Cognitive Behavioural Case Formulation Research Articles

An AAIDD-informed framework for cognitive behavioral case formulation and cognitive behavior therapy for young people with mild intellectual disabilities or borderline intellectual functioning.

An AAIDD-informed framework for cognitive behavioral case formulation and cognitive behavior therapy for young people with mild intellectual disabilities or borderline intellectual functioning.

An AAIDD-informed framework for cognitive behavioral case formulation and cognitive behavior therapy for young people with mild intellectual disabilities or borderline intellectual functioning.

An AAIDD-informed framework for cognitive behavioral case formulation and cognitive behavior therapy for young people with mild intellectual disabilities or borderline intellectual functioning.

Research and clinical approaches to addressing disparities in therapy access for individuals with ID: A commentary on “An AAIDD-informed framework for cognitive behavioral case formulation and cognitive behavior therapy”.

Research and clinical approaches to addressing disparities in therapy access for individuals with ID: A commentary on “An AAIDD-informed framework for cognitive behavioral case formulation and cognitive behavior therapy”.

Treatment of Comorbid Pica and Generalized Anxiety Disorder: A Case Study

This case report describes the assessment and treatment of a treatment-naïve 36-year-old Hispanic/Latina female with comorbid pica and generalized anxiety disorder (GAD), and iron-deficiency anemia. At the onset of treatment, the client consumed chalkboard chalk and vermiculite from potting soil approximately three times per week and presented with moderate-severity GAD. Assessment and treatment occurred over 24 weekly outpatient individual sessions. Treatment was delivered in concert with medical intervention to address anemia. A cognitive-behavioral case formulation was developed from multiple assessment sources. A process-based cognitive-behavioral therapy (CBT) intervention approach was used to target GAD and pica simultaneously, which included psychoeducation, self-monitoring, arousal reduction skills, cognitive training (reappraisal, distancing), and behavior modification/stimulus control techniques. Barriers to treatment and their solutions are discussed. At the end of treatment, the client demonstrated increased insight and understanding of her worry symptoms and pica behavior, acquired cognitive skills and arousal reduction strategies for managing GAD, and reported less than one episode of pica per week. The identified assessment and treatment approach is worthy of future investigation to inform empirically based treatment development efforts, especially for pica.

Idiographic measurement of depressive thinking: development and preliminary validation of the Sentence Completion Test for Chronic Pain (SCP).

Background and aims Depression is a common feature of chronic pain, but there is only limited research into the content and frequency of depressed cognitions in pain patients. This study describes the development of the Sentence Completion Test for Chronic Pain (SCP), an idiographic measure for assessing depressive thinking in chronic pain patients. The sentence completion task requires participants to finish incomplete sentences using their own words to a set of predefined stems that include negative, positive and neutral valenced self-referenced words. In addition, the stems include past, future and world stems, which reflect the theoretical negative triad typical to depression. Complete responses are coded by valence (negative, positive and neutral), pain and health-related content. Methods A total of 89 participants were included in this study. Forty seven adult out-patients formed the depressed pain group and were compared to a non-clinical control sample of 42 healthy control participants. This study comprised several phases: (1) theory-driven generation of coding rules; (2) the development of a coding manual by a panel of experts (3) comparing reliability of coding by expert raters without the use of the coding manual and with the use of the coding manual; (4) preliminary analyses of the construct validity of the SCP. The internal consistency of the SCP was tested using the Kuder-Richardson coefficient (KR-20). Inter-rater agreement was assessed by intra-class correlations (ICC). The content and construct validity of the SCP was investigated by correlation coefficients between SCP negative completions, the Hospital Anxiety and Depression Scale (HADS) depression scores and the number of symptoms on the Structured Clinical Interview for DSM-IV-TR (SCID). Results As predicted for content validity, the number of SCP negative statements was significantly greater in the depressed pain group and this group also produced significantly fewer positive statements, compared to the healthy control group. The number of negative pain completions and negative health completions was significantly greater in the depressed pain group. As expected, in the depressed pain group, the correlation between SCP negatives and the HADS Depression score was r=0.60 and the correlation between SCP negatives and the number of symptoms on the SCID was r=0.56. Conclusions The SCP demonstrated good content validity, internal consistency and inter-rater reliability. Implications Uses for this measure, such as complementing questionnaire measures by an idiographic assessment of depressive thinking and generating hypotheses about key problems within a cognitive-behavioural case-formulation, are suggested.

Person‐specific validation and testing of functional relations in cognitive‐behavioural case formulation: Guidelines and options

Although a number of manuals describe how to develop a cognitive-behavioural case formulation (CBCF) to assist the clinician in developing and implementing tailored CB treatment for complex or comorbid cases, methods to evaluate and test functional hypotheses in the formulation for a particular case are not widely known or used. Thus, formulation-based, tailored treatments for such cases are likely to be guided by case formulations of uncertain validity. The present article presents guidelines and choices available to the clinical trainee, researcher, or practitioner planning to use a person-specific (PS) approach to testing CBCF hypotheses about functional relations between triggers, cognitions, and distress or dysfunction. This approach involves repeated assessments completed by the client using an individualized questionnaire that includes both nomothetic and idiographic items of greatest relevance to the client. Guidelines and options for developing this questionnaire and for data collection within the context of a collaborative therapist-client relationship are described. PS data analyses are then used to test case formulation hypotheses that vary in complexity from simple bivariate relations to complex dynamic mediation. A case example using this PS approach is described. Simpler options for the PS evaluation of a CBCF usable by practitioners and trainees as well as more complex options for clinical researchers are included.

Cognitive Behavioral Therapy in a One-Session Treatment for a Preschooler With Specific Phobias.

Anxiety disorders among preschool-aged children are as prevalent as in older children, yet younger children are even less likely to receive treatment for these frequently impairing childhood disorders (Egger & Angold, 2006). Specific phobias (SPs) are often the earliest form of anxiety to onset, affect 2.3% of preschoolers (Egger & Angold, 2006), and tend to be stable from 3 years of age to at least 6 years of age (Bufferd, Dougherty, Carlson, Rose, & Klein, 2012). Recently, our group developed and piloted a modified intensive one-session treatment (OST) incorporating play therapy for preschoolers with SP (Farrell, Kershaw, & Ollendick, in press). Given that highly fearful young children may find concentrated, rapid exposure therapy highly confronting, we integrated play therapy into the commencement of this treatment to (a) assist with rapid rapport building with the therapist and (b) enhance the child's motivation through engaging them with play. An initial, controlled, baseline case series (N = 4) provided preliminary evidence of the feasibility, acceptability, and effectiveness of this innovative one-session (3 hours) therapy-POP! Pre-schoolers Overcoming Phobias (POP; Farrell et al., in press). The approach combines child-centered, nondirective play therapy (during Hour 1) and empirically supported OST (during Hours 2 and 3), with 4-year-old preschool children with clinical SPs of dogs. This article presents a case description of POP, describing the assessment approach, cognitive-behavioral case formulation, and intensive treatment of a 4-year-old girl who presented with a severe SP of dogs, along with various other comorbid SPs.

How valid is your case formulation? Empirically testing your cognitive behavioural case formulation for tailored treatment

AbstractAlthough clinicians have used cognitive behavioural case formulations (CBCFs) to guide treatment for many years, the validity of the case formulation (CF) is rarely evaluated. Given the central role of the formulation in treatment planning, particularly for complex or comorbid cases, a straightforward method to empirically evaluate the validity of the CBCF could increase the effectiveness of a treatment plan tailored for a particular client. This article describes a step-by-step, person-specific approach to evaluating a CBCF that can be used for appropriate cases in a clinical practice or especially a clinical training setting. The evaluation focuses on discriminant validity of person-specific scales and constructs and patterns of predicted functional relationships between idiosyncratic cognitions and distress. The approach is illustrated with an adult seen in a training clinic who was diagnosed with generalized anxiety and recurrent major depressive disorders and who completed 28 brief end-of-day, individualized questionnaires. The clinician's CBCF hypotheses were empirically evaluated using mostly simple statistical analyses available in readily accessible worksheets. Intervention implications of the CF evaluation are discussed.

On Correlated Errors

On Correlated Errors

Integrating Cognitive-Behavioral and Cognitive-Interpersonal Case Formulations: A Case Study of a Chinese American Male

This case study presents TC, a mid-20s Chinese American male with Major Depressive Disorder and Generalized Anxiety Disorder, whom I saw in therapy for 41 sessions. Case formulation and treatment were based on an integration of three approaches: Beck and his group's Cognitive Therapy; Persons and Tompkins' Cognitive-Behavioral Case Formulation model; and Safran and Segal's model of Cognitive-Interpersonal Cycle. Specific interventions such as restructuring and metacommunication were implemented. The case is notable for its emphasis on the value of examining and constructively using a cognitive therapist's personal reactions to a client's dramatically negative interpersonal behaviors, and on the importance of using the here-and-now in the exploration and modification of the client's cognitions and behaviors. Further, it suggests the possibility of a culture-specific challenge in doing cognitive-behavioral therapy (CBT) with clients of Chinese origin. Specifically, the case shows how certain thoughts that were drawn from cultural values of achievement and humility (e.g., Keep telling yourself that you are not good enough, and Don't ever be satisfied with your accomplishments) may have contributed to this client's depression and anxiety, while at the same time these thoughts also seemed to motivate this self-disciplined individual to become a more successful person. Specific clinical implications are discussed.

A cognitive behavioral case formulation framework for treatment planning in anxiety disorders

A cognitive behavioral case formulation framework (CBCFF) for anxiety disorders is presented, in which the etiological and maintaining factors for the anxiety disorders are outlined in a single, simple, visual framework. This CBCFF is then used to demonstrate the specific links of different cognitive and behavioural treatment components to aspects of the case formulation. An example is used to illustrate the use of the CBCFF, highlighting its utility with novel presentations for which no manualized treatments exist.

Sentence completion test for depression (SCD): An idiographic measure of depressive thinking

This study set out to investigate the reliability and validity of the Sentence Completion Test for Depression (SCD) as a clinical measure. In contrast to questionnaire measures of depressive thinking, respondents finish incomplete sentences using their own words. This elicits idiographic information concurrent with measuring depressive thinking. In Study 1, measures of negative thinking were tested between a depressed group and a non-depressed control group. A preliminary item analysis was conducted and replicated on separate samples in Study 2. Psychometric properties of the test were investigated. In Study 3, idiographic validity and sensitivity to change were explored in a sample of clinical cases with reference to cognitive-behavioural case-formulation. In Study 1, the depressed group produced more negatives and fewer positives, and the SCD demonstrated good content validity, internal consistency and inter-rater reliability. The preliminary short-form had comparable psychometric properties, and these were replicated on new samples in Study 2. Sensitivity and specificity values were above 90% in both studies. In Study 3, idiographic content generated hypotheses about target problems and dysfunctional beliefs within cognitive-behavioural case-formulation, and SCD scores were sensitive to clinical change. The SCD demonstrates good construct validity, internal consistency, inter-rater reliability, sensitivity, and specificity. It offers an idiographic assessment of depression that is complementary to questionnaire measures, particularly by generating hypotheses about target problems and dysfunctional beliefs within a cognitive-behavioural case-formulation. This is achieved without loss to reliability and validity at the nomothetic level.

Case formulation in TADS CBT

For the Treatment for Adolescents With Depression Study (TADS), a cognitive-behavioral therapy (CBT) manual was developed with the aim of balancing standardization and flexibility. In this article, we describe the manual's case formulation procedures, which served as one major mechanism of flexibility in TADS CBT. We first describe the essential components of a cognitive-behavioral case formulation. We then present a rationale for including individualized case formulation in manual-based treatments and clinical effectiveness studies, and discuss the specific case of TADS. We illustrate case formulation in an effectiveness study with a composite “case” of a 15-year-old male treated with TADS CBT. Clinical implications and future directions are discussed.

Using a Case Formulation to Manage Treatment Nonresponse

All clinicians must at times manage a treatment that isn’t progressing. A case formulation offers clinicians a systematic way to think about a case, thereby increasing the likelihood that they will be able to overcome difficulties and achieve a successful treatment outcome. This article describes the use of a cognitive-behavioral (CB) case formulation to solve problems in the client-therapist collaborative relationship and to improve compliance with the goals and tasks of therapy. The use of CB case formulation to plan and adjust the treatment of a multiproblem client is presented.

Interrater relability of cognitive-behavioral case formulations

This study tested the hypothesis that clinicians can agree on two aspects of a cognitive-behavioral case formulation: the client's overt problems and underlying cognitive mechanisms. To test this hypothesis, 46 clinicians listened to part or all of an initial interview for two anxious, depressed clients and then listed each client's overt difficulties and rated each client's underlying cognitive mechanisms. When groups of five clinicians were considered, clinicians showed moderate agreement in listing overt problems, and, except for one type of belief (dysfunctional attitudes) for one client, high agreement on ratings of underlying cognitive mechanisms.