Chapter 8: Cognitive Beliefs

What are cognitive beliefs?

An individual's perspective and beliefs (optimistic/pessimistic) about themselves, others, the world, and the future.

What metaphor is often used to illustrate multiple ways to perceive, think, feel, and behave based on beliefs?

The 'glass half full or half empty' metaphor.

How does OTPF-IV define a 'belief'?

"something that is accepted, considered to be true, or held as an opinion" (AOTA, 2020, p. 51).

How are cognitive beliefs classified within the client?

As a person factor residing within the client, influencing performance in occupations.

What factors can affect cognitive beliefs?

Illness, disease, deprivation, disability, life stages, and experiences.

Along with values and spirituality, what else do beliefs influence?

Motivation for occupations and life meaning.

At what level do core beliefs reside, influencing surface thoughts, emotions, behavior, and physiological arousal?

A deep structural level.

How do beliefs interact with human functioning?

They dynamically interact with behavior (including occupational performance), emotions, physiological reactions, and the environment.

What is the role of beliefs in processing internal and external information?

They are instrumental in perception, appraisal, and meaning-making.

How do beliefs often manifest in relation to future outcomes?

They often act as self-fulfilling prophecies.

When do beliefs develop?

From early childhood and continue throughout adulthood.

What is the surface level of beliefs, characterized by words, images, and self-talk in reaction to situations?

Automatic Thoughts.

Give an example of an automatic thought someone might have after doing poorly on a test.

"I'm a failure" or "I did poorly because I didn't prepare."

What are intermediate beliefs, often in an 'if…then' format, that are easier to test and arise from core beliefs?

Assumptions or Rules for Living.

Give an example of an assumption or rule for living related to a test.

"If I don't do good on a test, then I must not be smart enough." vs. "If I work hard, then I can be successful."

What are the deepest level of beliefs, defined as fundamental philosophies and templates about self, others, world, and future?

Core Beliefs or Schemas.

How do core beliefs typically operate?

Outside conscious awareness, being rigid, entrenched, and global.

Give an example of a core belief related to competence.

"I am incompetent" vs. "I am competent."

What is the dynamic relationship between core beliefs, intermediate beliefs, and automatic thoughts?

Core beliefs generate intermediate and surface thoughts; surface thoughts offer a window to underlying rules and core beliefs; and surface/intermediate thoughts reinforce core beliefs.

What three factors dynamically influence each other in human functioning?

Internal personal factors (beliefs, emotions, physiological states), behavior (actions, performance), and external environmental factors (contexts).

How do beliefs influence information processing?

They act as filters for perceiving, appraising, interpreting, and attaching meaning to information and experiences, triggering emotional, behavioral, and physiological responses.

Why are beliefs often referred to as 'self-fulfilling prophecies'?

Because people often seek consistency between life experiences and their beliefs, ignoring counterexamples, which makes verified beliefs more entrenched and leads to their fulfillment.

How do beliefs develop in early childhood?

Infants absorb experiences from interactions, forming core beliefs/schemas (e.g., "You are dumb" vs. "You can achieve"), which shape personality and adult views.

What influences the formation and change of beliefs in adulthood?

Family, role models, cultural values, trauma, spiritual orientation, and environments.

How do social contexts and relationships influence beliefs?

Humans function in various social contexts (family, friends, communities) that impart cultural, spiritual, political beliefs, and one's beliefs also influence affiliations.

What is Aaron Beck's Cognitive Model (1967) as it relates to psychiatric conditions?

Emotions and behavior are influenced by distorted beliefs, information processing biases, and interpretations of experiences, creating vulnerability to disorders.

In substance use disorders, what type of belief involves the expectation of reward?

Anticipatory beliefs (e.g., "Party will be a blast with booze").

In substance use disorders, what type of belief assumes the substance alleviates discomfort?

Relief-oriented beliefs (e.g., "Drink will relieve stress").

In substance use disorders, what type of belief involves a permissive view, acceptable despite consequences?

Facilitative beliefs (e.g., "Just one won't hurt").

What is the widely used and researched model for addressing cognitive beliefs that assumes thinking is accessible, evaluable, monitorable, and changeable?

Cognitive Behavioral Therapy (CBT).

What is the primary focus of traditional CBT?

Aims to restructure (alter) the content of dysfunctional thoughts, attitudes, and beliefs.

What are the primary indicators of change in CBT?

Cognition and behavior; emotions and physiological states are secondary.

What are some shared principles between CBT and Occupational Therapy?

Both are present-oriented, time-limited, solution-focused, person-centered, collaborative, grounded in theory and evidence, combine education/empirical processes, and value meaningful activity.

Who developed Acceptance and Commitment Therapy (ACT)?

Steven Hayes.

What are the philosophical roots of ACT?

Functional contextualism (behavior functions in context) and Relational Frame Theory (RFT – language based on contextual relationships).

What is 'psychological inflexibility' in ACT?

Rigid attempts to control discomfort, leading to experiential avoidance (avoiding thoughts/feelings) and being 'stuck'.

What is the key difference in approach between traditional CBT and ACT regarding dysfunctional thoughts?

Traditional CBT views the dysfunctional thought as the problem and attempts to restructure it, while ACT views the struggle with the dysfunctional thought as the problem and attempts to alter the person's relationship with the thoughts.

What is the ultimate goal of ACT?

To increase psychological flexibility (ability to contact the present moment fully, change/persist in behavior based on values).

Name the six core processes of the ACT Hexaflex.

Acceptance, Cognitive Defusion, Contact with the Present Moment (Mindfulness), Self-as-Context, Values, and Committed Action.

What is 'Acceptance' in ACT?

An alternative to experiential avoidance; opening up to unpleasant feelings/sensations without struggling. It's an action, not resignation.

What is 'Cognitive Defusion' in ACT?

Taking a step back, looking at thoughts rather than from thoughts; recognizing thoughts as just words/pictures, not objective truths.

What are some techniques used for Cognitive Defusion?

"I'm having the thought that…", singing thoughts, thanking mind, silly voices.

What is 'Contact with the Present Moment' (Mindfulness) in ACT?

Full awareness of the here-and-now with openness and receptiveness; engaging fully in actions.

Describe the 'Dropping Anchor' exercise in ACT.

Acknowledge thoughts/feelings (A), Come back into body (C), Engage in the world (E).

What is 'Self-as-Context' in ACT?

Recognizing oneself as the consciousness observing thoughts/feelings, not the content of them; a safe psychological space.

How are 'Values' defined in ACT?

How a person wants to behave/act; used for inspiration, motivation, and guidance.

What is 'Committed Action' in ACT?

Developing effective actions linked to chosen values; flexible action.

What are the three simplified core processes of the ACT Triflex?

Opening up (acceptance, defusion), being present (contact with present moment, self-as-context), and doing what matters (values, committed action).

What is 'The Choice Point' in ACT?

An ACT tool to map problems, identify suffering sources, and formulate an ACT approach, illustrating 'away moves' (ineffective, values-incongruent actions) vs. 'toward moves' (values-congruent actions).

For what conditions is CBT extensively researched and supported as effective?

Anxiety disorders, bipolar disorder, depression, eating disorders, PTSD, and substance abuse.

What is the evidence base for ACT?

Growing evidence with over 1,000 randomized controlled trials, effective for depression, anxiety, substance use, eating disorders, stress; improves quality of life, psychological flexibility, well-being, and functioning.

What is the OT role in assessing cognitive beliefs?

OTPs contribute valuable assessment information on occupational/skill performance, conduct task analysis, and provide training.

What are psychometric tools primarily used for in assessing cognitive beliefs?

Research focused: questionnaires, self-report inventories for validating constructs, identifying beliefs with diagnoses, and evaluating outcomes.

Provide examples of ACT-congruent questionnaires.

AAQ-II, BEAQ, MPFI, PIPS, CPAQ-R, BIPIS.

What is 'Socratic Questioning with Guided Discovery'?

A series of open-ended questions promoting reflection and self-awareness, used in semistructured assessments.

What are the four phases of Socratic Questioning?

1. Informational, 2. Empathic listening/summarizing, 3. Drawing attention to relevant info, 4. Analytic/synthesizing questions.

What are the three questions in the 'Three-Question Technique'?

1. Evidence for/against belief, 2. Alternative explanations, 3. Real implications.

What is a 'Thought Record'?

A worksheet to organize and evaluate thoughts, beliefs, and emotional responses, including columns for situation, emotions, automatic thoughts, distortions, alternative response, and outcome.

What is the 'TIC-TOC Technique'?

A technique to identify Task-Interfering Cognitions (TICs), thought distortions, and replace them with Task-Oriented Cognitions (TOCs).

What are the components of Ellis's ABC Model?

Identifies Activating events (A), irrational Beliefs (B), and Emotional/Behavioral Consequences (C) of distress.

What is the goal of interventions to address cognitive beliefs?

To modify cognitive beliefs or the relationship with them, leading to different behaviors and self-enhancing beliefs.

Who pioneered Cognitive Therapy, a method of cognitive restructuring?

A. T. Beck.

What are some common cognitive distortions (thinking errors)?

All-or-nothing thinking, magnifying/minimizing, catastrophizing, mental filter, emotional reasoning, and personalizing.

How are 'Self-Talk and Affirmations' used in interventions?

To counteract negative self-scripts by using positive self-talk (TOCs) and affirmations (written/oral statements confirming truth).

What is the basis of Ellis's Rational Emotive Behavior Therapy (REBT)?

Based on the ABC Model; challenges irrational beliefs about "musts" and "shoulds" that cause unhappiness.

What are 'Behavioral Experiments' in CBT?

Collaboratively testing thoughts, attitudes, beliefs, and behaviors to discover their validity.

What is the purpose of 'Behavioral Activation and Activity Scheduling'?

To counter inactivity associated with negative beliefs by increasing positive reinforcement through engaging in scheduled activities.

What is 'Self-Monitoring'?

Deliberate attention to beliefs, emotions, and behavior (recording frequency, ratings of mastery/pleasure).

What metaphor is used in ACT to explain Acceptance?

The 'Tug-of-War' metaphor.

What metaphor is used in ACT for Cognitive Defusion?

"Hands as Thoughts and Feelings" metaphor.

What tool is used in ACT for Values Clarification?

A "magic wand" question to explore ideal life/behaviors.

How is 'Committed Action' implemented in ACT interventions?

Translating values into effective patterns of occupational engagement through goal setting, planning, skills training, and graded exposure.

What are the four sources of influence on self-efficacy beliefs, according to Bandura's Social Cognitive Theory?

Mastery experiences, vicarious experiences, social modeling, and social persuasion.

What is 'Psychoeducation' in interventions?

Teaching relevant psychological principles, knowledge, and skills (e.g., concepts of cognitive restructuring, defusion) to facilitate self-management.

What types of assignments are included in 'Homework' as an intervention?

Reading, data collection, behavioral experiments, defusion practice, and activity scheduling to apply and practice skills outside therapy.

For which individuals might behavioral strategies or ACT-based approaches be more appropriate due to metacognitive limitations or psychosis?

Individuals with limited reflective abilities or psychosis, as cognitive restructuring requires higher metacognitive demands.

How does ACT compare to CBT regarding cultural flexibility?

CBT research often focused on European American perspectives, while ACT is more flexible for diverse cultural identities due to its focus on individual values and experiential nature.