Cognitive Beliefs ch.8

Week 4

Cognitive Beliefs

Convictions held as true

Influence and influenced by occupational, personal, and environmental factors

OTPs can address cognitive beliefs to positively influence occupational participation and performance

Theoretical Assumption

1. Deeply held core beliefs influence our thoughts, emotions, behavior, and
physiological arousal
2. Beliefs and their dynamic interaction with behavior, emotions, physiological states, and the environment comprise human functioning
3. Beliefs are instrumental in how we perceive, appraise, and attach meaning to information from ourselves and the environment (our beliefs are our filter)
4. Beliefs that are true or held to be true often act as self-fulfilling prophecies
5. Beliefs develop from childhood through adulthood
6. Beliefs affect relationships, group affiliations, and society, and these social contexts also affect beliefs

Levels of Beliefs

Beliefs are on a continuum of overlapping levels
o Automatic thoughts- surface level, spontaneous, flexible, situational, arise
from core beliefs
o Assumptions/rules for living- intermediate assumptions, values, conditional rules, arise from core beliefs
o Core beliefs or schemas- deepest level; templates of absolutes about self, others, or the world; rigid; global
• Exist in a dynamic feedback loop where core beliefs generate intermediate and surface level thoughts, and intermediate and surface level thoughts reinforce core beliefs

Levels of Beliefs: Feedback Loop

Surface beliefs or automatic thoughts

Intermediate beliefs: values, attitudes, and rules for living

Core beliefs or schemas: about self, world, future

Depression: Cognitive Beliefs

Cognitive triad of negative beliefs
1. Self
2. The world or environment
3. The future
o May lead to a pessimistic world-view, self-deprecation, unpleasant feelings, maladaptive behaviors

Anxiety Disorders: Cognitive Beliefs

Beliefs tend to focus on threats and catastrophic interpretations of situations
o Intolerance of Uncertainty Model
o In OCD, distorted beliefs lead to inflated responsibility for negative events and need for control
o In PTSD, distorted beliefs center around self-blame

Eating Disorders: Cognitive Beliefs

Distorted beliefs about self and eating

Emphasis on appearance and eating habits on self worth

Substance Use Disorders: Cognitive Beliefs

Anticipatory beliefs - expectation of reward

Relief-oriented beliefs - using will alleviate discomfort

Facilitative beliefs - permissive in spite of potential consequences

Schizophrenia: Cognitive Beliefs

Defeatist beliefs

Self stigma

Cognitive Beliefs and Stigma

Stigma is rooted in personal and public beliefs
• Experiencing stigmatized beliefs from others and/or holding stigmatizing beliefs about oneself may hinder recovery
• Restructuring beliefs about mental illness to focus on hope and the ability to live a successful, meaningful life can support recovery

Cognitive Beliefs Assessment

Structured:

Pain Self Efficacy Questionnaire

Self Efficacy Gauge

Semi-Structured:

Socratic Questioning

Dysfunctional Thought Records

TIC-TOC

ABC

Pain Self Efficacy Questionnaire

Adults with chronic pain

10 item Likert scale survey measuring confidence in ability to perform daily tasks with pain

Self Efficacy Guage

For adults with occupational performance dysfunction

27 item Likert scale survey measuring confidence to perform occupational performance tasks

Acceptance and Commitment Therapy Practice Model

Acceptance: be willing to experience difficult thoughts

Cognitive Defusion: observe your thoughts without being ruled by them

Being Present: focus on the here and now

Self as Context: notice your thoughts

Values: discover what is really important to you

Commitment: take action to pursue the important things in your life

CBT Effectiveness

Reducing anxiety

Improving mood and reducing relapse rates in bipolar disorder

Decreasing symptoms of depression

Targeting underlying pathology associated with eating disorders

Substance use treatment, particularly when combined with motivational and skill building approaches

Addressing SOME aspects of functioning in schizophrenia

CBT and OT

When using CBT (or related approaches) in OT, we should consider the relationship between cognitive beliefs and occupational participation and performance
o How do beliefs shape our participation and performance?
o How do participation and performance shape our beliefs?

CBT: Cognitive Restructuring

Socratic Questioning

Guiding Discovery

TIC_TOC

Self-Talk and Affirmations

Thought Records

Coordinated Anxiety Learning and Management (CALM)

Ellis’s Rational Emotive Behavior Therapy (REBT)

TIC-TOC

focuses on identifying and reframing cognitions that interfere with tasks (Task-interfering Cognitions → Task-Oriented Cognitions)
o Identify task-interfering cognitions (TICs)
o Identify the associated though distortions
o Reframe to task-oriented cognition (TOCs)

Thought Records

Worksheet to organize and evaluate thoughts, beliefs, and emotional responses during distress
o May help to challenge cognitive distortions

Cognitive Distortions

All or nothing

Magnifying or minimizing

Catastrophizing or fortune-telling

Mental filter

Emotionalizing or emotional reasoning

Personalizing

Coordinated Anxiety Learning and Management (CALM)

Model for treating anxiety in primary care settings

8 week computer guided program w educational videos, opportunities to practice new skills, and homework

Ellis’s Rational Emotive Behavior Therapy (REBT_

Core tenet: irrational beliefs about how things “must” and “should” be for
people to be happy actually lead them to make themselves miserable
o Participants first identify, evaluate, and challenge irrational beliefs and then restructure and replace these beliefs using a graded approach
o ABC Model
▪ Activating event
▪ Irrational beliefs
▪ Emotional and behavioral consequences

CBT: Behavior/Learning Methods

Behavioral Experiments

Behavioral Activation and Activity Scheduling

Self-Monitoring

Behavioral Experiments

Collaborative strategy where client has opportunities to test thoughts, attitudes, beliefs, and behaviors
o Involves developing a hypothesis, predicting the outcome, engaging in the behavior, evaluating results, and revising beliefs and behaviors

Behavioral Activation and Activity Scheduling

Inactivity/avoidance may result from negative beliefs
o Behavioral activation aims to increase activity, counteract avoidance behavior, increase access to positive resources
o May include activity scheduling like making a list, chart, or calendar of activities to increase commitment and engagement

Self Monitoring

A self-regulatory or self-management process that involves attending to aspects of one’s beliefs, emotions, or behaviors
o May involve tallying frequency or rating degree of pleasure associated with the belief or behavior
o Use this information to guide participation

Acceptance and Commitment Therapy (ACT)

Falls under the CBT umbrella
• Uses a variety of strategies to address cognitive beliefs
o Become “unstuck” from rigid cognitive beliefs
o Reduce experiential avoidance
o Act in alignment with personal values
• Focuses on increasing psychological flexibility by helping individuals change their relationship with difficult thoughts and feelings (rather than eliminating them) so they can take meaningful action in the context of their life and values

ACT: Core Processes

1. Acceptance: I can approach problems instead of avoid them
2. Cognitive Defusion: It is just a thought, let it pass.
3. Contact with the Present Moment: Focusing on and engaging fully in
whatever I am doing.
4. Self-as-Context: What am I thinking and doing?
5. Values: What do I stand for? What is important to me?
6. Committed Action: I can do what matters to me, even if it is difficult

ACT Interventions: Ways of Speaking

But vs. And

Want vs. Willing

I’m having the thought..

Thanks, mind!

ACT Interventions: Defusions Methaphors

Thoughts are like: junk email. You can’t stop it from coming in, but you don’t have to read all of it

ACT Interventions: Values Clarification

Life Deviation

Birthday Party Speech

Mastery Experiences

Performance successes and accomplishments help increase self-efficacy
o Low self-efficacy beliefs can be compounded by difficulties with problem-solving, coping, assertiveness, and stress management
o Need to understand strengths and deficits in addition to clients’ beliefs about their strengths and deficits to guide treatment planning

Psychoeducation

Process of teaching relevant psychological principles, knowledge, and skills
o Can include information about cognitive beliefs and why modifying distorted beliefs can improve mental health and behavioral problems
o Can utilize a didactic approach, workbooks, or reading materials

Other Considerations: Cognitive Beliefs

Metacognitive Demands
o Cognitive restructuring requires the ability to reflect on one’s thinking,
identify and evaluate one’s beliefs, differentiate between beliefs and reality,
and consider the influence of beliefs on feelings and behavior
o For people with difficulty employing metacognition, behavioral or social
cognitive strategies may be more effective
• Cultural Considerations