CBT formulation models and templates

How to choose a CBT formulation model

What a CBT formulation is

A CBT formulation is a shared, working explanation of a client’s difficulties: what keeps the problem going now and, where it helps, how it developed. It links the client’s own experience to a cognitive-behavioural model, so that the treatment plan follows from the explanation rather than from a generic list of techniques. A formulation is built collaboratively and revised as therapy goes on; it is a hypothesis to test, not a diagram completed once at assessment and filed away.

A useful formulation is simple enough for the client to recognise themselves in, specific enough to predict what should happen if one part of the cycle changes, and open to revision when new information does not fit.

Cross-sectional, longitudinal and disorder-specific models

Cross-sectional formulations map a single moment. The best known is the five-part hot cross bun formulation (Padesky & Mooney, 1990), which links a situation to thoughts, emotions, body sensations and behaviour and shows how each keeps the others going. The Five Areas model (Williams & Garland, 2002) has a similar shape but gives the client’s life situation, relationships and practical problems an area of their own. Both are quick to build, easy to explain and useful across presentations, which makes them good first formulations.

Longitudinal formulations add history. A longitudinal formulation traces how early experiences shaped core beliefs and rules for living, what critical incident activated them, and how the resulting maintenance cycle runs today. Beck’s cognitive model of depression is the classic source. A longitudinal view helps when problems are long-standing, when beliefs about the self are central, or when a client is asking “why me, and why now?”.

Disorder-specific models describe the maintaining processes identified for one presentation: the catastrophic misinterpretation of bodily sensations in panic (Clark, 1986), self-focused attention and safety behaviours in social anxiety (Clark & Wells, 1995), or the appraisals and nature of the trauma memory in PTSD (Ehlers & Clark, 2000). The disorder-specific CBT treatments are built on these models, so choosing one means the formulation and the intervention share a language.

Which model for which presentation

Every interactive model on Formulate, by presentation. Each page has a pre-filled example, a blank template and the primary references.