongoing basis that supports their new belief. Keeping a record of positive data can also help clients recall these experiences in the future, such as when their negative core beliefs are activated (Padesky & Greenberger, 2020).

"It sounds as though the negative core belief you hold about <yourself / other people / the world> plays an important role in your difficulties. One way that we can address this negative belief is to help you develop a new, positive belief about <yourself / other people / the world>. Would you like to try this?"

Your new positive core belief

Help the client identify a new core belief that they want to strengthen. Some clients readily identify a positive belief they held before the onset of their difficulties, while others need to construct an entirely new one. Either way, ensure the belief is stated in the client’s own words and uses emotionally resonant language. If the client is multilingual, encourage them to use the language that best relates to their difficulties (Padesky & Greenberger, 2020). Finding the right wording for this belief may take several weeks and clients may want to edit it as time goes on. You might ask:

• "Let’s start by writing down the positive belief that you want to strengthen. What comes to mind?"
• "In a perfect world, how would you want <yourself / other people / the world> to be?"
• "If <you / other people / the world>weren’t that way, how would you like <yourself / them / it> to be?"

If the client struggles to identify a new belief, consider using creative questions that drawn on role models or fictional characters:

• "Is there a person you admire who lives their life the way you would want to?"
• "Can you think of a character or mystical creature you would like to emulate? What belief might they hold about themselves, other people, or the world? Would you like to develop that belief in yourself too?"

Note that new beliefs can take a variety of forms, including absolute statements that contradict the negative core belief (e.g., “I am lovable”), qualified beliefs (e.g., “The world can be dangerous, but most of the time it is safe”), beliefs that incorporate acceptance (e.g., “It’s OK if I make mistakes, I am still good enough”), and even positive images.

What to look out for

Because the client’s new belief is weak or doesn’t yet exist, they are likely to overlook, discount, or distort evidence that supports it. Providing specific examples of the types of evidence they should search for will help to correct this bias. This can also be a good opportunity to remind the client that they should record any evidence that fits with their new belief, no matter how small or insignificant it seems. For example:

• "One way to strengthen your new positive belief is to write down any evidence you find that supports it. At first, you might find it difficult to notice this evidence because you don’t trust this positive belief yet. Your old, negative core belief might also lead you to distort or dismiss this data. So, let’s come up with some examples of the positive evidence you should actively look out for. What experiences would show your new belief is true, no matter how small they might seem? If you wanted to strengthen this belief for a friend, what evidence would you want to record on their behalf? What might I point out to you and say, “Could that be evidence that supports your new belief”?"

Date

Ask the client to record when they identified the positive evidence. Suggested prompt:

• "First, write down when you find evidence that supports your new belief. This will help us keep track of how much evidence you collect each day. Let’s start with putting today’s date in your record."

Evidence that supports my new positive core belief

Ask the client to describe the event, experience, or action they took that supports their new belief. Encourage them to provide sufficient detail so that they can easily recall what happened. Demonstrate this process by helping the client identify one or two pieces of positive evidence from the last day or week:

• "Make notes about any evidence you find that fits with your new positive core belief."
• "What have you done today that supports your new belief, no matter how small or insignificant it seems?"
• "Has anyone behaved towards you in a way that fits with this new belief?”

Further recommendations for helping clients get the most out of their Positive Core Belief Evidence Record include:

• Agree on how much positive data the client will aim to collect each day: two or three pieces of evidence is usually a good starting point (Padesky & Greenberger, 2020).
• Identify visual or audio cues that will help the client remember to look for positive data (e.g., sticky notes or an alarm on their phone).  
• Inform the client that discounting and critical thoughts (e.g., “That doesn’t count”) are likely to arise during this task – encourage them to notice these thoughts and let them go. Clients can also practice challenging their discounting thoughts (e.g., “I helped a friend, but I could have done more… But what I did was still helpful and that counts”; Beck, 2005).
• If the client is unsure about the evidence they identify, ask them to rate their confidence in it using 0–100% scale, where 0 would mean, “I have no confidence in this evidence”. This will encourage the client to still record data they are sceptical about.
• Be alert for positive data that emerges during the client’s therapy sessions (e.g., achievements they haven’t noticed) and ask the client whether they would like to add this to their record.
• Once the client is familiar with the process, encourage them to look for evidence in a wider variety of domains. For instance, if the client has been looking for evidence in their close relationships, prompt them to search for data at work too.
• If the client is unable to find positive data, check they are not searching for evidence within a toxic environment, such as an abusive relationship (Waller et al., 2007).
• Remind the client that collecting data in support of a new core belief is an ongoing task. It takes time (often several months), but will get easier as the new belief grows in strength.

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