Cognitive Behavioural Therapy (CBT) is more than a set of techniques—it’s a structured, collaborative approach to understanding and addressing psychological difficulties. At the heart of CBT lies formulation, a tool that integrates psychological theory, clinical expertise, and the client’s lived experience into a coherent map of their difficulties and the possible pathways to change.

What is a CBT Formulation?

A CBT formulation is not just a diagnostic label—it’s a hypothesis-driven framework that answers:

Why is this person, with this history, experiencing these problems now—and what maintains them?

A good formulation is:

• Individualised – tailored to the client’s history, beliefs, and coping styles.

• Collaborative – created with the client, not imposed on them.

• Dynamic – revised as therapy unfolds and new insights emerge.

Why Formulation Matters

Research shows that formulation strengthens therapy in multiple ways:

• Provides a shared understanding of problems.

• Helps to prioritise treatment goals.

• Guides the selection of appropriate interventions.

• Validates the client’s experiences, enhancing the therapeutic alliance.

• Offers hope by showing how change is possible.

Key Components of a CBT Formulation

The widely used five-part model (sometimes called the hot-cross bun model) highlights interconnected domains:

• Situation/Trigger – What activates distress?

• Thoughts – What automatic thoughts/appraisals arise?

• Emotions – What feelings are experienced?

• Physical Sensations – What bodily reactions occur?

• Behaviours – How does the person respond?

These domains interact in feedback loops that sustain difficulties.

Levels of Formulation

• Cross-sectional (present-focused): A “here-and-now” snapshot of how difficulties are maintained.

• Longitudinal (developmental): A deeper map linking early experiences, core beliefs, and current patterns—often pointing toward schema-level interventions.

Writing the Formulation: Step by Step

1. Assessment & Information Gathering

   • Use interviews, questionnaires, and behavioural observations.

   • Explore presenting concerns, history, strengths, and coping methods.

2. Identify Patterns

   • Look for reinforcing cycles (e.g., avoidance reducing anxiety short-term but maintaining it long-term).

3. Map Maintenance Cycles

   • Diagram key loops; visual formulations often help clients see connections clearly.

4. Link Past and Present

   • Highlight how early experiences shaped beliefs like “I’m unlovable” and how these drive current behaviours.

5. Highlight Strengths and Resilience

   • Balance vulnerabilities with protective factors—especially important in sensitive areas like suicide prevention.

6. Collaborative Feedback

   • Share the draft with the client, refine together, and ensure it resonates.

Common Pitfalls to Avoid

• Using overly technical language – keep it accessible.

• Overpathologising – remember to include strengths.

• Treating it as static – a good formulation evolves with therapy.

Bringing It to Life in Therapy

A formulation isn’t just for your notes—it’s the roadmap for change. It guides interventions such as:

• Behavioural experiments.

• Thought records.

• Schema-focused work.

It also acts as a reflective tool for therapists, aiding supervision and helping treatment stay focused.

Final Thoughts

Writing a CBT formulation is both an art and a science. It blends theory with the client’s unique story, offering a clear framework for recovery. Done well, it transforms therapy from a set of techniques into a collaborative journey of meaning-making and change.

About My Practice

I’m Dr. Srinivas Rajkumar T, Psychiatrist based in Chennai. I integrate evidence-based approaches such as CBT into my clinical work to help patients achieve meaningful recovery.

I currently consult at Apollo Clinic, Velachery.
📞 Phone: 8595155808

If you are seeking professional support for anxiety, depression, stress, or other psychological concerns, you can book an appointment with me at Apollo Clinic, Velachery.