The Cross-Sectional Formulation worksheet helps clinicians understand and communicate the interconnections between thoughts, emotions, behaviors, and bodily sensations in specific contexts. It offers a snapshot of these elements - a cross-section at a moment in time.
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 worksheet allows mental health professionals to delve into a client's current cognitive and emotional landscape by focusing on specific events or triggers. The Cross-Sectional Formulation provides a structured approach to examining how cognitive, emotional, physiological, and behavioral domains interact. Crucially, it guides both client and therapist in understanding how changes in one domain can influence others and can be used to explore problem-maintaining mechanisms.
Cross-sectional formulations serve as a valuable tool in therapy by:
Understanding interconnections fueling anxious responses.
Clarifying cycles of negative thinking and behavior patterns.
Analyzing stress responses to enhance coping strategies.
Everyday issues such as work stress or social anxieties.
Choose a specific, recent client situation to analyze.
Examine thoughts, feelings, physiological response, and behavioral reactions.
Explore interconnections between cognitive, emotional, somatic, and behavioral responses.
Help clients see how changes in one area might influence others.
Develop intervention strategies based on identified patterns.
Formulation is a central component of cognitive behavioral therapy (CBT), serving as the bridge between theory and therapeutic practice. It enables therapists to make sense of clients’ difficulties by organizing complex information into a coherent understanding that guides treatment decisions. According to Butler (1998), formulation is a hypothesis-driven activity that draws on theoretical models and clinical judgment to explain how a person’s problems developed, how they are maintained, and what might be done to alleviate them.
There are multiple types of formulation used in CBT, each serving a different purpose. Cross-sectional formulations, like the one presented in this resource, offer a present-focused 'snapshot' of the client’s experience. They illustrate the moment-to-moment interplay of thoughts, emotions, behaviors, and physiological responses in a specific situation. This approach aligns with the work of Padesky and Mooney (1990), who emphasized the importance of helping clients visualize the interconnected nature of their psychological experiences to facilitate insight and change.
In contrast, longitudinal formulations take a developmental perspective, mapping out how early life experiences, core beliefs, and life events have shaped a person’s enduring patterns of response. These more comprehensive formulations often include predisposing, precipitating, perpetuating, and protective factors. While longitudinal models help therapists understand the broader origins of a problem, cross-sectional models are particularly effective for identifying immediate intervention points and fostering client collaboration early in therapy.
A good formulation balances parsimony and complexity — it should be simple enough to communicate clearly, yet rich enough to inform intervention. The Cross-Sectional Formulation worksheet helps clinicians and clients collaboratively map psychological processes as they occur in real time. By focusing on specific events or triggers, therapists can use this tool to develop client insight, identify maladaptive maintenance cycles, and design targeted interventions. This approach reinforces CBT’s commitment to collaborative empiricism — working together to generate and test hypotheses about what keeps problems going and how they can be changed.
