Sunday, 4 October 2009

CBT Formulation (case conceptualisation)

CBT formulation (or case conceptualiation) is the keystone of CBT. It is the blueprint to help you and the client figure out what is going on.
Many versions of CBT formulation have been advocated, including the following (overlapping) elements
  • Getting a list of problems, issues and goals
  • Diagnosis
  • Key core beliefs (global statements about self, world and future)
  • Key dysfunctional assumptions (life rules, shoulds, musts)
  • Vicious cycles and maintaining factors (things that keep the problem going, safety behaviours, compensatory strategies)
  • Triggers (things that set the problem off now)
  • Modifiers (things that make it better or worse)
  • Vulnerability factors (childhood experiences, genetic factors)
  • Critical Incidents (what started the big problem recently)
  • Treatment Plan
  • Alternative core beliefs, assumptions and policies
  • Typical cycle of event, thought, mood, physiology and behaviour
Formulations are often done in diagram form, preferably in collaboration with the client.

Some free internet resources

Will Kuyken's Evidence-based case formulation chapter (pdf)

Workshop on CBT Formulation (pdf)

Eoin Stephen's paper on A Case Formulation Approach to CBT (pdf)

Chris Allen's  articles on case conceptualisation part 1 and part 2

Clients’ experience of case formulation in cognitive behaviour therapy for psychosis ,

Recommended Reading
Needleman, L. Cognitive Case Conceptualisatin: A Guidebook for Practitioners
Persons, J Cognitive Therapy in Practice: A case Formulation Approach
Beck, J Cognitive Therapy: Basics and Beyond
Kuyken, W, Padesky, C, Dudley, R Cognitive Case Conceptualisation
Padesky, C - Audio cd on case conceptualisation available from

Saturday, 3 October 2009

Two free measures that can help with CBT

There are a wealth of measurements available in CBT, such as the Beck Depression Inventory (BDI), but most are copyrighted (ie you have to pay for them). Furthermore many of them take a long time to complete, which means you might only want to administer them once a month or so.

Whilst it is worth getting hold of and using these measures, you and your clients might also benefit from using two quick to use and free measures that are currently used in the IAPT services in the UK.
These are the GAD-7  (for anxiety) and PHQ-9 (for depression)

You can find the measures and guides to using them here
They take a couple of minutes to administer so, when appropriate, can be used every week as a quick gauge of where clients are at and also a measure of progress.