Case Formulation and Disorder-Specific Models
“[Formulation is] The lynch pin that holds theory and practice together” (Butler, 1998).Cognitive behavioral therapists use individually tailored formulations as a framework with which to understand their patients’ difficulties and to plan effective treatment. A case formulation helps therapists and patients to understand the origin, current status, and maintenance of a problem. Formulations are developed collaboratively between therapists and patients during the assessment phase of therapy and are revised as new information is gathered during the course of treatment. Jacqueline Persons wrote an influential account of individualized case formulation (1989). Her current case formulation approach (2008) describes how a complete CBT case formulation ties together all of the following parts:
- all of a patient’s symptoms, disorders, and problems;
- hypotheses about the mechanisms causing the disorders and the problems;
- proposes the recent precipitants of the current problems and disorders;
- describes the origins of the mechanisms.
8 of 108 resources
What Keeps Tinnitus Going
What Keeps Tinnitus Going is a tinnitus formulation diagram which combines information about neurological-level change (the brain’s ‘filter’) an ...
https://www.psychologytools.com/resource/what-keeps-tinnitus-going/
SWOT Analysis
SWOT Analysis is a tool, originally from management theory, which can help to guide action in the face of uncertainty or ambivalence. Clients can be a ...
https://www.psychologytools.com/resource/swot-analysis/
Recognizing Bulimia Nervosa
Bulimia Nervosa is characterized by frequent and recurrent episodes of binge eating, which are defined as a period of time in which the individual exp ...
https://www.psychologytools.com/resource/recognizing-bulimia-nervosa/
Cognitive Behavioral Model Of Persistent Postural-Perceptual Dizziness (PPPD: Whalley, Cane, 2017)
Persistent postural-perceptual dizziness (PPPD) is a form of dizziness which is thought to be maintained by psychological factors. This is a Cognitive ...
https://www.psychologytools.com/resource/cognitive-behavioral-model-of-persistent-postural-perceptual-dizziness-pppd-whalley-cane-2017/
Recognizing Anorexia Nervosa
Anorexia Nervosa is characterized by the restriction of energy intake, leading to a severely low weight in the context of an individual’s age, heigh ...
https://www.psychologytools.com/resource/recognizing-anorexia-nervosa/
Recognizing Hypochondriasis
Hypochondriasis is characterized by the persistent preoccupation or fear about the possibility of having serious illnesses. To combat this fear, clien ...
https://www.psychologytools.com/resource/recognizing-hypochondriasis/
The Parts Of Your Panic (Psychology Tools For Overcoming Panic)
Psychology Tools for Overcoming Panic takes a cognitive behavioral therapy (CBT) approach to this common anxiety problem. This chapter helps a client ...
https://www.psychologytools.com/resource/the-parts-of-your-panic-psychology-tools-for-overcoming-panic/
Putting It All Together (Psychology Tools For Living Well)
Cognitive behavioral therapy can help your clients to live happier and more fulfilling lives. Psychology Tools for Living Well is a self-help course ...
https://www.psychologytools.com/resource/putting-it-all-together-psychology-tools-for-living-well/
Links to external resources
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Assessment
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Collaborative Case Conceptualization Rating Scale (CCC-RS)
| Kuyken, Padesky, Dudley | 2009
- Kuyken, W., Beshai, S., Dudley, R., Abel, A., Görg, N., Gower, P., … & Padesky, C. A. (2016). Assessing competence in collaborative case conceptualization: Development and preliminary psychometric properties of the Collaborative Case Conceptualization Rating Scale (CCC-RS).Behavioural and Cognitive Psychotherapy,44(2), 179-192.
- Rating scale & coding manual
- Score sheet & feedback form
Case Conceptualization / Case Formulation
- Formulation in Compassion Focused Therapy | Paul Gilbert | 2007
- Maxi formulation | Helen Moya
- A case formulation approach to cognitive-behavior therapy | Jacqueline Persons | 2015
- The “Blobby” formulation | Helen Kennerley | 2015
- Good practice guidelines on the use of psychological formulation | British Psychological Society: Division Of Clinical Psychology
- A quick guide to ACT case conceptualization | Russ Harris | 2009
- Outline of ACT assessment / case formulation process | Jason Luoma
- ACT simple case formulation | Julian McNally
- Team formulation: key considerations in mental health services | Association of Clinical Psychologists UK | 2022
- DBT Case Formulation Format | Comtois
- The case formulation approach to cognitive behavior therapy | Jacqueline Persons | 2014
Information Handouts
- Cycle vs. Heart Illustration for EFT | Paul Sigafus | 2013
Information (Professional)
- Working with Schemas, Core Beliefs, and Assumptions | Frank Wills | 2008
Presentations
- The role of a case conceptualization model and core tasks of intervention | Donald Miechenbaum | 2014
- Cafe formulation in cognitive-behavioral therapy | Caleb Lack
Video
- CBT case formulation | Jacqueline Persons
Worksheets
- Case Formulation Template
Recommended Reading
Cognitive Behavioral Models Of Disorders
- Morrison, A. P. (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy, 29(3), 257-276.
- Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia.Social phobia: Diagnosis, assessment, and treatment,41(68), 00022-3.
Generalized Anxiety Disorder
- Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model.Behaviour research and therapy,36(2), 215-226.
Cognitive Behavioral Models Of Disorders
- Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319-345.
- Espie, C. A. (2002). Insomnia: conceptual issues in the development, persistence, and treatment of sleep disorder in adults. Annual Review of Psychology, 53, 215–243.
- Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment.Behaviour Research and Therapy,41(5), 509-528.
- Fennell, M. J. (1997). Low self-esteem: A cognitive perspective. Behavioral and Cognitive Psychotherapy, 25(1), 1-26.
- Fernie, B. A., Bharucha, Z., Nikčević, A. V., Marino, C., & Spada, M. M. (2017). A Metacognitive model of procrastination. Journal of Affective Disorders, 210, 196-203.
- Garety, P. A., Kuipers, E., Fowler, D., Freeman, D., & Bebbington, P. E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31(2), 189-195.
- Harvey, A. G. (2002). A cognitive model of insomnia. Behavior Research and Therapy, 40, 869–894.
- Heimberg, R. G., & Becker, R. E. (1981). Cognitive and behavioral models of assertive behavior: Review, analysis and integration. Clinical Psychology Review, 1(3), 353-373.
- Mansueto, C. S., Golomb, R. G., Thomas, A. M., & Stemberger, R. M. T. (1999). A comprehensive model for behavioral treatment of trichotillomania. Cognitive and Behavioral Practice, 6(1), 23-43.
- Marlatt, G. A. (1985). Relapse prevention: Theoretical rationale and overview of the model. In G. A. Marlatt & J. R. Gordon (Eds.), Relapse prevention (1st ed., pp. 280–250). New York: Guilford Press.
- Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470.
Social Anxiety Disorder
- Moscovitch, D. A. (2009). What is the core fear in social phobia? A new model to facilitate individualized case conceptualization and treatment. Cognitive and Behavioural Practice, 16. 123-134
Cognitive Behavioral Models Of Disorders
- Salkovskis, P. M., Forrester, E., & Richards, C. (1998). Cognitive–behavioral approach to understanding obsessional thinking.The British Journal of Psychiatry,173(S35), 53-63.
- Salkovskis, P. M., Warwick, H. M. C., Deale, A. C. (2003). Cognitive-Behavioral Treatment for Severe and Persistent Health Anxiety (Hypochondriasis).Brief Treatment and Crisis Intervention, 3, 353-367
- Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317–332.
Generalized Anxiety Disorder
- Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder.Behavioural and cognitive psychotherapy,23(3), 301-320
Cognitive Behavioral Models Of Disorders
- Whalley, M. G., & Cane, D. A. (2017). A cognitive-behavioral model of persistent postural-perceptual dizziness. Cognitive and Behavioral Practice, 24(1), 72-89.
Team formulation
- Berry, K., Haddock, G., Kellett, S., Roberts, C., Drake, R., & Barrowclough, C. (2016). Feasibility of a ward‐based psychological intervention to improve staff and patient relationships in psychiatric rehabilitation settings. British Journal of Clinical Psychology, 55(3), 236-252.
- What is the case formulation approach to cognitive-behavior therapy? | Jacqueline Persons | 2008
Case formulation / Case conceptualization
- Geisser, S., & Rizvi, S. L. (2014). The Case of” Sonia” Through the Lens of Dialectical Behavior Therapy.Pragmatic Case Studies in Psychotherapy,10(1), 30-39.
- Haynes, S. N., Leisen, M. B., Blaine, D. D. (1997). Design of individualized behavioral treatment programs using functional analytic clinical case models. Psychological Assessment, 9(4), 334-348
- Kuyken, W., Padesky, C. A., Dudley, R. (2008). The science and practice of case conceptualization. Behavioural and Cognitive Psychotherapy, 36, 757-768
- Persons, J. B., & Lisa, S. T. (2015). Developing and Using a Case Formulation to Guide Cognitive-Behavior Therapy. Journal of Psychology & Psychotherapy, 5(2), 1
- Special issue: Team formulation. (2015). Clinical Psychology Forum, 275.
- Spencer, H. M., Dudley, R., Johnston, L., Freeston, M. H., Turkington, D., & Tully, S. (2022). Case formulation—A vehicle for change? Exploring the impact of cognitive behavioural therapy formulation in first episode psychosis: A reflexive thematic analysis. Psychology and Psychotherapy: Theory, Research and Practice.
Cognitive Behavioral Models Of Disorders
- Boelen, P. A., van den Hout, M. A., & van den Bout, J. (2006). A Cognitive-Behavioral Conceptualization of Complicated Grief. Clinical Psychology: Science and Practice, 13(2), 109–128.
Generalized Anxiety Disorder
- Borkovec, T. D., Alcaine, O., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder.Generalized anxiety disorder: Advances in research and practice,2004.
Cognitive Behavioral Models Of Disorders
- Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006).Solving the puzzle of deliberate self-harm: The experiential avoidance model.Behaviour Research and Therapy, 44(3), 371–394.
What Is Case Conceptualization / Case Formulation?
Types of Case Formulation
Case formulations can vary according to their purpose, and according to the information they attempt to convey. A number of types of formulation have been described:
- A cross-sectional formulation presents information relevant to a short time period, as though an event were sliced open at a particular moment in time to reveal the triggering event, thoughts (interpretations/appraisals), emotions, body feelings, and behaviors or reactions. One of the most popular formats for a cross-sectional formulation is Padesky and Mooney’s ‘hot cross bun’ (1990).
- A longitudinal formulation presents information relevant to the origin and maintenance of a problem. Weerasekera’s “Multiperspective model” popularized the use of the “5 Ps” approach (presenting, predisposing, precipitating, perpetuating, and protective) to case formulation (Weerasekera, 1993). Judith Beck’s cognitive conceptualization (1995) links longitudinal factors (including relevant childhood data, core beliefs, conditional assumptions, coping strategies) to cross-sectional breakdowns (situation, automatic thought and appraisal, emotion, behavior).
- Micro-formulations have been described as a helpful way of understanding the origin and effects of troubling imagery (Hackmann, Bennett-Levy, & Holmes, 2011). In this approach problematic images are explored along with their origin, associated appraisals, current impact, maintenance factors, and cognitive consequences.
- Disorder-specific models describe the critical presenting, predisposing, precipitating, and perpetuating factors relevant to a condition. Disorder-specific cognitive behavioral conceptualizations have been published for most conditions including low self-esteem, panic, obsessive-compulsive disorder, psychosis, post-traumatic stress disorder.
References
- Beck, J. S. (1995). Cognitive behavior therapy: Basics and beyond. New York: Guilford Press.
- Butler, G. (1998). Clinical formulation. In A. S. Bellack and M. Hersen (eds) Comprehensive clinical psychology. New York: Pergamon Press
- Hackmann, A., Bennett-Levy, J., & Holmes, E. A. (2011). Oxford guide to imagery in cognitive therapy. New York: Oxford University Press.
- Padesky, C. A., & Mooney, K. A. (1990). Presenting the cognitive model to clients. International Cognitive Therapy Newsletter, 6, 13–14.
- Persons, J. B. (1989). Cognitive therapy in practice: A case formulation approach. New York: WW Norton.
- Persons, J. (2008). The case formulation approach to cognitive-behavior therapy (guides to individualized evidence-based treatment).
- Weerasekera, P. (1993). Formulation: A multiperspective model. Canadian Journal of Psychiatry, 38(5), 351–358.