5Ps formulation
A whole-person formulation in five parts: what is happening now, what made you more vulnerable, what set it off, what keeps it going, and what helps.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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5Ps formulation
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The five Ps: a shared map
Based on Macneil et al. (2012) and Weerasekera (1993): the five Ps as five boxes and a summary, with no diagram.
This sheet helps you and your therapist build a shared picture of what is going on: what is happening now, what made you more vulnerable, what set it off, what keeps it going, and what helps. Fill it in together, in your own words. It is a working draft that you can change as you both learn more.
You choose how much to share. You can leave any box blank or come back to it later. If thinking about the past brings up strong feelings, tell your therapist.
Presenting: what is the difficulty now?
What brought you here, and how is it affecting your days?
Predisposing: what made this more likely?
Things from before that may have made you more vulnerable. Share only what feels right for now.
Precipitating: what set it off?
What was happening around the time it started or got worse?
Perpetuating: what keeps it going?
These are often the places where change is most possible.
Protective: what helps?
Strengths and supports count as much as difficulties.
Putting it together
Safety and support
If you are in crisis or feel unsafe, you can get help now. In an emergency call 999. Samaritans are free on 116 123, day or night. You can also text SHOUT to 85258. This sheet supports your therapy. It is not a crisis service and does not replace professional care.
Try it here — nothing you type is saved. Sign up to assign it and let clients complete it on any device.
When to use the 5Ps formulation
The 5Ps formulation is an interactive cognitive behavioural therapy (CBT) formulation model. It draws on core CBT skills used right across the model, with presentations including depression, anxiety, OCD, trauma and low self-esteem, rather than being tied to a single diagnosis.
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist and client complete the model together and make sense of what it surfaces. You can preview the full formulation above, then assign it digitally for clients to revisit between sessions on any device or download it as a print-ready PDF.
How it works
Most people work through it in around 25 minutes. It moves through six short steps:
- The five Ps: a shared map: Based on Macneil et al. (2012) and Weerasekera (1993): the five Ps as five boxes and a summary, with no diagram. This sheet helps you and…
- Presenting: what is the difficulty now? What brought you here, and how is it affecting your days?
- Predisposing: what made this more likely? Things from before that may have made you more vulnerable. Share only what feels right for now.
- Precipitating: what set it off? What was happening around the time it started or got worse?
- Perpetuating: what keeps it going? These are often the places where change is most possible.
- Protective: what helps? Strengths and supports count as much as difficulties.
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The CBT approach behind it
In common with other CBT methods, the 5Ps formulation works by mapping how the parts of a problem connect and keep it going (formulation). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This formulation is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Weerasekera, P. (1993). Formulation: a multiperspective model. Canadian Journal of Psychiatry, 38(5), 351-358. doi:10.1177/070674379303800513
- Macneil, C.A., Hasty, M.K., Conus, P., & Berk, M. (2012). Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice. BMC Medicine, 10, 111. doi:10.1186/1741-7015-10-111
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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