Everyone has core beliefs about themselves and the world, which have been shaped largely by our personal experiences. For anxious or depressed people, these core beliefs are often negative (but not necessarily negative and accurate, or negative and helpful). Some common core beliefs in depression are: “I am a failure,” “I am worthless, bad, or evil,” and “I am unlovable.” Anxiety often has similar beliefs and may also include “I will die.” Core beliefs greatly affect our lives; they shape the way we think, feel, and behave. Core beliefs often lead to “intermediate thoughts,” which are patterns of thoughts related to the core belief but are more specific than core beliefs (e.g., intermediate thoughts may be “rules” about the world). An example of an intermediate thought linked to the “I am a failure” core belief could be, “If I try something new, I will fail. If I don’t try something new, at least I won’t fail at it.” These intermediate thoughts then trickle down into very specific examples that comprise our daily lives.

So, how do we change core beliefs? Can we just reassure ourselves “I am not a failure. I’m a success!” or “I am not unlovable. People love me!” We can try doing that or have someone else tell us those positive reassurances, but often this is not effective, or it is only mildly effective for a short period of time.

To maximize the chances of making long-lasting positive and reality-based changes to our beliefs, most evidence-based treatments approach this through bottom-up processing. “Bottom-up processing” means we need to do the therapeutic work on little situations and thoughts in our daily lives. Think of these as “examples” of our core beliefs and intermediate thoughts. If someone has a core belief of “I am unlovable,” one intermediate thought might be “If I talk to someone I don’t know, they will reject me. If I avoid talking to them, I will avoid rejection.” This thought could occur in many situation-specific “examples” in daily/weekly life, and the person may choose to avoid social situations to avoid confirming their “I am unlovable” core belief. Avoidance results in i) maintaining the core beliefs and intermediate thoughts, ii) missing out on opportunities to counter them (e.g., to learn the person is in fact lovable and that meeting people will probably go better than expected), and iii) missing out on living life the way we want to. A negative belief system coupled with avoidance can spur depression, anxiety, or both.

In CBT and PAT (two of the therapies I provide), we often target these “examples” of life and work through them together. By working through these examples repeatedly, we can challenge the intermediate thoughts and core beliefs and change them so that they become more realistic (and more positive). This helps us feel better and live our lives to the fullest.

Structure of Our Belief System