Tuesday, April 20, 2010

Core Beliefs Matter in Treatment of OCD

Cognitive Behavioral Therapists often refer to "Core Beliefs" about self and the world. These beliefs shape everything we do, including Exposure Therapy for OCD. These beliefs matter.
  • I must be perfect or I'm a failure and therefore worthless.
  • I must do everything right on the very first try.
  • I must never make a mistake.
These beliefs are on auto-pilot. They guide my actions before I even realize it. OCD feeds on these beliefs, and uses every opportunity to remind me that I shouldn't do the things I fear, or do my treatment, because the stakes are too high. Another bit of CBT jargon is "Feared Consequences," and mine are dire.
  • If I make a mistake, this will prove I am worthless, and I will have no hope of peace or joy in my life.
  • I will implode from the pressure of my defectiveness.
  • I will go crazy from the anxiety.
Leonard had quite a lot to slog through with me to get to the point of doing Exposure and Response Prevention. ERP sounds daunting enough--"Do what you don't want to do in order to get better,"--without adding "And do it perfectly the first time." ERP works by taking it step by step, starting with something tolerable and moving up a ladder or hierarchy of feared actions. Contending with the a harsh critical voice yelling, "Whatever you do isn't enough" paralyzed me at first.

What are your core beliefs? Are they true for everyone, or only for yourself?


  1. I have found your post a real comfort. Whilst my 'core beliefs' and 'feared consequences' are not the same as yours, there is quite a bit of similarity and that is comforting to me. It has helped me to feel a little less isolated and alone. Thank you lots.

  2. A few core beliefs I'm trying to shake:
    *All love is conditional - If you break someone's conditions, they will stop loving you.
    *I am inherently broken and need fixing before I will be a worthwhile person
    *People only show friendship to me out of politeness; they are actually tired of dealing with me and my issues

  3. Thank you for replying! I to feel less alone knowing others share the experience of beliefs that shape our worlds, often in a way that creates suffering. Blue Morpho--the "I am inherently broken" belief is a powerful one for me too--my therapist says I'm still in there, whole, and unbroken, and I've gotten glimpses of how that would change my world view if I believed it.

  4. I just re-read this post (I'm certain that I've read it before), and it was a great reminder for me - given where I'm at in my recovery. We have some similarities, and I have some others too. But I like that you say it is important to work on some of these because they can hinder your progress.

  5. Hi Pure O--Yes! These beliefs can be very powerful! To know they are there, and realize the ways they get in the way was very helpful.