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.
ABC Model
Worksheets
Alternative Action Formulation
Worksheets
Belief Driven Formulation
Worksheets
CBT Appraisal Model
Worksheets
CFT Compassion Formulation
Worksheets
Classical Conditioning
Information handouts
Cognitive Behavioral Model Of Anorexia Nervosa (Fairburn, Cooper, Shafran, 2003)
Information handouts
Cognitive Behavioral Model Of Body Dysmorphic Disorder (BDD: Veale, 2004)
Information handouts
Cognitive Behavioral Model Of Bulimia Nervosa (Fairburn, Cooper, Shafran, 2003)
Information handouts
Cognitive Behavioral Model Of Clinical Perfectionism (Shafran, Cooper, Fairburn, 2002)
Information handouts
Cognitive Behavioral Model Of Depersonalization (Hunter, Phillips, Chalder, Sierra, David, 2003)
Information handouts
Cognitive Behavioral Model Of Fear Of Body Sensations
Information handouts
Cognitive Behavioral Model Of Generalized Anxiety Disorder (GAD: Dugas, Gagnon, Ladouceur, Freeston, 1998)
Information handouts
Cognitive Behavioral Model Of Health Anxiety (Salkovskis, Warwick, Deale, 2003)
Information handouts
Cognitive Behavioral Model Of Insomnia (Harvey, 2002)
Information handouts
Cognitive Behavioral Model Of Intolerance Of Uncertainty (Hebert, Dugas, 2019)
Information handouts
Cognitive Behavioral Model Of Low Self-Esteem (Fennell, 1997)
Information handouts
Cognitive Behavioral Model Of Obsessive Compulsive Disorder (OCD: Salkovskis, Forrester, Richards, 1998)
Information handouts
Cognitive Behavioral Model Of Panic (Clark, 1986)
Information handouts
Cognitive Behavioral Model of Perfectionism (Shafran, Egan, Wade, 2010)
Information handouts
Cognitive Behavioral Model Of Persistent Postural-Perceptual Dizziness (PPPD: Whalley, Cane, 2017)
Information handouts
Cognitive Behavioral Model Of Post Traumatic Stress Disorder (PTSD: Ehlers & Clark, 2000)
Information handouts
Cognitive Behavioral Model Of Social Phobia (Clark, Wells, 1995)
Information handouts
Cognitive Behavioral Model Of The Relapse Process (Larimer, Palmer, Marlatt, 1999)
Information handouts
Cognitive Behavioral Model Of Tinnitus (McKenna, Handscombe, Hoare, Hall, 2014)
Information handouts
Cognitive Case Formulation
Worksheets
Cross Sectional Formulation
Worksheets
Daily Monitoring Form
Worksheets
Developing Psychological Flexibility
Information handouts
Emotion Focused Formulation
Worksheets
Emotions Motivate Actions
Information handouts
Exploring Problems Using A Cross Sectional Model
Worksheets
Exploring Problems Using An A-B-C Model
Worksheets
Friendly Formulation
Worksheets
Functional Analysis
Worksheets
Functional Analysis With Intervention Planning
Worksheets
Health Anxiety Formulation
Information handouts
How Does Emotion Affect Your Life?
Exercises
How Does This All Add Up To A Panic Attack? (Psychology Tools For Overcoming Panic)
Books & Chapters
Interpersonal Beliefs And Styles
Worksheets
Longitudinal Formulation 1
Worksheets
Longitudinal Formulation 2
Worksheets
Low Self-Esteem Formulation
Worksheets
Making Sense Of Your Panic (Psychology Tools For Overcoming Panic)
Books & Chapters
Motivation and Ambivalence
Exercises
Motivational Systems (Emotional Regulation Systems)
Information handouts
Obsessive Compulsive Disorder (OCD) Formulation
Worksheets
Operant Conditioning
Information handouts
Panic Formulation
Worksheets
Problem List
Exercises
Process Focused Case Formulation
Worksheets
PTSD Formulation
Worksheets
Putting It All Together (Psychology Tools For Living Well)
Books & Chapters
REBT Problem Formulation
Worksheets
Reciprocal CBT Formulation
Worksheets
Recognizing A Hypomanic Episode
Information handouts
Recognizing A Manic Episode
Information handouts
Recognizing Agoraphobia
Information handouts
Recognizing Anorexia Nervosa
Information handouts
Recognizing Attention Deficit Hyperactivity Disorder (ADHD)
Information handouts
Recognizing Bipolar Disorder
Information handouts
Recognizing Bulimia Nervosa
Information handouts
Recognizing Depersonalization / Derealization Disorder (DPD)
Information handouts
Recognizing Depression
Information handouts
Recognizing Generalized Anxiety Disorder (GAD)
Information handouts
Recognizing Insomnia
Information handouts
Recognizing Obsessive Compulsive Disorder (OCD)
Information handouts
Recognizing Panic Attacks And Panic Disorder
Information handouts
Recognizing Persistent Depressive Disorder (Dysthymia)
Information handouts
Recognizing Post Traumatic Stress Disorder (PTSD)
Information handouts
Recognizing Social Anxiety Disorder
Information handouts
Recognizing Specific Phobia
Information handouts
Schema Formulation
Worksheets
Social Anxiety Formulation
Worksheets
Stages Of Change
Information handouts
Stages Of Social Anxiety
Worksheets
SWOT Analysis
Exercises
TEAR Model of Grief
Information handouts
The Parts Of Your Panic (Psychology Tools For Overcoming Panic)
Books & Chapters
Theory A / Theory B
Worksheets
Theory A / Theory B (Archived)
Archived
Therapy Blueprint
Archived
Therapy Blueprint (Universal)
Worksheets
Therapy Blueprint For OCD
Worksheets
Therapy Blueprint For Panic
Worksheets
Therapy Blueprint For PTSD
Worksheets
Therapy Blueprint For Social Anxiety
Worksheets
Transdiagnostic Cognitive Behavioral Model Of Eating Disorders (Fairburn, Cooper, Shafran, 2003)
Information handouts
Transdiagnostic Processes
Information handouts
TRAP TRAC
Exercises
Treatment Planning Checklist
Exercises
Understanding My Panic
Information handouts
Understanding PTSD
Information handouts
Values
Exercises
Vertical Arrow Down Arrow Vertical Descent
Exercises
Vicious Flower Formulation
Exercises
What Keeps Anorexia Going?
Information handouts
What Keeps Body Dysmorphic Disorder (BDD) Going?
Information handouts
What Keeps Bulimia Going?
Information handouts
What Keeps Depersonalization And Derealization Going?
Information handouts
Assessment
- Collaborative Case Conceptualization Rating Scale (CCC-RS) | Kuyken, Padesky, Dudley | 2009
- Rating scale & coding manual download archived copy
- Score sheet & feedback form download archived copy
- 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. download archived copy
Information
CBT
- The “Blobby” formulation | Helen Kennerley | 2015 download archived copy
- Understanding formulation (client handout)
downloadarchived copy - BPS DCP Good Practice Guidelines on the use of psychological formulation
downloadarchive.org - Working with Schemas, Core Beliefs, and Assumptions download archived copy
- Cognitive behavioral case formulation and treatment plan example download archive.org
- What is the case formulation approach to cognitive-behavior therapy? download archived copy
ACT
- A quick guide to ACT case conceptualization
downloadarchived copy - ACT assessment / case formulation process download archived copy
- ACT simple case formulation download archived copy
Team formulation
- Team formulation: key considerations in mental health services | Association of Clinical Psychologists UK | 2022 download archived copy
Intervention
- DBT case formulation format
downloadarchived copy - Case formulation template
downloadarchive.org
Presentations
- The case formulation approach to cognitive behavior therapy| Jacqueline Persons | 2014 download archived copy
- A case formulation approach to cognitive-behavior therapy | Jacqueline Persons | 2015 download archived copy
- The role of a case conceptualization model and core tasks of intervention | Donald Miechenbaum download archived copy
- Cafe formulation in cognitive-behavioral therapy | Caleb Lack download archived copy
Recommended Reading
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. download archived copy
- 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 download archived copy
- Kuyken, W., Padesky, C. A., Dudley, R. (2008). The science and practice of case conceptualization. Behavioural and Cognitive Psychotherapy, 36, 757-768
downloadarchived copy - 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 download archived copy
- Special issue: Team formulation. (2015). Clinical Psychology Forum, 275.
downloadarchived copy - 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. download archived copy
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.
- 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.
- 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.
- Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470.
- Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. Social phobia: Diagnosis, assessment, and treatment, 41(68), 00022-3.
- 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.
- 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. - 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.
- 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
- 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.
- Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and cognitive psychotherapy, 23(3), 301-320
- 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. download archived copy
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.