CBT Model - Maintaining Processes - Past And Present

This CBT Model - Maintaining Processes - Past And Present worksheet provides a framework for explaining what triggers a problem, why it persists, and why it has arisen.

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

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

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Overview

Formulation is a key component of cognitive behavioral therapy (CBT) and essential to effective practice. Effective cognitive behavioral formulations tend to focus on maintenance cycles that explain why difficulties persist across situations, and research has identified several ‘common’ maintaining factors that operate across psychological disorders - including attentional processes, safety-seeking behaviors, and avoidance. This CBT Model - Maintaining Processes - Past And Present worksheet provides a framework for exploring the origins and persistence of a problem. It focuses on key maintaining factors that operate across various disorders, as well as life experiences, core beliefs, and dysfunctional assumptions that have contributed to the development of these difficulties.

Why Use This Resource?

Effective formulations enhance cognitive behavioral practice and inform cognitive behavioural interventions by describing clients’ problems, explaining how and why they developed, and identifying processes that maintain them.

Connects life experiences with present difficulties.
Explains why these problems persist.
Organizes a large amount of information into a coherent, theory-informed explanation.
Informs treatment planning.

Key Benefits

Clarity

Provides a clear framework for making sense of psychological issues.

Insight

Illuminates how past experiences shape current thinking.

Understanding

Describes how and why problems are maintained.

Engagement

Supports collaboration in therapy.

Who is this for?

Anxiety

Explaining the role of avoidance and attention to threats in anxiety.

Depression

Understanding the links between negative core beliefs and negative automatic thoughts in low mood.

Trauma

Exploring how traumatic experiences shape underlying beliefs, automatic thoughts, and patterns of behavior.

Integrating it into your practice

Explore

Identify a recent triggering event and the automatic thoughts associated with it.

Focus

Understand what the client pays attention what they think in that way.

Feelings

Discuss the physical and emotional reactions linked to these automatic thoughts.

Actions

Identify coping strategies and avoidant behaviors that were utilized.

Background

Identify beliefs, assumptions, and historical experiences underlying negative patterns of thinking.

Reflect

Encourage client feedback on the formulation.

Theoretical Background & Therapist Guidance

Formulation in cognitive behavioral therapy (CBT) is an active and dynamic process that starts at the beginning of treatment and continues throughout the therapy (Beck, 2011). Understanding maintenance processes is essential for grasping how problematic thought patterns associated with psychological disorders persist (Wells, 1998).

Cognitive behavioral formulations often focus on maintenance cycles that explain why difficulties continue across various situations, known as cross-sectional formulations, rather than on developmental histories (Kennerley et al., 2017; Kuyken et al., 2009). However, incorporating core beliefs, dysfunctional assumptions, and the life experiences that led to their formation can help connect the client’s past with their present, providing context for their symptoms.

What's inside

A comprehensive guide to formulation in CBT.
A structured framework for connecting past experiences and present difficulties.
Sections to explore what maintains these problems in the here-and-now.
Questions and prompts to guide therapists in constructing a formulation.

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FAQs

This worksheet focuses on both maintaining factors and how past experiences influence current difficulties.

Including the past and present can help develop hypotheses about the beliefs and assumptions underlying clients’ symptoms, pinpoint appraisals that are most relevant to the client’s difficulties (e.g., those closely linked to underlying beliefs), and identify life experiences that might need to be addressed in therapy.

Formulation helps clients understand their difficulties, enhances engagement and collaboration, and provides a clearer roadmap for therapy.

How This Resource Improves Clinical Outcomes

By offering a detailed case conceptualization framework, the worksheet supports:

Insight into the origins and perpetuation of clients' difficulties.
Informing the course and content of therapy.
Developing a therapeutic alliance through collaborative understanding.

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References And Further Reading

Arntz, A. (2018). Modifying core beliefs. In: S. C. Hayes & S. G. Hoffman (Eds.), Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy (pp.339-350). Context Press.
Arntz, A., Rauner, M., & Van den Hout, M. (1995). "If I feel anxious, there must be danger" : Ex-consequentia reasoning in inferring danger in anxiety disorders. Behaviour Research and Therapy, 33, 917-925. DOI: 10.1016/0005-7967(95)00032-S](https://doi.org/10.1016/0005-7967(95)00032-S).
Bakker, G. M. (2008). Problem's maintaining circles: Case illustrations of formulations that truly guide therapy. Clinical Psychologist, 12, 30-39. DOI: 10.1080/13284200802069050.
Barry, T. J., Vervliet, B., & Hermans, D. (2015). An integrative review of attention biases and their contribution to treatment for anxiety disorders. Frontiers in Psychology, 6, 968. DOI: 10.3389/fpsyg.2015.00968.
Beck, A. T. (1963). Thinking and depression: I. Idiosyncratic content and cognitive distortions. Archives of General Psychiatry, 9, 324-333. DOI: 10.1001/archpsyc.1963.01720160014002.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. Meridian.
Beck, A. T., & Beck, J. S. (1991). The Personality Belief Questionnaire. Bala Cynwyd, PA: The Beck Institute for Cognitive Therapy and Research.
Beck, A. T., Freeman, A., & Davis, D. D. (2015). General principles and specialized techniques in cognitive therapy of personality disorders. In: A. T. Beck, D. D. Davis, & A. Freeman (Eds.), Cognitive therapy of personality disorders (3rd ed.) (pp. 97-124). Guilford 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. New York: Guilford.
Blakey, S. M., & Abramowitz, J. S. (2016). The effects of safety behaviors during exposure therapy for anxiety: Critical analysis from an inhibitory learning perspective. Clinical Psychology Review, 49, 1-15. DOI: 10.1016/j.cpr.2016.07.002.
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Butler, G. (1998). Clinical formulation. In: A. S. Bellack and M. Hersen (Eds.), Comprehensive Clinical Psychology (pp.1-23). Oxford.
Butler, G., Fennell, M., & Hackmann, A. (2008). Cognitive-behavioral therapy for anxiety disorders: Mastering clinical challenges. Guilford Press.
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Frijda, N. H., & Mesquita, B. (2000). Beliefs through emotions. In: N. H. Frijda, A. S. R. Manstead, & S. Bem (Eds.), Emotions and beliefs: How feelings influence thoughts (pp. 45-77). Cambridge University Press.
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Kennerley, H., Kirk, J., & Westbrook, D. (2017). An introduction to cognitive behaviour therapy (3rd ed.). Sage.
Kuyken, W., Padesky, C. A., & Dudley, R. (2009). Collaborative case conceptualisation: Working effectively with clients in cognitive-behavioral therapy. Guilford Press.
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