CBT Essentials Part 5
Welcome to the fifth instalment of ‘CBT Essentials’ a mini-series within Forrest Rambles where I’m exploring the building blocks of CBT. You can read the previous editions on agenda setting, mood questionnaires, goals and homework on my website.
Once you and your therapist have spent some time gathering information about your difficulties and made plans as to a way forwards, the next stage is to develop a formulation. In a nutshell this is a diagram which lays out the main areas of your problem and considers how they are interacting with each other. Formulations are a great tool for understanding where the problems lie and therefore starting to see possible solutions. The word ‘see’ is crucial here as mental health problems are often hard to explain. It’s not like breaking your leg and being able to take an x-ray. That’s what a ‘formulation’ gives us, a picture of the problem, a way of seeing it, and ideas for potential solutions.
Your therapist will work with you to develop your own unique formulation based on your experiences, thoughts, feelings and behaviours. I’ve talked in previous blogs about the importance of collaborating with your therapist and making treatment work for you, it’s the same with formulations. Work with your therapist to make sure your formulation makes sense to you and that it captures all the important points.
Formulations are diagrams made up of boxes, arrows and words (or pictures). The key ingredients are information about the situation, your thoughts, feelings and physical responses and finally your behaviour. A formulation may be a general one, often called a 5 areas model or a hot cross bun model like this …
Your therapist may also suggest using a formulation which is specific to the problem which you have agreed to focus treatment on. A formulation for depression will look different to one for generalised anxiety disorder for example, and a formulation for health anxiety will be different again. This is just to ensure that the unique characteristics of these problems are captured.
Sometimes a formulation is an effective way of putting a specific situation under the microscope to understand exactly what happened and learn from it e.g. when you’ve had a panic attack. Formulations can also be used to take a birds eye view of problems, considering them in a broader context, looking at how events from the past might have impacted on how you are thinking and feeling in the here and now.
You will return to your formulation throughout treatment to help you to understand why you are doing certain exercises and to see the progress which you are making. Therefore, it’s important to take your time with developing your formulation at the start of treatment. You may want to practice a few different versions for homework. You may want to ask your therapist to explain it again to make sure it makes sense. You may want to add things as you go through treatment and learn more about yourself and the problems which you are facing. Finally, don’t be afraid to be creative with your formulation, why not include pictures, colours, symbols, collage etc.
I hope you’ve enjoyed this edition of ‘CBT Essentials’. Please share the link via your Social Media platforms and join me next month to learn more about how to get the most from your therapy.