CBT week 5: deeper beliefs

This is week 5 of our six-week, self-guided course in cognitive behavioral therapy (CBT). So far you have caught thoughts, tested them and tried behavior experiments.

This week you will look one layer deeper. Many quick thoughts grow out of a few deep beliefs about yourself, other people or the world. CBT calls these core beliefs. Finding one can explain why the same kind of thought keeps coming back. Go slowly this week.

Why this step matters

CBT sees thoughts in layers. On top are the automatic thoughts you have caught since week 2. Under them are rules and assumptions, often in an "if... then" form, such as "If I ask for help, people will think I'm weak." At the bottom are core beliefs, broad conclusions such as "I am incompetent."⁶

Rules protect us in the short run, but they keep us from testing the core belief. If you never ask for help, you never learn that people might respond kindly.⁶

Core beliefs often start in childhood, from the meaning a child takes from hard events. Three habits keep them strong. We watch for signs it is true. We avoid challenges or try to be perfect. And we explain away good things as luck or politeness.³

According to Dr. Aaron Beck, deep beliefs rarely vanish completely. With CBT they can grow quiet. Stress can wake them up, and the same skills can quiet them again.⁷ That is why week 6 is about staying well.

Common core beliefs

Deep beliefs often sound short and harsh. Here are some examples people with low self-esteem report:¹

• "I'm not good enough."
• "I'm unlovable."
• "I'm unimportant."
• "I'm a loser."
• "I'm incompetent."⁶

A gentle approach

Good CBT does not argue with you or tell you your thinking is wrong. It uses curious questions, and you reach your own answers.⁹ Treat yourself the same way this week. You are exploring, not judging.

How to use the downward arrow

The downward arrow was used by Dr. Aaron Beck, who developed cognitive therapy. He would keep asking a person what a thought meant to them, and what they feared most, until the deepest worry came out.²

1. Choose a thought. Pick an automatic thought from your records that comes back often. Write it at the top of a page.
2. Ask what it means. Under it, draw an arrow pointing down. Ask, "If this were true, what would it mean to me?" Write the answer.
3. Ask again. Draw another arrow. Ask, "And if that were true, what would that say about me?" Or, "What is the worst part of that?"
4. Keep going. Repeat 3 to 5 times. Stop when the answer is short, broad and about you as a person, such as "I'm worthless."
5. Rate it. Write how much you believe this deep belief, from 0 to 100.
6. Look for the rule. Look back up the arrow. Can you spot an "if... then" rule along the way? Write it down.
7. Care for yourself. Take a few slow breaths. Finding a belief is not the same as proving it.

A worked example

This is a made-up example to show the steps.

Thought: "My daughter didn't call back today."

→ What would that mean? "She's too busy for me."

→ And if that were true? "I'm not important to her anymore."

→ What would that say about me? "Now that I'm old, I'm a burden."

→ And what does that mean about you as a person? "I'm worthless." Belief: 75 out of 100.

Rule found along the way: "If I'm not useful to people, I don't matter."

Seeing it written down can be a shock. It also explains why one missed call hurt so much.

Starting a more balanced belief

You cannot swap a deep belief overnight, but you can grow a new one. A self-help program from a public clinic in Australia suggests these steps.⁴

1. Write a balanced belief. Make it realistic, not perfect. For example: "I have weak spots like anyone, and I'm good at many things." Or "I'm a worthwhile person."⁴
2. Rate both beliefs. Rate the old belief and the new one from 0 to 100.⁴
3. Look at the old evidence again. List what you use to support the old belief. Ask if there are other explanations, such as depression, stress or the fact that everyone makes mistakes.⁴
4. Keep a daily evidence log. Each day, write one to three small things that fit the new belief. A kind word you gave, a task you finished or a call from a friend all count.^4,10
5. Act as if. Try small actions that fit the new belief, like asking for help or doing something nice for yourself. This is a behavior experiment, like week 4.⁴
6. Re-rate every week. Small shifts are real progress. In one example, belief in the new view grew from 30 to 70 over time.⁴

In the example above, a balanced belief might be: "I'm a person of worth, whether or not I'm busy or useful. My daughter has a full life, and she still loves me."

Notes for later life

The American Psychological Association recommends group CBT for depression in older adults. Part of that work is learning to question long-held assumptions and beliefs.¹¹ It also recommends group life review, which helps people look at painful memories with curiosity and new eyes.¹¹ See reminiscence and life review.

Retirement, illness or needing help can seem to "prove" an old belief. The loss is real, but the meaning you give it can be checked. A helper can read the questions aloud and write your answers. See depression in later life.

Common problems

I reached the bottom and now I feel worse.

You touched an old wound. Take a break, do something soothing and talk to someone you trust. If the low feeling lasts, reach out to a professional. Call or text 988 if you feel unsafe.⁵

My arrow went in circles.

Try asking, "What is the worst part of that?" or "What does this say about me, others or the world?" Landing on a belief about others, like "People can't be trusted," is useful, too.

The new belief feels fake.

That is normal at first. Pick a new belief that is only a little kinder and that you can believe at least a bit, perhaps 20 or 30 out of 100. Let the evidence log do the work over weeks.⁴

When to get a therapist

Deep-belief work is often where a therapist helps most. Consider one if:

• the beliefs are tied to trauma, abuse or neglect;
• this work brings strong distress that does not settle after a day or two;
• you have practiced for weeks and your mood is still low or getting worse;
• the beliefs affect your relationships, work or caregiving.

NIMH suggests asking a therapist what approach they use, what the evidence is and whether they work with people your age.¹² For trauma, cognitive processing therapy helps people check beliefs about safety, trust, control, self-esteem and closeness. It usually takes about 12 weekly sessions.⁸ See how to find a therapist and paying for therapy.

Keep taking any medicine as prescribed. Talk with your doctor before changing anything.

Next step

In week 6: staying well, you will make a plan to keep your progress, handle setbacks and practice when old beliefs wake up. You can go back to week 4 or the CBT course overview any time.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.