A maintenance-focused formulation for psychosis — mapping triggers, experiences, appraisals, emotions, and coping responses.
This formulation maps how psychotic experiences are maintained by a cycle of triggers, the experience itself, the meaning you give it, the emotions it produces, and the coping strategies you use. It doesn't assume the experience is or isn't real — it focuses on the distress and what maintains it.
Use when delivering CBT for psychosis (CBTp) after establishing a strong therapeutic alliance. The formulation maps the client's experiences within a stress-vulnerability framework, incorporating life experiences, core beliefs, triggering events, and maintenance cycles.
Approach formulation gently and collaboratively. Use the client's own language for their experiences rather than imposing diagnostic terminology. Frame the formulation as a shared understanding of what they've been going through and why, not as a judgment about their beliefs.
For clients in acute psychosis, keep the formulation simple and focused on current distress rather than attempting a comprehensive historical formulation. For those with cognitive difficulties, use visual and diagrammatic approaches rather than text-heavy formats.
Do not formulate if the client is too distressed, disorganised, or paranoid to engage collaboratively. If formulation increases distress or paranoia about the therapist's intentions, slow down and return to engagement work. Never formulate in a way that invalidates the client's experience.
CBTp formulation should help the client make sense of their experiences in a way that reduces distress and increases coping. Focus on the emotional and behavioural impact of beliefs rather than challenging their content directly. Normalising experiences within a stress-vulnerability framework is often more helpful than reality-testing.
Suitable for clients working with psychosis, cbtp, formulation, maintenance, voices, paranoia. This tool can be used as a standalone worksheet or as part of a structured homework plan.
Create a free account to access 10 professional CBT tools per month.
Explore how common unusual experiences are in the general population — and how context, stress, and sleep deprivation can produce them in anyone.
Systematically evaluate and build on existing coping strategies for managing distressing psychotic experiences.
Examine beliefs about the power of voices — challenging omniscience, omnipotence, and the need to comply.