The Alternative Action Formulation is a cognitive behavioral therapy (CBT) worksheet designed to help clients and therapists collaboratively understand problems and focus on more adaptive behavioral strategies.
Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.
Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.
A fillable version of the resource. This can be edited and saved in Adobe Acrobat, or other PDF editing software.
An editable Microsoft PowerPoint version of the resource.
This formulation template utilizes a problem > coping strategy > unintended consequence format that encourages clients and therapists to explore current difficulties and develop alternative coping mechanisms. It is a valuable resource for facilitating cognitive behavioral therapy (CBT) case conceptualizations by offering a clear and concise method for identifying and modifying maladaptive behavior patterns.
The Alternative Action Formulation promotes a collaborative therapeutic approach, integrating CBT principles to enhance understanding and problem-solving strategies.
Clients who feel stuck in cycles of withdrawal, rumination, or self-criticism, and who use coping strategies like avoidance or inactivity that offer short-term relief but maintain low mood in the long term.
Individuals who engage in safety behaviors (e.g., avoidance, reassurance seeking, checking) that reduce distress temporarily but reinforce underlying fears and perpetuate anxiety.
Clients who use dissociation, avoidance, or substance use to manage trauma-related distress, but find that these coping mechanisms prevent emotional processing and maintain symptoms.
Those who respond to life stressors with habitual coping strategies that are ineffective or self-defeating, such as overworking, emotional suppression, or irritability.
Begin with identifying the client's current issues and coping strategies.
Explore the consequences of these strategies, noting both short-term gains and long-term drawbacks.
Encourage the client to consider alternative strategies that are more adaptive.
Discuss potential solutions and focus on incremental, practical changes.
Document insights and progress in the worksheet for ongoing reference and adjustment.
The Alternative Action Formulation is rooted in core principles of cognitive behavioral therapy (CBT), particularly the understanding that psychological problems are maintained by learned patterns of thinking and behavior that may have short-term benefits but long-term costs (Beck, 1976; Persons, 2012). This worksheet supports the process of case formulation by guiding clients and therapists through a structured examination of maladaptive coping strategies and their unintended consequences.
Many clients present to therapy using automatic coping strategies — such as avoidance, withdrawal, reassurance-seeking, or rumination — that are initially effective in reducing emotional discomfort but which ultimately reinforce distress or interfere with valued goals. These patterns are well-documented in the CBT literature across multiple disorders (Clark & Beck, 2010; Salkovskis, 1996). For example, avoidance in anxiety may prevent fear extinction, while rumination in depression maintains negative mood and disrupts problem-solving.
The problem > coping strategy > unintended consequence format mirrors widely used CBT formulation models that emphasize functional analysis: understanding what maintains a problem and what reinforces ineffective responses (Kuyken, Padesky, & Dudley, 2009). This type of structured formulation helps make maintenance cycles explicit and fosters insight into the links between thoughts, feelings, behaviors, and outcomes.
Additionally, the worksheet encourages clients to identify and experiment with alternative actions — new behavioral strategies that may feel unfamiliar or effortful but offer potential for more adaptive and sustainable outcomes. This reflects the CBT emphasis on behavioral activation, exposure, and skills development as vehicles for change (Jacobson et al., 2001; Barlow et al., 2011).
The resource also accommodates a biopsychosocial perspective, recognizing that current coping strategies may be influenced by biological predispositions (e.g., heightened threat sensitivity), developmental history (e.g., learned family patterns), and current contextual factors (e.g., lack of social support). Mapping these layers in a collaborative, visual way can reduce self-blame and foster therapeutic engagement.
Importantly, the Alternative Action Formulation supports the development of metacognitive awareness: helping clients to step back from habitual responses and reflect on why they do what they do, and what alternative responses might serve them better. In this sense, it aligns closely with the values of collaborative empiricism and guided discovery that underpin effective CBT practice (Padesky, 1996).
