How Your Past Affects Your Present (CBT)
Cognitive behavioral therapy (CBT) describes three levels of cognition – automatic thoughts, assumptions, and core beliefs – which are influenced by historical and current life experiences. Using the metaphor of an iceberg, the How Your Past Affects Your Present information handout is designed to introduce these levels of cognition to clients, and explain how they interact with one another. This can help to support case formulation, psychoeducation, and treatment planning.
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Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.
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Introduction & Theoretical Background
Levels of cognition
Aaron Beck’s cognitive model describes three levels of cognition (Beck, 1995). Alongside life experiences, these can affect how events are perceived:
- At the top level are automatic thoughts. These are thoughts which arise automatically and involuntarily, often taking the form of internal statements or mental images. Because of the speed at which they occur, automatic thoughts are often accepted uncritically (even when they are objectively inaccurate). While people are usually aware of their emotional responses, they are generally less conscious of the thoughts and images associated with them.
- At the intermediate level are underlying assumptions. They are also known as intermediate beliefs, associated beliefs, conditional assumptions, or rules for living. These develop in response to how individuals make sense of their experiences, and they vary in their accuracy and functionality (Beck, 1995). Often, they shape behavioral strategies for preventing or coping with the activation of core
Therapist Guidance
"A key idea in CBT is that what you think impacts how you feel. However, our thoughts don’t just come out of nowhere: our underlying beliefs and life experiences influence the way we think. Can we use this handout to explore how these ideas fit together?"
References And Further Reading
- Beck, A. T. (1967). Depression: Clinical, experimental, and theoretic aspects. Harper and Row.
- Beck, J. S. (1995). Cognitive therapy: Basics and beyond. Guilford Press.
- Clark, D. A., & Beck, A. T. (2010). Cognitive therapy of anxiety disorders: Science and practice. Guilford Press.
- Dowd, E. T. (2002). History and recent developments in cognitive psychotherapy. In R. L. Leahy & E. T. Dowd (Eds.), Clinical advances in cognitive psychotherapy: Theory and application (pp.15-28). Springer.
- Fennell, M. J. V. (1998). Cognitive therapy in the treatment of low self-esteem. Advances in Psychiatric Treatment, 4, 296-304. DOI: 10.1192/apt.4.5.296.
- Kuyken, W., Padesky, C. A., & Dudley, R. (2009). Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. Guilford Press.
- Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice. BMC Medicine, 10, 1-3. DOI: 10.1186/1741-7015-10-111.
- Padesky, C.