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What is a CBT formulation?

January 27, 2020

If you’ve been looking into cognitive behavioural therapy (CBT), you may well have seen the word formulation being used and wondered what it meant. It might sound scientific, but the term actually refers to something that’s very straightforward: the classic ‘vicious cycle’ that’s at the centre of many patients’ problems.

When someone has depression, an anxiety disorder or a phobia, for example, there tends to be a pattern to how they experience it. Thoughts, emotions, behaviours and physical symptoms are all interconnected. Mapping out how they link to one another helps both the therapist and the patient to understand the difficulties they’re having.

For instance, someone who is anxious about driving might think that if they get behind the wheel something bad will happen. This will lead to feelings of fear, that in turn make the patient want to avoid driving. If they can’t avoid it, they may experience symptoms of panic, with their heart racing and their breathing getting faster.

This reinforces the fearfulness and makes the person feel worse, which triggers more negative thoughts and worries, causing the cycle to continue.

Everyone is different, and everyone’s cycle will look different, so in CBT the therapist will work with the individual to describe and map out how they experience it. Sometimes drawing a diagram or a picture works well, with arrows indicating how one thing leads to another, to show how the problem perpetuates and escalates.

This understanding can be therapeutic in itself if someone has been worrying about how their problem is affecting them. Formulating it normalises what they’re experiencing, helping them to realise there’s a reason they respond as they do, and that the difficulties they’re having are common.

Mapping out a problem also helps with pinpointing what needs to be treated.

CBT is different from other forms of therapy which involve talking, listening and ‘processing’, in that it equips the patient with tools and techniques they can use to manage their problem. Formulation enables the therapist to identify where the strong links are between thoughts, feelings, behaviours and physical symptoms, and the specific things that need to change for the patient to feel better. From there, they can determine what needs to be done in treatment, and where to focus attention to break that vicious cycle.

The CBT formulation process works well because it simplifies and explains difficulties that can seem complicated and hard to grasp, giving both the therapist and the patient clarity over what’s happening. It’s also easy to adapt and personalise to an individual.

Formulation is probably most effective when it’s done as part of CBT, but it’s something you can try yourself. Start by writing down a few examples of situations you’ve experienced as part of your problem. Then note down the thoughts you had as a result, how that made you feel emotionally and physically, and what you did as a result. Look for any connections or patterns.

If you’d like support with formulation, online CBT can be a good way to start understanding and addressing the difficulties you’re having quickly. You can also find out what you can expect during online CBT.

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