CBT Formulation
If we had a top therapies list, I would bet that Cognitive Behavioral Therapy (CBT) would be at the number one spot. It is often recommended as the first-line treatment for a range of mental health difficulties and is the widest used therapy in clinical settings, being backed up by a range of evidence and research. CBT is a very practical therapy, where therapist and client work together to build an understanding of the client’s mental health difficulties in the here and now (e.g. anxiety or low mood) and develop strategies to manage these difficulties. Other characteristics of this approach are that there are a time-limited number of appointments and the client is often asked to do ‘homework’ outside of the session.
For the first blog, I’m going to start with some of the essential building blocks of formulation: the basic CBT ‘Formulation’.
Dr Aaron Beck originally created this approach for depression, however it has since being applied to a range of mental health difficulties. I will not be able to do justice to the complexities of how CBT was developed and the theory behind it in this post. Therefore, please view this as a brief summary and for the purpose of explaining formulation.
CBT suggests that there are 5 inter-connected systems which we can explore to understand someone’s psychological distress and behavior in a specific situation. These are:
The external situation or environment
Thoughts/appraisals/cognitions about the situation – in CBT these are called “Negative Automatic Thoughts”.
Emotions
Body sensations
Behavior – or what someone ‘does’
All these 5 areas link together and feed into each other like a vicious cycle, which maintains psychological distress. The ideas is, that if one of these areas can be targeted and changed, then it breaks the cycle and distress reduces, (e.g. challenging the negative automatic thoughts).
The ‘Formulation’ is a structured way to explore these 5 factors. It’s known as the ‘5 areas/aspects formulation’. It focuses on understanding a specific situation in the here and now and does not explicitly consider the role of past experiences.
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