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Is cognitive case formulation science or science fiction?
Abstract
As with all systematic models of therapy, cognitive therapy distills a theory to the understanding of particular cases through the case formulation method. This article sets out criteria to evaluate whether cognitive case formulation follows the process of scientific inquiry, and it questions whether the formulation method meets these criteria. In terms of the evidence base for the cognitive theory that underpins cognitive case formulation, the research suggests that although the descriptive elements of cognitive theory are substantiated, the explanatory elements have received less support. In terms of the scientific status of the cognitive case formulation process, current evidence for the reliability of the cognitive case formulation method is modest, at best. There is a striking paucity of research examining the validity of cognitive case formulations or the impact of cognitive case formulation on therapy outcome. Implications for the clinical use of cognitive case formulation within a scientistpractitioner model are discussed, and potential programs of research to evaluate the case formulation method are described. Key words: depression, anxiety, personality disorder, cognitive therapy, case formulation, cognitive models.
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“They also included inconsistent evidence of change processes using measures derived from traditional theoretical models 34,35”
From “Third-wave” cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry (2021) · cites this paper as [34]
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“There is little existing evidence that demonstrates a link between formulation and outcome generally (Bieling and Kuyken, 2003), but it would be anticipated that providing staff with a framework for understanding biopsychosocial problems would lead to improved outcomes.”
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“However, the evidence for the efficacy of this diagram in improving outcomes is weak (Bieling & Kuyken, 2003), and so it could be removed from the intervention.”
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“There appears to be good reliability for the descriptive elements of some formulations but not necessarily the mechanistic elements of a formulation (Bieling & Kuyken, 2003).”
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“Although clinicians value them highly in practice, the reliability and validity of formulations is unclear (Bieling & Kuyken, 2003), with a number of potential issues being highlighted (see Kuyken et al. 2005; Mumma, 2011).”
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“Indeed, Horowitz and colleagues (1989) proposed that a CF helps the therapist to understand the nature of the therapeutic relationship and thus elicit greater empathy for the client beyond the presenting problems [47] (see also [31,48]).”
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Risk Formulation: The New Frontier in Risk Assessment and Management
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Case Formulation: A Review and Overview of this Volume
Sturmey, P. (2009) · doi:10.1002/9780470747513.ch1 · Cited by 11
Chronischer Tinnitus im Wechselspiel somatischer und psychischer Faktoren
Boecking, B., Brüeggemann, P., Rose, M., & Mazurek, B. (2023) · HNO · doi:10.1007/s00106-023-01370-2 · Cited by 10
Core Principles in Cognitive Therapy with Youth
Friedberg, R. D., & Brelsford, G. M. (2011) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2011.01.009 · Cited by 10
Clinical errors in cognitive–behavior therapy.
Kim, E. H., Hollon, S. D., & Olatunji, B. O. (2016) · Psychotherapy · doi:10.1037/pst0000074 · Cited by 11
When, how and why does indirect formulation work? Proposing a ‘shared formulation’ framework
Jackman, L. (2013) · Clinical Psychology Forum · doi:10.53841/bpscpf.2013.1.245.25 · Cited by 10
Evaluating the role of formulation in counselling psychology: A systematic literature review
Challoner, H., & Papayianni, F. (2018) · The European Journal of Counselling Psychology · doi:10.5964/ejcop.v7i1.146 · Cited by 10
“Despite such concerns, studies by Bieling and Kuyken (2003) and Eells and Lombart (2003) attempted to compare formulations for validity and accuracy.”
BackgroundMethodResultInfluentialPilgrim, D. M., & Carey, T. A. (2010) · Social Theory & Health · doi:10.1057/sth.2010.11 · Cited by 9
Taxonomy as a contextualist views it
Hayes, S. C. (2004) · Journal of Clinical Psychology · doi:10.1002/jclp.20064 · Cited by 9
“Support for the hypothesized mediators of change in CBT is poor, particularly in areas that are causal and explanatory rather than descriptive (Beck & Perkins, 2001; Bieling & Kuyken, 2003).”
BackgroundThrower, N. E., Berry, K., Johnston, I., & Morris, L. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2998 · Cited by 8
Current Issues in Case Formulation
Mumma, G. H. (2011) · doi:10.1002/9781119977018.ch2 · Cited by 8
de Kwaadsteniet, L., & Hagmayer, Y. (2017) · Clinical Psychological Science · doi:10.1177/2167702617712270 · Cited by 7
The value of formulation: A question for debate
Butler, G. (2006) · Clinical Psychology Forum · doi:10.53841/bpscpf.2006.1.160.9 · Cited by 7
Sassaroli, S., Caselli, G., Mansueto, G., Palmieri, S., Pepe, A., Veronese, G., & Ruggiero, G. M. (2021) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-021-00421-3 · Cited by 7
“…generally attribute a pivotal role to case formulation that is not merely instrumental, but theoretically consistent with the main focus of CBT (Bieling & Kuyken, 2003; Butler, 1998; Persons & Tompkins, 1 3 1997), and regard case formulation as a vital part of their practice (Flitcroft et al.,…”
BackgroundKilcullen, M., & Day, A. (2017) · Clinical Psychologist · doi:10.1111/cp.12141 · Cited by 6
Interviewing and Case Formulation
Koerner, N., Hood, H. K., & Antony, M. M. (2014) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780199328710.013.024 · Cited by 5
Jefferis, S., Fantarrow, Z., & Johnston, L. H. (2020) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12311 · Cited by 5
Metadata
- Authors
- Bieling, P. J., & Kuyken, W.
- Affiliations
- St. Joseph’s Healthcare Hamilton (CA)
- University of Exeter (GB)
- Venue
- Clinical Psychology: Science and Practice
- Published
- 2003
- Volume
- 10
- Issue
- 1
- Pages
- 52-69
- ISSN
- 0969-5893 (ISSN-L)
- 1468-2850
- OpenAlex
- W2056187445
- Cited by
- 174
- References
- 163
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 11 · 2020: 7 · 2019: 6 · 2018: 6 · 2017: 9 · 2016: 15 · 2015: 8 · 2014: 8 · 2013: 11 · 2012: 6
- FWCI
- 6.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology Science and Practice (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- cognitive therapy, scientific validity, reliability statistics, treatment outcomes, scientist-practitioner model, cognitive models, depression, anxiety, personality disorders, evidence base
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