Clinical Prompt
1. Identifying rules
- Write out core belief
- Make a quick list
- Use the Situational Check List
2. Generate Predictions
3. Select Testable Hypothesis
- Choose a rule where it is easy to set up a test condition.
- Choose a rule that allows the client to test the core belief directly.
- The rule should include a clear prediction of a behavioral response [yours and others], not just subjective feelings.
- The outcome should be relatively immediate.
- Choose a relatively low-fear rule to test.
4. Testing Rule Predictions
- Am I setting the test up fairly so it doesn’t promote a negative outcome?
- Am I being objective as I interpret the results?
- Identify one relatively low-risk situation in which to make the initial test.
- Write a specific, behavioral prediction of what the outcome will be, based on the core belief.
- Make a Contract
- Script the new behavior
Exploratory Questions
Predictions Log
Rewriting Core Beliefs.
Forms & Charts
Situational Check List cbt#25-001
Download Available | Checklist
Technique #25 Testing Assumptions
Introduction
Your most deeply held core beliefs are the bedrock of your personality. They describe you as worthy or worthless, competent or incompetent, powerful or helpless, loved or scorned, self-reliant or dependent, belonging or outcast, trusting or suspicious, flexible or judgmental, secure or threatened, trusting or suspicious. Core beliefs influence your life in two major ways. First, they establish rules for survival and coping. Second, they set the tone of a constant inner monologue by which you interpret events and evaluate your performance. These core beliefs are difficult to evaluate directly. They tend to be so global and generalized that proving or disproving them becomes a hopeless task. How can you absolutely prove or disprove that you are not safe in the world, or are not loved?
Fortunately there is a way to evaluate core beliefs. The rules generated by core beliefs are testable, because implicit in each rule is a prediction of what will happen if the rule is broken. Each rule also creates a prediction about what will happen if you break the rule. These rules and their predictions create testable hypotheses by judiciously defining the rule and prediction and then breaking them and comparing the outcomes with the catastrophic prediction.
Symptom Effectiveness
Time for Mastery
Instructions
1. Identify the Rules
a. Write out the core belief:
On the top of a sheet of paper, have the client write down a core belief that s/he would like to explore and question. Ideally, this is a belief that s/he has identified as painful or restrictive.
b. Make a quick list
Have the client make a list of what s/he thinks s/he should and should not do to promote herself in keeping with the core belief. Example: if the belief is that you are a coward, what does this imply about behavior. Perhaps you should avoid conflict, travel with tough friends, etc. The client should not give a lot of thought to this quick list, but draw from the ‘top of his/her head’ the first things that come to mind.
c. Use the Situational Checklist
The client should ask the question: if my core belief is true, what must I do or not do in each of the situations listed on the checklist. Keep asking what is the rule for each item on that list. Then add the rule to the left hand column of the sheet.
2. Generate Predictions
It is time to link the uncovered rules dictated by the core belief to a specific catastrophic prediction of outcome if the rule is broken. Have the client go through the list of rules and on the right hand column of the page have him/her predict the painful outcome that s/he believes will happen if s/he breaks the rule. The prediction should always contain specific, objective consequences: how others would behave, how s/he would behave, what would happen. These should be stated in ways that are measurable, You may also wish to include subjective consequences: how s/he would feel, what s/he would think. Don’t let the client write consequences which only describe painful feelings. That isn’t enough.
The prediction is the client’s fear talking. S/he should really get in touch with what scares him/her about breaking a rule. These fears and rules are an adaptive effort to keep negative things from happening. Don’t be surprised if several different rules are supported by the same catastrophic prediction. It is quite usual for certain theme fears to show up again and again.
3. Select Testable Hypothesis
Urge the client to think of him/herself as a scientist. It is important that s/he follow the guidelines in order to frame the rule/prediction in a way that can be tested.
a. Choose a rule where it is easy to set up a test condition.
It should be something where the client has control, where a simple change in behavior puts the test in motion. It would be hard to test a rule such as ‘don’t get into fights’ since these happen spontaneously and depend partly on mood.
b. Choose a rule that allows the client to test the core belief directly.
If you are testing whether you are a coward, this would demand that you place yourself in jeopardy.
c. The rule should include a clear prediction of a behavioral response [yours and others], not just subjective feelings.
d. The outcome should be relatively immediate.
For the initial tests, choose rules where the predicted consequences can be observed as soon as possible after breaking the rule.
e. Choose a relatively low-fear rule to test.
Or find a rule that could be tested in gradients, from only slightly scary to very scary. Example: a rule ‘it is not good to be alone’ rule could be tested in increments of half hours.
4. Testing Rule Predictions
A scientist would attempt to apply the rules of science to self-exploration. This means making every effort to put aside your biases, fears and assumption in order to fairly test and objectively evaluate the data. Scientists are not supposed to ‘stack the deck’. They are not supposed to manipulate the experiments so that an expected or desired outcome is inevitable. They aren’t supposed to filter the data so that only certain facts are stressed while others are buried.
The task of maintaining objectivity while exploring yourself is like trying to walk a straight line through a forest. You inevitably keep bumping into things. All you can do is continue trying for the general direction. As the client tests the long-held rule of living, s/he may find him/herself inadvertently acting in ways that promote the likelihood of a negative, catastrophic outcome. The client needs to understand both the difficult and the likelihood. S/he will need to be comfortable with that fact, and the fact that you will point out such occasions without recrimination. Attempting to be scientific means asking two questions about each test:
• Am I setting the test up fairly so it doesn’t promote a negative outcome?
• Am I being objective as I interpret the results?
At this point, the client should be clear about what rule s/he wants to test first.
1) Identify one relatively low-risk situation in which to make the initial test – choose a relationship or place that isn’t too threatening. Make sure that this test is something that the client is really willing to do. If you suspect that it isn’t, look for a situation that evokes less anxiety.
2) Write a specific, behavioral prediction of what the outcome will be, based on the core belief. This is the hypothesis to be tested, an assumption that certain bad things will happen when you break the rule. The prediction should be specific to the particular situation you are testing, not a general assumption about what happens when you break a rule. Behavioral outcomes are predictions of what the client and others will do and say.
3) Make a contract. This means a firm commitment that the rule will be broken on a specific day, in a specific situation.
4) Script the new behavior. This is important. The client should figure out in advance exactly what s/he plans to do or say. If s/he is testing a new pattern of communication, it is extremely important to examine the script for anything that could make the prediction a self fulfilling prophecy. It is common that the expectation of rejection, anger, or embarrassment will affect how a person says things. You may find that the attempt at new communication sounds cold, angry, blaming, vague or contains some message that invites a negative response. And that negative reaction will appear to confirm the core belief.
You may want to tape record the script so the client can hear it, or have the client role play the script with you or someone else. Hone the script into an effective tool. Part of the script preparation may be the exploratory questions to clarify ambiguity listed below.
• Are you feeling OK about what I said?
• Did you have any reaction to that?
• How did that strike you?
• I couldn’t tell whether anything was going on for you when we talked about __________. Anything to that?
• Is it OK with you that I told you that I ___________?
5) Test the new behavior and collect the data. If the reactions of other people to the test were ambiguous, the client may need to ask them the exploratory questions.
On the same paper on which the client noted the negative predictions, note which, if any of the predictions actually occurred. And not specifically what did not occur. Note the answers to the exploratory questions as well.
6) Select a second situation to test the rule and repeat steps 2 through 5.
As you identify new situations to test the rule, try to urge the client to work toward increasingly more threatening [and therefore more meaningful] tests. The more catastrophic the predictions about breaking the rule, the more impact the test will have on the core belief if the prediction is not entirely borne out. Encountering few of the negative outcomes that are predicted during early tests will encourage the client when taking on the tougher challenges.
Predictions Log
developed by Christine Padesky [Beck, Freeman and Associates 1989]
The predictions and test data that the client has started writing down is the beginning of a Predictions Log. This is an extremely important tool for evaluating core beliefs. It is the scientist’s lab book. It will help the client record and remember his/her observations. After performing a number of tests for a particular rule, it will be helpful for the client to go back and review what s/he has learned. Does the rule still seem valid? Or should it be changed to account for what has been observed?
As the client continues to test s/he can begin looking for spontaneous opportunities to break old rules; trying things s/he used to avoid. Encourage this expansion of focus to additional rules. Be vigilant for any situation in which s/he can try new behavior. Over time, scripting the behavior ahead of time will become less and less formal, and eventually unnecessary.
Inevitably the client will have setbacks. Someone will reject him/her, s/he will feel scared, uncomfortable, hurt, etc. Sometimes the negative predictions will come true. Often they will not. Keep track in the Predictions Log. This data is essential for the goal of expanding and correcting core beliefs.
Rewriting Core Beliefs
After a period of testing and data collection, it is important to see if the client can synthesize what is being learned. How does the data impact on the core beliefs. Does it suggest ways to revise assumptions?
At this point the client might try to rewrite the core beliefs so that it incorporates the results of your tests. Identify exceptions to the core beliefs. Note anything in the belief that has turned out to be simply false. Include balancing realities – thing s/he has learned about him/herself that mitigate or soften the old negative self-portrait.
Situational Checklist
• dealing with other people’s
anger
needs/desires/requests
disappointments/sadness
withdrawal
praise/support
criticism
• dealing with mistakes
• dealing with stress/problems/losses
• risk taking/trying new things/ challenges
• conversation
• expressing your
needs
feelings
opinions
pain
hope/wishes/dreams
limits/saying no
• asking for support/help
• being
alone
with strangers
with friends
with family
• trusting others
• making friends
who to seek
how to act
• finding an intimate partner
who to seek
how to act
• ongoing romantic relationship
• sex
• work/career/school
• dealing with adults
• dealing with peers
• health/illness
• traveling
• maintaining your environment/self care