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CBT Model – Here And Now

Formulation is a key component of cognitive behavioral therapy (CBT) and essential to effective practice. The CBT Model – Here And Now worksheet is a simple, descriptive formulation that aims to introduce clients to the cognitive behavioral model, and illustrates the role that thoughts, feelings, and behaviors play in their difficulties. It can be used to familiarize clients with the cognitive behavioral model and its key concepts by illustrating how these concepts (e.g., thoughts, emotions, and behavior) are related; explaining connections between problem areas (e.g., anxiety and insomnia); breaking complex or distressing experiences down into smaller parts; identifying steps towards change.

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Notice: The 'Fillable PDF' format has been retired. For resources with form elements, both the 'Professional' and 'Client' versions are now available as fillable PDFs by default.

Professional version

Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.

Client version

Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.

Editable version (PPT)

An editable Microsoft PowerPoint version of the resource.

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  • English (GB)
  • English (US)

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Introduction & Theoretical Background

Formulation in talking therapies

Formulations (also known as case formulations, case conceptualizations, and working hypotheses) are a central component of most talking therapies and a key skill for mental health professionals (DCP, 2010; RCP, 2017; Sperry & Sperry, 2012). In essence, a formulation is a way to make sense of an individual’s difficulties. It is a provisional account or hypothesis, informed by psychological theory, about what an individual is struggling with and why (Johnstone & Dallos, 2014). A formulation is also a tool that therapists use to relate theory to practice (Butler, 1998). Sperry and Sperry (2012, p. 4) describe formulations as:

A method and clinical strategy for obtaining and organizing information about a client, understanding and explaining the client’s situation and maladaptive patterns, guiding and focusing treatment, anticipating challenges and roadblocks, and preparing for successful termination.

Formulation is a fundamental part of most (if not all) therapeutic

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Therapist Guidance

"I’d like to explore how the issues we’ve talked about fit together. One way we can do that is by drawing them as a diagram. Would that be OK?"

Step 1 – Explore the client’s experience

Event

Ask the client to identify and describe a specific recent event that triggered their difficulty. Note that trigger events can be external (e.g., a difficult interaction) or internal (e.g., an unusual physical sensation). Some individuals find it helpful to close their eyes and visualize the event (Beck, 2011). Consider asking: 

"Let’s start by writing down a situation that recently triggered [current difficulty]. Can you think of an example? What happened?"

Next, explore the client’s cognitive, emotional, and behavioral responses to the trigger event. Therapists are encouraged to add this information to the formulation in whatever order the client shares it (Kuyken et al., 2009).

Thoughts

Examine the client’s cognitive response to the trigger

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References And Further Reading

  • Bakker, G. M. (2008). Problem‐maintaining circles: Case illustrations of formulations that truly guide therapy. Clinical Psychologist, 12, 30-39. DOI: 10.1080/13284200802069050.
  • Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities Press.
  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.
  • Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford.
  • Butler, G. (1998). Clinical formulation. In: A. S. Bellack and M. Hersen (Eds.), Comprehensive Clinical Psychology (pp.1-23). Oxford.
  • Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461-470. DOI: 10.1016/0005-7967(86)90011-2.
  • Division of Clinical Psychology [DCP] (2010). The core purpose and philosophy of the profession. The British Psychological Society.
  • Dudley, R., & Kuyken, W. (2014). Case formulation in cognitive behavioural therapy: A principle-driven approach. In: L. Johnstone & R. Dallos (Eds.), Formulation in psychology and psychotherapy: Making sense of people’s

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