Core beliefs vs core pain

There are many different types of psychotherapy. However, multiple authors have argued that these all rely on an underlying set of principles. This explains why most psychotherapies have similar efficacy rates.

In this article, we will look at the similarities and differences between core beliefs from Cognitive Behavioural Therapy (CBT) and core pain from Emotion-Focused Therapy (EFT).

Core beliefs in CBT

A central component of CBT is that people have untrue beliefs and that these beliefs drive unwanted emotions. For example, the belief "the dog will bite me" might cause us to have a panic attack each time we see a dog on the street. Or "if I speak in public everyone will laugh at me and it will be unbearable" might cause us to avoid giving presentations.

Albert Ellis said these specific beliefs were underpinned by a set of core beliefs. He produced multiple lists of these but for this article, I will use the three major musts which can be summarised as follows:

1. I must do well and have the approval of others
2. I must be treated kindly and fairly by others
3. Life must be easy and free from discomfort

Each specific belief can be mapped to one of these. In the scenarios above, the dog example maps to number three, life must be free of discomfort. The public speaking example maps could map to all three beliefs.

These beliefs are not inherently bad: we all need approval, kindness and comfort. But they become unhelpful beliefs when they do not fit the facts, prevent us from achieving our goals and lead to unhealthy coping mechanisms.

In traditional CBT, we work to identify a client's irrational beliefs and replace them with more helpful beliefs. In third-wave CBT, we practice changing our relationship with these beliefs.

Core pain in EFT

While CBT focuses on cognition, EFT focuses on emotion. At the heart of our psychological difficulties are primary maladaptive emotions, which are the central component of core pain.

EFT draws a distinction between primary emotions and secondary emotions. For example, we may experience shame (primary) but cover it up with anger (secondary).

Although any emotion can potentially be a primary maladaptive emotion, they are typically clustered into three areas:

• Shame
• Sadness/loneliness
• Fear

Each of these clusters suggests an unmet emotional need. Shame calls for acceptance, loneliness calls for love and fear calls for safety and protection.

In EFT, we work towards identifying core pain and thereby revealing the unmet need. We then transform this pain using compassion or protective anger.

Comparing the two

Reviewing the two lists, we can see that if we allow a degree of flexibility, both frameworks categorise difficulties around three core themes.

Theme	CBT core belief	EFT cluster
Need for acceptance	I must do well and have the approval of others	Shame
Need for love	I must be treated kindly and fairly by others	Loneliness
Need for safety	Life must be easy and free from discomfort	Fear

There are clear conceptual differences between the two. In CBT, beliefs are placed in the driving seat. These are developed and reinforced over time and can be changed by collaboratively challenging the irrational aspects of each belief.

In EFT, emotions are placed in the driving seat. These are typically the result of past emotional wounds and can be changed by giving the individual a different felt experience in the therapy room.

However, despite these conceptual differences, the underlying themes remain the same. We all need to feel that we are okay, that others are okay, and that the world is safe. Good therapy seeks to address this.

Conclusion

Regardless of the type of psychotherapy you are using, clients typically seek help with similar underlying issues. Safety, love and acceptance are often at the heart of these issues and considering how different models address these needs can help us understand how psychotherapy works.