Vicious Flower Formulation
A transdiagnostic maintenance formulation: the central fear or problem in the middle, with the processes that keep it going — avoidance, safety behaviours, self-focused attention, reassurance-seeking, unhelpful thinking, and physical sensations — drawn as petals that each feed back to the centre.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Vicious Flower Formulation
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The vicious flower
Write the central fear or problem in the middle, then map the processes that keep it going as petals around it. Each petal feeds back to the centre — which is why the problem keeps itself alive.
Central fear / problem
Avoidance
Safety-seeking behaviours
Self-focused attention / monitoring
Reassurance-seeking & checking
Unhelpful thinking
Physical sensations
Making sense of it
Safety and support
This maps what keeps a problem going right now, not what is wrong with you. It is not your fault, and every petal is an understandable attempt to feel safer. Need more support? If you are in crisis or feel unsafe, you can get help now: call 999 in an emergency, call Samaritans free on 116 123 (day or night), or text SHOUT to 85258. This worksheet supports therapy and self-help; it is not a crisis service or a substitute for professional care.
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When to use the Vicious Flower Formulation
The Vicious Flower Formulation is an interactive cognitive behavioural therapy (CBT) worksheet. As a core CBT skill it is 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 introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete 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 three short steps:
- The vicious flower — Write the central fear or problem in the middle, then map the processes that keep it going as petals around it. Each petal feeds back to…
- Making sense of it
- Safety and support — This maps what keeps a problem going right now, not what is wrong with you. It is not your fault, and every petal is an understandable…
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 Vicious Flower 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 worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Salkovskis, P.M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571-583.
- Salkovskis, P.M. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 19(1), 6-19.
- Butler, G., Fennell, M. & Hackmann, A. (2008). Cognitive-Behavioral Therapy for Anxiety Disorders: Mastering Clinical Challenges. New York: Guilford Press.
- Moorey, S. (2010). The six cycles maintenance model: Growing a "vicious flower" for depression. Behavioural and Cognitive Psychotherapy, 38(2), 173-184. doi:10.1017/S1352465809990580
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
- Samaritans: 116 123 — free, day or night, 365 days a year
- SANEline: 0800 689 5555 — 4:30pm–10:30pm, every day
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