CBT For Chronic Illness And Palliative Care: A Workbook and Toolkit

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CBT For Chronic Illness And Palliative Care: A Workbook and Toolkit Nigel Sage, Michelle Sowden, Liz Chorlton and Andrea Edeleanu Slide Set 6 Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Formulation in CBT Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

What is a formulation? Shared understanding of the problem Onset of the problem Maintenance of the problem Jigsaw Often several possible formulations Choose the best ‘fit’ Revise over time Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Hot cross bun or formulation? Thoughts Emotions Behaviour Physical sensations Environmental influences Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Hot cross bun or formulation? A formulation attempts to describe a particular sequence of thoughts, emotions, behaviour or physical sensations that follow a triggering event and lead to the presenting problem Vicious cycle Downward spiral Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Vicious cycle formulation Triggering event Wakes in the night with chest pain Thought I’m having a heart attack Emotion Panic Physical sensations Heart racing, chest pain, light headed Unhelpful behaviour Lies awake monitoring pulse (presenting problem behaviour) Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Downward spiral formulation Triggering event - Hears an ambulance Thought - “he’s had an accident” Physical sensation - Heart pounding, dry mouth, clammy Emotion - Fear Behaviour - Jumps up, paces the room Thought - “He’s so inconsiderate. If it wasn’t him, he should be home by now” Emotion - Anger Physical sensation - Tense stomach, knotted muscles, hot Thought - “Here he is. How dare he keep doing this to me?” Presenting problem behaviour – shouts at son as he walks in the room Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Formulation: Summary Different ways to present the information Written description Flowchart Personal preference – words or diagrams Aims to Reduce complexity make sense of the information for the patient Provide guidance for interventions Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

CBT For Chronic Illness And Palliative Care: A Workbook and Toolkit Nigel Sage, Michelle Sowden, Liz Chorlton and Andrea Edeleanu Publisher: John Wiley & Sons (2008) ISBN: 978-0470517079 Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008