Dimensions of Core Feared Beliefs - Why Your OCD and Anxiety Fears Influence Other Choices You Make

Core beliefs act as filters through which we view the world. When we understand how they influence us, we can start to create a separation from the stories playing out through our thoughts and view each situation independently. Oftentimes, patients with OCD and anxiety-related disorders struggle with how they appraise certain situations and how they believe those situations may turn out. Underlying appraisals and beliefs are what we call core beliefs, which are central ideas about the self (Neeman and Drydan 2015). Many people have both positive core beliefs and negative core beliefs. Positive core beliefs are more flexible. For instance, someone may have the core belief of “I am strong” or “I am likeable,” and recognize that these apply in most situations. Negative core beliefs are more rigid, absolute, global and overgeneralized. They often pass through our awareness during times of distress or high stress. A person with a negative core belief such as “I am bad” may look for information that confirms this belief. Any information that is processed that contradicts the belief is likely to be dismissed, distorted and overlooked (Neeman and Drydan 2015). A negative core feared belief is what a sufferer may believe may happen to them if there was a bad outcome. Many people who struggle with anxiety and OCD often have core feared beliefs that influence their negative thinking and how they behave. They also believe that they will somehow not be able to tolerate their core feared belief (i.e., I may be perceived as bad).

A dimension of a core feared belief is the extension of how the core feared belief is influencing the patient in other areas of their life without conscious awareness. This at times can shape a patient's life considerably and can be quite limiting. This article explores how dimensions of a core feared belief can influence a patient and how specific exposures related to core feared beliefs may be helpful for patient success.

When individuals with OCD struggle, the themes central to their OCD concerns are likely influenced by their core feared beliefs. This also means that if you have multiple themes they are likely being maintained by the same core fear belief. The downward arrow technique is often used in Cognitive Behavioural Therapy to help uncover the core belief. Once the thought is apparent it’s important to figure out what the thought means or would mean for the patient. The purpose of this article isn’t to explore how to find out a core feared belief as there are many other resources in the CBT literature that speak to this.

There doesn’t seem to be much literature that speaks to how core feared beliefs related to OCD and anxiety often spill into other domains of a patient’s life. A patient may attend a session for a fear of becoming racist and may have a core fear belief of being alone. The fear of becoming racist may be central to the goals of the treatment, but how the core extends to other areas of their life often doesn’t get so much discussed. The patient may also to a lesser degree be fearful or even ‘sensitive’ to situations that have a potential impact on them being exposed to their core feared belief (in this case being alone ( note the future tense)). At times, I have seen patients change their lives by avoiding situations that may leave them exposed to their core feared belief (not related to their primary OCD/anxiety concern) without them even being consciously aware of it. In this case, it could mean the patient choosing to be self-conscious of how they look or placating in their relationships. All likely being shaped by the same core feared belief. I often refer to this extension as a dimension of a core feared belief. I also believe that this could help with developing new exposure exercises that specifically target core feared beliefs. For instance, once this person has successfully worked on their primary OCD concerns related to racism, ritual reduction and exposure related to their core feared belief would likely be the next step. For the patient example above the provider may help the patient understand how they are shaping their lives based on the core feared belief and create a ritual reduction schedule. This may mean working with the patient on wearing clothes that the patient desires to wear that could be open to judgment from others.

Example:

A patient may attend sessions wanting to address anxiety-related concerns about vomiting (emetophobia). They may also engage in several rituals to prevent themselves from being judged by their peers and avoiding the risk of being alone (the core feared belief). The dimension of the core feared belief may be how sensitive the patient may become if they were rejected by their friends or how envious they get if their partner is engaging in dialogue with someone that they perceive as a threat to their relationship (situations that are based on assumptions and beliefs that are being driven by the core feared belief of being alone). Although the dimensions of the core feared belief are not the central theme of the work, I believe it's important to speak to the patient and help them better understand how the core feared belief may be influencing their decisions and actions. This allows for opportunities to create additional exposure and ritual reduction opportunities related to the core. In this example, the exposure may be to help the client recognize where they have made decisions based on the core feared belief (for example, placating with friends and family, choosing jobs that others approve of, not making new friends) and help them learn to better tolerate living with uncertainty related to their fears.

Neenan, M., & Dryden, W. (2015). Cognitive behaviour therapy: 100 key points and techniques (2nd ed.). Routledge/Taylor & Francis Group.