Case Formulation Research Articles

Kognitiv atferdsterapi

Cognitive behavioural therapy (CBT) is a psychotherapeutic method focusing on the interaction between thoughts, behaviours, emotions and physiological factors in individuals. The central emphasis is on how people process the information they receive. It is assumed that the meaning or interpretation an individual has in each situation leads to uncomfortable emotions or inappropriate behaviours. Working systematically, the therapist first helps the patient see connections between their own behaviour, thoughts and feelings and to identify and explore negative automatic thoughts (NATs) and potential core beliefs. The therapist then encourages the patient to come up with alternative thoughts and test whether they result in less discomfort and better coping. The goal is for the patient to learn how to use CBT techniques by themself. The article describes a therapy process with a patient struggling with depression. Based on a case formulation that provides an overview of factors contributing to the development and maintenance of the patient's problems, the most central therapeutic interventions are described: establishing agreement on therapy goals, session structure, setting an agenda, mood checks, and homework assignments. The article also provides examples of how the therapist encourages cognitive restructuring through open-ended questions and guided discovery. Keywords: cognitive behavioural therapy, guided discovery, case formulation

Aksept og verdibasert atferdsterapi (ACT)

Acceptance and commitment therapy (ACT) is a form of contextual cognitive behavioural therapy. The present article briefly presents the philosophical foundation of ACT and a core understanding of precipitating and perpetuating factors in both physical and mental health. ACT aims to increase psychological flexibility and improve quality of life. ACT is transdiagnostic and is considered an evidence-based treatment for a wide range of psychological disorders. Using a case formulation of ‘Nadine’, we illustrate examples of ACT techniques and interventions that may facilitate meaningful change. Keywords: psychological flexibility, transdiagnostic, case formulation, evidence-based

Beyond Addiction: Rethinking Problematic Internet use from a Motivational Framework.

This article sheds light on the potential of a motivational framework to enhance the understanding of problematic Internet use and facilitate an in-depth analysis of the potentially pathological manifestations that become apparent in individuals' interactions with Internet applications. The motivational framework operates under the assumption that the origins of problematic Internet behaviors can be traced back to the appetitive dimension of these particular behaviors in the context of the individual's specific needs and personal history. In this framework, the Internet is not perceived as a mere instrument for multiple actions but as a genuine environment wherein individuals have the capacity to express and potentially satisfy their distinct needs. Consequently, the motivational framework advocates a model for understanding problematic Internet use that posits active agency on the part of individuals as they actively seek strategies for the management and regulation of their emotions through online activities. As a result, the framework recommends caution in categorizing dysregulated behaviors on the Internet as behavioral addictions. Instead, it advocates for a thorough evaluation of individuals exhibiting problematic use of Internet services and applications, emphasizing an assessment that scrutinizes the persistence and significance of specific Internet behaviors over time, along with an exploration of the underlying motivations driving these behaviors. Through this lens, the understanding of symptom development is significantly enriched. Recognizing the specific motivations that guide individual behaviors within the online environment emerges as a crucial component in improving case formulation and developing personalized treatment approaches.

Delivery of Neuropsychological Interventions for Adult and Older Adult Clinical Populations: An Australian Expert Working Group Clinical Guidance Paper.

Delivery of neuropsychological interventions addressing the cognitive, psychological, and behavioural consequences of brain conditions is increasingly recognised as an important, if not essential, skill set for clinical neuropsychologists. It has the potential to add substantial value and impact to our role across clinical settings. However, there are numerous approaches to neuropsychological intervention, requiring different sets of skills, and with varying levels of supporting evidence across different diagnostic groups. This clinical guidance paper provides an overview of considerations and recommendations to help guide selection, delivery, and implementation of neuropsychological interventions for adults and older adults. We aimed to provide a useful source of information and guidance for clinicians, health service managers, policy-makers, educators, and researchers regarding the value and impact of such interventions. Considerations and recommendations were developed by an expert working group of neuropsychologists in Australia, based on relevant evidence and consensus opinion in consultation with members of a national clinical neuropsychology body. While the considerations and recommendations sit within the Australian context, many have international relevance. We include (i) principles important for neuropsychological intervention delivery (e.g. being based on biopsychosocial case formulation and person-centred goals); (ii) a description of clinical competencies important for effective intervention delivery; (iii) a summary of relevant evidence in three key cohorts: acquired brain injury, psychiatric disorders, and older adults, focusing on interventions with sound evidence for improving activity and participation outcomes; (iv) an overview of considerations for sustainable implementation of neuropsychological interventions as 'core business'; and finally, (v) a call to action.

Development of a training programme in individual case formulation skills and a scale for assessing its effectiveness.

Little is known about the skills involved in clinical formulation. The individual case formulation (ICF) approach, based on functional analysis, employs clinical descriptions that are theory-free and depicts formulations constructed according to a set of basic conventions. We report a test of whether this method could be taught and if the quality of the resulting diagrams could be reliably rated. Participants (n=40) participated in a training course in formulation. A draft rating scale was refined in the course of rating formulation diagrams and basic inter-rater reliability established. Results of the study support further development of the ICF approach.

A longitudinal view of an approach to responsiveness: Principles followed and lessons learned

Responsiveness is currently a hot topic in the psychotherapy literature with a large variation in what the term means to colleagues of various orientations. This adds to its popularity but limits the scope of whatever is written or said about responsiveness. The fact that the meaning of responsiveness has developed over time within the approaches adds also to the variation, while an understanding of development has the potential of deepening the understanding of each approach. As a fair description and comparison of even just the most important approaches is by far out of reach for a page-limited article, the development of one approach, which may be termed the “Bernese” approach is described here, along with lessons learnt and general comments. The approach includes Plan Analysis case formulations, the concept of complementary or Motive-Oriented Relationship, a description of a combined qualitative and quantitative assessment, and many methodological and conceptual considerations. Personal development is woven in. Overall, it seems fair to say that this approach, at its core developed long before responsiveness became popular, has turned out to still be useful, with a gain in depth as far as concepts and assessment are concerned.

Using GIMME to model the emotional context of suicidal ideation based on clinical data: From research to clinical practice

Research and clinical experience highlight the variability of suicidal ideation (SI) within and between individuals. Although the idiographic emotional contexts in which SI occurs may offer explanations for its dynamic nature, most statistical methods focus on nomothetic patterns, making it difficult to advance our understanding of SI. Furthermore, the gap between nomothetic methods and a need for idiographic understanding of SI poses challenges to translating empirical knowledge into individualized clinical treatment. Group iterative multiple model estimation (GIMME) is a method that may bridge the idiographic-nomothetic divide by analyzing temporal relationships among a network of variables at both group- and individual-levels. This study explored the feasibility and clinical utility of GIMME applied to examine the relationships between various emotions and SI among individuals with borderline personality disorder who underwent Dialectical Behavior Therapy. We present graphic outputs that emerged throughout treatment and discuss how they could aid clinical assessment and case formulation (ClinicalTrials.gov Identifier: NCT03123198.).

Developing Clinical Perspectives: Reflections on Student and Teacher Experiences of an Undergraduate Music Therapy Course

Abstract Centered in the Scholarship of Teaching and Learning, we describe and reflect upon student and teacher experiences of an undergraduate music therapy course in which students are introduced to two core clinical perspectives derived from the music therapy literature: decision-making and case formulation. Guiding the reader through four interrelated course phases, we discuss key content areas, challenges students encountered, and the ways the course instructors engaged with and worked through these challenges. Key learning outcomes are identified, specifically focusing on the importance of 1) teaching multiple perspectives early in a music therapy curriculum, 2) prerequisite knowledge, 3) musical competence, and 4) an integrated curriculum. In doing so, we advocate for an integral perspective to clinical practice, through which students develop the ability to locate themselves and shift perspectives in service of their clients.

Bruk av kasusformulering for gravide og partnere i tiden rundt fødsel

Background: It is documented that preventive interventions for vulnerable children should start during pregnancy. Clinicians who work with families in the perinatal period must deal with a complexity created by the combination of risk and protection in the child's care system. National guidelines for treatment offered within mental health care in the perinatal period are currently lacking. We present areas of assessment that can inform the clinician working with pregnant women and their partners and show how the use of a biopsychosocial and cultural case formulation can promote therapeutic work in the perinatal period (P-CF). Method: Based upon clinical experience, theory, research, guidelines and knowledge about parents and children in the perinatal period, a selection is made of risk and protective factors that may influence the child’s development and health. Findings: The selected risk and protective factors are systemised in a biopsychosocial and cultural case formulation for the care system in the perinatal period (P-CF). Use of P-CF in clinical settings are exemplified. Implications: The use of P-CF enables the clinician to generate hypotheses about both development and skewed development. Systematic use can increase equality and quality in clinical decision-making processes by making the clinician's assessments less dependent on personal preferences and degree of experience. P-KF can assist the clinician in balancing risk and protective factors and elucidate where therapeutic interventions need to me made and how they should be provided. Keywords: perinatal, mental health, early intervention, case formulation, pregnancy

Sociocultural Framework for Psychiatric Case Formulation.

A Cultural Formulation Interview (CFI) field trial in India, widely reported racist violence in the United States, and casteist and religious communal conflicts in India highlighted inattention to structural issues affecting mental health problems in the Outline for Cultural Formulation (OCF) and the CFI in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Consequently, we revised the OCF as a sociocultural formulation (SCF) to better consider structures of society and culture. We studied and compared clinicians' ratings of SCF case formulations from a constructed assessment instrument (SCF Interview [SCFI]) and the CFI. Socio-cultural formulations from SCFI interviews were rated higher for details of societal structural impact, and overall interrater agreement was better. CFI interviews were rated higher for clinical rapport. Revision of the CFI should enhance consideration of structural issues and incorporate them in SCFs that better integrate assessment process and case formulation content. The need to acknowledge structural sources of mental health problems is clear, and our study indicates how a sociocultural framework may be used for that.

Use of the Transcultural Integrative Ethical Decision-Making Model in the Care of a Rohingya Infant With Hypoplastic Left Heart Syndrome

Objective:Concerns have been expressed about the challenges of upholding traditional Westernized psychological ethical boundaries while honoring the cultural and religious values of diverse cultures.Method:The Transcultural Integrative Ethical Decision-Making Model was utilized to resolve ethical dilemmas related to a refugee Rohingya family during a pediatric hospitalization.Results:Culturally informed case conceptualization and peer consultation were critical in assisting the decision-making process to balance psychological ethical guidelines and the distinctive needs of the family.Conclusion:The Transcultural Integrative Ethical Decision-Making Model can serve as a guide for psychologists to help make ethical decisions while working with families from diverse cultures that may not share the values associated with a Westernized mental healthcare approach.

‘Understanding our family’: Co-producing empowering & non-blaming stories with families in a CAMHS inpatient unit

The influence and importance of a family on children and young people’s mental health and wellbeing has been well documented (Kana’Iaupuni et al., 2005). Therefore, when children and young people encounter mental health services it is vital that a family focused perspective is prioritised (Gross & Goldin, 2008). However, efforts to consider and explore family dynamics in the context of children’s lives have often been blaming and overly expert (Dallos, 2019). There have been some attempts to move away from individualistic understandings of children’s distress to more family functional formulations (Dallos, et al., 2020). Nonetheless, there remains very little literature and evidence around involving families in co-producing psychological formulations in a non-blaming, transparent and empowering way, but in particular this scarcity is evident in inpatient child and adolescent mental health services (CAMHS). The present paper will outline a co-produced family focused formulation called ‘Understanding Our Family’ developed for inpatient CAMHS settings by the authors. ‘Understanding Our Family’ is informed by the Power Threat Meaning Framework (Johnstone, et al., 2018) to provide an alternative understanding to what brings families into contact with inpatient settings and to offer a de-stigmatising and empowering narrative to families subject to multiple stressors and complex systems. The present article discusses and critically interrogates the challenges and opportunities of developing, implementing, and embedding this approach within a CAMHS inpatient setting in the North of England.

Identifying and responding to trauma in children, young people and families in a hospital setting

Children and young people may enter a hospital system for a number of reasons including for a diagnosis of a long term, lifelimiting or life-threatening condition, a change in health status or a hospital admission for medical management of a mental health condition. All of which can be conceived of as potential traumatic stressors. For parents and families the subsequent medical investigations and treatments themselves can be traumatic to witness in a loved-one, often accompanied with a high sense of threat, and a low sense of self-efficacy and control, with outcomes often uncertain. Children, young people and families who come to the hospital come with a full range of histories and experiences, from all walks of life and all kinds of cultural backgrounds, that can impact on their ability to trust healthcare staff or to cope with the feelings evoked in this setting. Similarly, hospital staff come to their chosen careers with a range of experiences that can lead to intense emotional responses, are impacted by repeated exposure to traumatic events, and by vicarious trauma from witnessing the trauma of children, young people and families. As well as working directly with children, young people and families, a key role of the psychologist in the paediatric setting is to help contain this anxiety by helping them and staff make sense of and respond to the challenges they face, through sharing a psychological formulation, collaboration, teaching and contributing to the development of policies and procedures that enable the system to prevent, identify and respond effectively to trauma.

B - 112 Navigating your Survivorship Journey: Leveraging the Biopsychosocial Model in Conceptualization and Continued Care for Brain Tumor Survivors.

A neuropsychological assessment provides a limited snapshot of functioning based on the aperture of the lens selected. The journey of cancer survivorship is complex, requiring navigation of the social and cultural milieu (Carpentieri et al., 2003; Hoffmann-Lamplmair et al., 2023; Hörnquist et al., 2015; Otth et al., 2021). A biopsychosocial model provides a holistic approach to understanding survivorship (Walsh et al., 2016). The case conceptualization of a 17-year-old non-Hispanic Asian male posterior fossa tumor survivor, 13years post-treatment, will be discussed. Longitudinal neuropsychological assessment data [2011-2023] were compared to identify neurocognitive late effects associated with chemoradiotherapy. Parent- and self-reports of adaptive, behavioral, and emotional functioning were obtained. The impact of reduced verbal communication and overreliance on parent-reports are compared to self-report and clinical assessment data. Neurocognitive late effects (executive functioning, processing speed, verbal fluency) were prominent in 2023. Although two extended episodes of atypical behavior emerged in the past year, parent- and self-reports did not indicate any elevated concerns for emotional dysregulation. However, social desirability bias, tendency to underreport emotional symptoms, and an internal negative self-view were significant on self-reports. Although some changes in functioning could be explained by late effects of treatment (Schreiber et al., 2017), others may be better accounted for by social and cultural factors that impact the conceptualization and acceptance of emotional symptoms (Kim et al., 2013). Acknowledging and disclosing emotional difficulties (Liw et al., 2022), as well as seeking mental health care (Abe-Kim et al., 2007), is culturally mediated and can be both protective and/or limiting.

Experiential avoidance in anxiety and depression: Insights from working with an older adult client

This article presents the single case of Janet, whose GP referred her to an Older Adult Community Mental Health Team. Janet engaged in cognitive behaviour therapy (CBT) for depression and generalised anxiety, using Laidlaw’s comprehensive case conceptualisation for older people as a guide, and with a key focus on experiential avoidance as a maintaining factor for her distress in the context of grief. Experiential avoidance, is suggested to significantly mediate the relationship between depression and generalised anxiety, which are both common for older adults; however, the evidence base is limited for treatment and guidelines are unclear. Outcome measures demonstrated reductions in self-reported low mood, anxiety and worry. Further research on the role of experiential avoidance in anxiety and depression in older adults is needed to establish a clearer understanding of its role in maintaining emotional distress within this population. Janet provided consent for the case study to be published within an academic journal. Pseudonyms and amended demographic details are used to preserve confidentiality.

Linehan's biosocial model applied to emotion dysregulation in autism: a narrative review of the literature and an illustrative case conceptualization.

Emotion dysregulation (ED) is a transdiagnostic difficulty prevalent in autism spectrum condition (ASC). Importantly, recent research has suggested that ED is involved in self-harm and suicidality. Pre-existing models on the etiology of ED in ASC focus mainly on biological factors to ASC features, such as sensory sensitivities, poor flexibility, and sensitivity to change. However, although psychosocial factors seem to play a role in the emergence of ED in ASC as well (e.g., childhood maltreatment and camouflaging), there is a lack of a comprehensive model conceptualizing biosocial factors involved in ED in autistic people. Linehan's biosocial model (1993) is one of the leading etiological models of ED in borderline personality disorder (BPD). It conceptualizes ED as emerging from transactions between a pre-existing emotional vulnerability in the child and an invalidating developmental environment. Beyond its clinical relevance, Linehan's model has gathered empirical evidence supporting its pertinence in BPD and in other psychiatric disorders. Although ASC and BPD are two distinct diagnoses, because they may share ED, Linehan's biosocial model might be useful for understanding the development of ED in ASC. Hence, this article aims to provide an application and extension of Linehan's model to conceptualize ED in ASC. To do so, we conducted a narrative review of the literature on ED and its underlying factors in ASC from a developmental perspective. To investigate the pertinence of the biosocial model applied to ED in autistic people, we were interested on data on (i) ED and its behavioral correlates in ASC, in relation to the biosocial model, (ii) the potential biological and psychosocial correlates of ED in ASC and (iii) the overlapping difficulties in ASC and BPD. Finally, to assess the pertinence of the model, we applied it to the case of an autistic woman presenting with ED and suicidal behaviors. Our review and application to the case of an autistic woman suggest that ED in ASC encompasses factors related to both biological and psychosocial risk factors as conceptualized in the BPD framework, although in both domains ASC-specific factors might be involved.

The ethical imperative to honor autistic clients' autonomy in mental health treatment.

Autistic adolescents and adults commonly experience mental health concerns; however, mental health clinicians may hold implicit stigmatizing views of autism that contribute to case conceptualization and treatment goal setting that align more with caregivers' than clients' goals. This impingement on client autonomy is concerning, problematic, and potentially harmful for autistic clients who are of an age to set their own treatment agenda regardless of co-occurring intellectual disability and/or language delays. An application of the shared decision-making framework, an evidence-based tool for promoting client autonomy, can help to avoid these challenges in treatment. In this perspective, we use a case vignette as an anchor for discussing the imperative of honoring autistic clients' autonomy in mental health treatment and guiding shared decision-making to reduce stigma, promote autonomy, and increase collaborative care for autistic clients in mental health treatment.

In-Person and In-Home Teleneuropsychological Assessments With Youth With Neurodevelopmental Disorders: What’s the Difference?

Psychoeducational assessments provide clinicians with the foundation for diagnostic determinations and meaningful recommendations for youth with neurodevelopmental disorders. Due to the COVID-19 pandemic, the field shifted from seeing clients face-to-face (FTF) to conducting evaluations virtually via teleneuropsychology (TNP) in the client’s own home. The current study sought to determine the equivalence of cognitive and achievement scores obtained in the context of FTF versus TNP testing. Nineteen youth with diverse neurodevelopmental disorders completed the Woodcock Johnson-Fourth Edition (WJ-IV). Results suggest generally equivalent results, with the caveat that scores from measures of Fluid Reasoning and Auditory Processing were significantly different across testing modalities. Environmental factors, characteristics of the clients, administration challenges, technical considerations, and practice effects may have contributed to differences in scores. These findings have implications for assessment standardization, case conceptualization, and implementation of recommendations in the school setting when psychoeducational assessments are conducted virtually.

Chronic tinnitus: An interplay between somatic and psychological factors

Chronic tinnitus is acommon, sometimes highly distressing phenomenon that can be triggered and maintained by an interplay of physical and psychological factors. Partnering with clinical psychology and psychosomatic medicine, modern otolaryngology integrates both medical (e.g., hearing loss) and psychological influences (e.g., interactions between biographical experiences, personality traits, subjective evaluation of intrapsychic and interpersonal stimuli, emotional states, and intrapsychic or interpersonal emotion regulation strategies). Both groups of variables can influence the intensity and course of chronic tinnitus symptomatology both directly and indirectly, whereby the quality and relative degrees of psychological and physical components in aperson's self-experience can fluctuate. With this in mind, the present article distinguishes between chronic tinnitus symptomatology with or without hearing loss-and strongly advocates for an integrated understanding of the symptomatology within aholistic psychological frame of reference. After abrief introduction to the principles of psychosomatic medicine and psychotherapy, the article discusses psychological case conceptualization using avulnerability-stress-coping (VSC) model as an example, outlines clinical aspects and diagnostics of chronic tinnitus symptomatology, and concludes with aconceptualization of chronic tinnitus-related distress as afunction of person-centered VSC interactions.

A Systematic Review of Response Styles Among Latinx Populations.

Culture influences responses to psychological measurements in ways unrelated to target constructs, thus biasing test scores and potentially contributing to under- and over-diagnosis of mental health problems in populations for which measures have not yet been normed. We conducted a systematic review of publications addressing response style among Latinx population groups in North and South America. In a final corpus of 24 studies, Latinx/Latin American populations were generally found to exhibit higher levels of extreme response style (n = 17), acquiescent response style (n = 10), and socially desirable responding (n = 5). The few publications (n = 3) that investigated midpoint responding reported no differences. Seven publications (29%) attempted to adjust scores to mitigate response style bias, using both scale design and statistical techniques. Findings suggest that researchers and clinicians should directly assess culturally patterned response style as a construct, rather than inferring style indirectly using other measures. For clinicians, knowledge of response style represents another facet of case conceptualization.