Hostname: page-component-7c8c6479df-fqc5m Total loading time: 0 Render date: 2024-03-28T20:45:21.737Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  20 July 2016

Gregory H. Mumma*
Affiliation:
Department of Psychological Sciences, Texas Tech University, Lubbock TX, USA
Jonathan Fluck
Affiliation:
Department of Psychological Sciences, Texas Tech University, Lubbock TX, USA
*
*Author for correspondence: Dr G. H. Mumma, Department of Psychological Sciences, Texas Tech University, Lubbock TX, USA79409-2051. (email: g.mumma@ttu.edu)

Abstract

Although 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.

Type
Review of Assessment Tools and Methods
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Recommended follow-up reading

Bieling, PJ, Kuyken, W (2003). Is cognitive case formulation science or science fiction? Clinical Psychology: Science and Practice 10, 5269.Google Scholar
Haynes, SN, O'Brien, WH, Kaholokula, JK (2011). Behavioral Assessment and Case Formulation. Hoboken, NJ: Wiley.Google Scholar
Mumma, GH (2011). Validity issues in cognitive-behavioral case formulation. European Journal of Psychological Assessment 27, 2949.Google Scholar
Mumma, GH, Mooney, SR (2007). Comparing the validity of alternative cognitive case formulations: a latent variable, multivariate time series approach. Cognitive Therapy and Research 31, 451481.Google Scholar
Tarrier, N (2006). Case Formulation in Cognitive Behavior Therapy: The Treatment of Challenging and Complex Cases. London: Routledge.Google Scholar

References

Anderson, JC, Gerbing, DW (1988). Structural equation modeling in practice: a review and recommended two-step approach. Psychological Bulletin 3, 411423.Google Scholar
Anker, MG, Duncan, BL, Sparks, JA (2009). Using client feedback to improve couple therapy outcomes: a randomized clinical trial in a naturalistic setting. Journal of Consulting and Clinical Psychology 77, 693704.Google Scholar
Bakker, GM (2008). Problem-maintaining circles: case illustrations of formulations that truly guide therapy. Clinical Psychologist 12, 3039.Google Scholar
Barlow, DH (2008). Clinical Handbook of Psychological Disorders: a Step-by-Step Treatment Manual. New York: The Guilford Press.Google Scholar
Barlow, DH, Farchione, TJ, Fairholme, CP, Ellard, KK, Boisseau, CL, Allen, LB, Ehreneich-May, J (2011). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide. New York: Oxford University Press.Google Scholar
Beck, AT, Epstein, N, Brown, G, Steer, RA (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893897.Google Scholar
Beck, AT, Haigh, EAP (2014). Advances in cognitive theory and therapy: the Generic Cognitive Model. Annual Review of Clinical Psychology 10, 124.CrossRefGoogle ScholarPubMed
Beck, AT, Rush, AJ, Shaw, BF, Emery, G (1979). Cognitive Therapy of Depression. New York: Guilford.Google Scholar
Beck, AT, Steer, RA (1988). BHS: Beck Hopelessness Scale: Manual. San Antonio: Psychological Corporation.Google Scholar
Beck, AT, Steer, RA, Brown, GK (1996). BDI-II: Beck Depression Inventory – Second Edition: Manual. San Antonio: Psychological Corporation.Google Scholar
Beck, JS (2011). Cognitive Behavior Therapy: Basics and Beyond, 2nd edn. New York: Guilford.Google Scholar
Bieling, PJ, Kuyken, W (2003). Is cognitive case formulation science or science fiction? Clinical Psychology: Science and Practice 10, 5269.Google Scholar
Borckardt, JJ, Nash, MR, Murphy, MD, Moore, M, Shaw, D, O'Neill, P (2008). Clinical practice as natural laboratory for psychotherapy research: a guide to case-based time-series analysis. American Psychologist 63, 7795.Google Scholar
Clark, DA, Beck, AT (2010). Cognitive Therapy of Anxiety Disorders: Science and Practice. New York: Guilford.Google Scholar
Clark, DA, Beck, AT, Alford, BA (1999). Scientific Foundation of Cognitive Theory and Therapy of Depression. New Jersey: John Wiley & Sons.Google Scholar
Durand, VM, Merges, E (2008). Functional communication training to treat challenging behavior. In: Cognitive Behavior Therapy: Applying Empirically Supported Techniques in Your Practice, 2nd edn (ed. O'Donohue, W. T. & Fisher, J. E.), pp. 229229. New York: Wiley.Google Scholar
Eells, TD (ed.) (2006). Handbook of Psychotherapy Case Formulation, 2nd edn. New York, NY: Guilford.Google Scholar
Emmelkamp, PM, Bouman, TK, Blaauw, E (1994). Individualized versus standardized therapy: a comparative evaluation with obsessive-compulsive patients. Clinical Psychology and Psychotherapy 1, 95100.Google Scholar
Farchione, TJ, Fairholme, CP, Ellard, KK, Boisseau, CL, Thompson-Hollands, J, Carl, JR, Gallagher, MW, Barlow, DH (2012). Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behavior Therapy 43, 666678.Google Scholar
First, MB, Gibbon, M, Spitzer, RL, Williams, JB (1996). Structured Clinical Interview for the Diagnostic and Statistical Manual IV: Axis I, Research Edition. New York: Biometrics.Google Scholar
Fresco, DM, Mennin, DS, Heimberg, RG, Turk, CL (2003). Using the Penn State Worry Questionnaire to identify individuals with generalized anxiety disorders: a receiver operating characteristic analysis. Journal of Behavior Therapy and Experimental Psychiatry 34, 283291.Google Scholar
Garb, HN (1998). Studying the Clinician: Judgment Research and Psychological Assessment. Washington, DC: American Psychological Association.Google Scholar
Ghaderi, A (2007). Logical functional analysis in the assessment and treatment of eating disorders. Clinical Psychologist 11, 112.Google Scholar
Grove, WM, Zald, DH, Lebow, BS, Snitz, BE, Nelson, C (2000). Clinical versus mechanical prediction: a meta-analysis. Psychological Assessment 12, 1930.Google Scholar
Hayes, SC, Barlow, DH, Nelson-Gray, RO (1999). The Scientist Practitioner: Research and Accountability in the Age of Managed Care, 2nd edn. Boston: Allyn and Bacon.Google Scholar
Haynes, SN, Mumma, GH, Pinson, C (2009). Idiographic assessment: conceptual and psychometric foundations of individualized behavioral assessment. Clinical Psychology Review 29, 179191.Google Scholar
Haynes, SN, O'Brien, WH (2000). Principles and Practice of Behavioral Assessment. New York: Plenum.Google Scholar
Haynes, SN, O'Brien, WH, Kaholokula, JK (2011). Behavioral Assessment and Case Formulation. Hoboken, NJ: Wiley.Google Scholar
Hokanson, JE, Tate, RL, Niu, X, Stader, S, Flynn, H (1994). Illustration of concomitant time series analyses in a case of somatoform disorder. Cognitive Therapy and Research 18, 413437.Google Scholar
Jacobson, NS, Schmaling, KB, Holtzworth-Munroe, A, Katt, JL, Wood, LF, Follette, VM (1989). Research-structured vs. clinically flexible versions of social learning-based marital therapy. Behaviour Research and Therapy 27, 173180.Google Scholar
Kahlon, S, Neal, A, Patterson, TJ (2014). Experiences of cognitive behavioural therapy formulation in clients with depression. The Cognitive Behaviour Therapist 7, 115.Google Scholar
Kazdin, AE (2003). Research Design in Clinical Psychology, 4th edn. Boston: Allyn and Bacon.Google Scholar
Kline, RB (2005). Principles and Practice of Structural Equation Modeling, 2nd edn. New York: Guilford.Google Scholar
Korchin, SJ (1976). Modern Clinical Psychology. New York: Basic.Google Scholar
Kuyken, W (2006). Evidence-based case formulation. In: Case Formulation in Cognitive Behaviour Therapy (ed. Tarrier, N.), pp. 1235. New York: Routledge.Google Scholar
Kuyken, W, Padesky, CA, Dudley, R (2009). Collaborative Case Conceptualization: Working Effectively with Clients in Cognitive-behavioral Therapy. New York: Guilford.Google Scholar
Lambert, MJ, Whipple, JL, Hawkins, EJ, Vermeersch, DA, Nielsen, SL, Smart, DW (2003). Is it time for clinicians routinely to track patient outcome? A meta-analysis. Clinical Psychology 10, 288301.Google Scholar
Meyer, TJ, Miller, ML, Metzger, RL, Borkovec, TD (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy 28, 487495.Google Scholar
Molenaar, PCM (2004). A manifesto on psychology as idiographic science: bringing the person back into scientific psychology, this time forever. Measurement 2, 201218.Google Scholar
Molenaar, PCM, Valsiner, J (2005). How generalization works through the single case: a simple idiographic process analysis of an individual psychotherapy (http://www.valsiner.com/articles/molenvals.htm). International Journal of Idiographic Science 1. Accessed 20 April 2005.Google Scholar
Mumma, GH (1998). Improving cognitive case formulations and treatment planning in clinical practice and research. Journal of Cognitive Psychotherapy 12, 251274.CrossRefGoogle Scholar
Mumma, GH (2004). Validation of idiosyncratic cognitive schema in cognitive case formulations: an intraindividual idiographic approach. Psychological Assessment 16, 211230.Google Scholar
Mumma, GH (2006). Cognitive-behavioral case formulation: a collaborative empirical approach to validation. In: Evaluating Cognitive Behavioral Case Formulation Hypotheses Using Repeated Measurement (chair: G. H. Mumma). Symposium presented at the 114th Annual Convention of the American Psychological Association, New Orleans, LA, August 2006.Google Scholar
Mumma, GH (2011). Validity issues in cognitive-behavioral case formulation. European Journal of Psychological Assessment 27, 2949.Google Scholar
Mumma, GH, Mooney, SR (2007a). Comparing the validity of alternative cognitive case formulations: a latent variable, multivariate time series approach. Cognitive Therapy and Research 31, 451481.Google Scholar
Mumma, GH, Mooney, SR (2007 b) Incremental validity of cognitions in a clinical case formulation: an intraindividual test in a case example. Journal of Psychopathology and Behavioral Assessment 29, 1728.Google Scholar
Mumma, GH, Smith, JL (2001). Cognitive-behavioral interpersonal scenarios: inter-formulator reliability and convergent validity. Journal of Psychopathology and Behavioral Assessment 23, 203221.Google Scholar
Needleman, LD (1999). Cognitive Case Conceptualization. Mahwah, NJ: Erlbaum.Google Scholar
Nezu, AM, Nezu, CM, Friedman, SH, Haynes, SN (1997). Case formulation in behavior therapy: problem solving and functional analytic strategies. In: Handbook of Psychotherapy Case Formulation (ed. Eells, T. D.), pp. 368401. New York: Guilford.Google Scholar
Nezu, AM, Nezu, CM, Lombardo, E (2004). Cognitive-behavioral Case Formulation and Treatment Design: A Problem Solving Approach. New York: Springer.Google Scholar
Nunnally, JC, Bernstein, IH (1994). Psychometric Theory, 3rd edn. New York: McGraw-Hill.Google Scholar
O'Donohue, W, Lilienfeld, SO (eds) (2013). Case Studies in Clinical Psychological Science: Bridging the Gap from Science to Practice. New York, NY: Oxford.Google Scholar
Persons, JB (1989). Cognitive Therapy in Practice: A Case Formulation Approach. New York: Norton.Google Scholar
Persons, JB (2008). The Case Formulation Approach to Cognitive-behavior Therapy. New York: Guilford.Google Scholar
Persons, JB, Beckner, VL, Tompkins, MA (2013). Testing case formulation hypotheses in psychotherapy: two case examples. Cognitive and Behavioral Practice 20, 399409.Google Scholar
Persons, JB, Tompkins, MA (2007). Cognitive-behavioral case formulation. In: Handbook of Psychotherapy Case Formulation, 2nd edn (ed. T. D. Eells), pp. 290316. New York: Guilford.Google Scholar
Robinson, PJ (2013). Treatment of depression. In: Case Studies in Clinical Psychological Science: Bridging the Gap from Science to Practice (ed. W. O'Donohue and S. O. Lilienfeld, pp. 85101. New York, NY: Oxford.Google Scholar
Schulte, D, Kunzel, R, Pepping, G, Schulte-Bahrenberg, T (1992). Tailor-made versus standardized therapy of phobic patients. Advances in Behavioral Research and Therapy 14, 6792.Google Scholar
Stöber, J, Bittencourt, J (1998). Weekly assessment of worry: an adaptation of the Penn State Worry Questionnaire for monitoring changes during treatment. Behaviour Research and Therapy 36, 645656.Google Scholar
Sturmey, P (2008). Behavioral Case Formulation and Intervention. New York: Wiley.CrossRefGoogle Scholar
Sundberg, N, Tyler, L (1962). Clinical Psychology: An Introduction to Research and Practice. New York: Appleton-Century-Crofts.Google Scholar
Tarrier, N (2006). Case Formulation in Cognitive Behavior Therapy: The Treatment of Challenging and Complex Cases. London: Routledge.Google Scholar
Tee, J, Kazantzis, N (2011). Collaborative empiricism in cognitive therapy: a definition and theory for the relationship construct. Clinical Psychology: Science and Practice 18, 4761.Google Scholar
Waltz, J, Addis, ME, Koerner, K, Jacobson, NS (1993). Testing the integrity of a psychotherapy protocol: assessment of adherence and competence. Journal of Consulting and Clinical Psychology 61, 620630.Google Scholar
Weisz, JR, Chorpit, BF, Frye, A, Ng, MY, Lau, N, Bearman, KS, Ugueto, AM, Langer, DA, Hoagwood, KE (2011). Youth top problems: using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. Journal of Counseling and Clinical Psychology 79, 369380.Google Scholar
Wells, A (2006). Cognitive therapy case formulation in anxiety disorders. In: Case Formulation in Cognitive Behavior Therapy: The Treatment of Challenging and Complex Cases (ed. N. Tarrier), pp. 5280. London: Routledge.Google Scholar
Widaman, K (2015). Confirmatory theory testing: moving beyond NHST. The Score (January 2015), pp. 1, 35.Google Scholar
Zayfert, C, Becker, CB (2007). Cognitive-behavioral Therapy for PTSD: A Case Formulation Approach. New York: Guilford.Google Scholar
Submit a response

Comments

No Comments have been published for this article.