Validity Issues in Cognitive-Behavioral Case Formulation

Abstract

Despite considerable interest and growth in methods to develop or generate cognitive behavioral case formulations (CBCFs), relatively little conceptual and empirical work has focused on the validation or testing of these formulations. A case formulation can be regarded as an idiographic theory of the person and his or her life situation. This complex set of clinical judgments consists of a measurement model including the behavior problems or distress constructs and how they are measured; and a causal model involving variables such as thoughts or beliefs hypothesized to trigger and maintain this person’s distress or dysfunction. This article describes four types of validity issues in CBCF and how these validity issues can be evaluated using person-specific, intraindividual data collected daily or multiple times a day. Specific topics include the evaluation of content and construct (convergent and discriminant) validity for the measurement model, and the evaluation of predictive and treatment-related validity for the causal model. One goal of the person-specific evaluation of CBCF validity is to develop an intraindividual statistical prediction model that has the advantages of actuarial prediction yet is fine-grained and tailored to the specific issues and life circumstances of greatest relevance for a particular individual. Greater attention to evaluation of validity issues in CBCF is important for future research comparing formulation-based to manualized treatment. Implications and applications to clinical practice and training are discussed.