What guides guided self-help? Recognising the role of formulation in Low Intensity CBT

Abstract

The emphasis on formulation, as a lynchpin and driver of cognitive behavior therapy (CBT) has received increasing attention, consensus of value among practitioners and emerging studies of efficacy. The terms, “formulation” and “conceptualisation” are frequently used interchangeably in literature which is exclusively focussed on high intensity CBT. In contrast, little has been included on the value or recognising the existence of formulation, for Low Intensity CBT practitioners providing guided self-help. This may contribute to misconceptions that Low Intensity CBT is a mechanistic set of techniques. Links to CBT competencies, curricula, role of supervision and roots in UK Behavioral Nurse Therapist training, are made to highlight the implicit presence of Low Intensity formulation. We suggest a definition of formulation, as a key Low Intensity competency. This uses an individualised treatment rationale and problem statement, derived from a structured functional assessment. We propose, explicitly emphasising these, constitutes Low Intensity case formulation, which guides intervention. This is a refocus of existing practice, not introduction of completely new elements. A brief illustration of “how to” deliver formulation-driven Low Intensity CBT is made. This promotes a concise “within-session” and “between-session” thread. This adjustment, on what guides Low Intensity interventions, is relevant to practitioners, supervisors and trainers in promoting Low Intensity best practice. This argues that recognising the value of formulation assists in optimising skills development, client outcomes and satisfaction with Low Intensity CBT. Cautions with the approach and the need for further research are noted.