Case formulation and the outcome of cognitive behavior therapy

We review studies of the effects on treatment outcome of the use of a case formulation to guide cognitive-behavior therapy (see earlier reviews by (Nelson-Gray, 2003; Haynes et al., 1997). We begin the chapter by describing cognitive behavior therapy (CBT) guided by a case formulation, and contrast it to CBT guided by a standardized protocol. Then we review evidence from randomized controlled trials, uncontrolled trials, and single case studies that test the hypothesis that treatment outcome is better when cognitive behavior therapy (CBT) is guided by a case formulation than when it is guided by a standardized protocol. Next we present some evidence that factors that are often included in a case formulation (e.g., the psychological mechanisms that cause and maintain the patient’s symptoms, the patient’s ethnic and/or cultural background, motivation for treatment) are predictors or moderators of outcome, or mediators of the change process. These types of evidence provide some support for the notion that using a case formulation to aid decision-making during treatment can improve treatment outcome. We conclude by discussing the implications of our findings for research, training, and clinical practice.