5 ps formulation example
Persons, J.B., 1989. Concurrently treating both is very complex, challenging, and expensive. 0000156014 00000 n Cognitive behavioral therapists use individually tailored formulations as a framework with which to understand their patients' difficulties and to plan effective treatment. B., Lemle Becker, V., & Tompkins, M. A. Substance Abuse and Mental Health Services Administration. Here's what the completed table would look like with the psychological factors incorporated. All work is written to order. Drayton, M., Birchwood, M. and Trower, P., 1998. This can be both positive or negative but they have a direct correlation to how the person is today. 0000119267 00000 n 0000238491 00000 n It can be changed and reviewed as the treatment is in progress if any new information come to light. https://doi.org/10.1111/j.1752-0606.2011.00280.x Social isolation and withdrawn from family members, Ongoing social isolation due to psychosis causing him to be fearful of others, Followed by an early intervention in psychosis team, History of immigration (increases risk for psychosis), Long-standing feelings of isolation and insecurity since childhood, Joined a gang, entering a stressful lifestyle, led to increased hyper-vigilance and paranoia in the past few months, Ongoing delusions leading patient become suspicious of healthcare workers/family, Previously responded well to CBT for psychosis, Family history of psychosis and schizophrenia. There could be a discussion of alcohol use disorder being a disease, not that different from any other passed-on trait or disease. Keywords: substance use and misuse, Five Ps, idiographic, systematic, flexible. These symptoms have been further perpetuated by the personality factors and traits described above, and her ongoing financial stressors. The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. CBT has been found to not be effective in schizophrenia (Lynch et al. Chadwick, P., Williams, C., & Mackenzie, J. 0000015792 00000 n Published data on those incarcerated appears to be several years old. We then move onto Perpetuating which looks at what factors are contributing to the remain of the problems the person is facing. They are examples that the author chose to illustrate the Five Ps in practice. British Journal of Clinical Psychology, 37(3), pp.269-284. The officers evaluated him, detained him, and subsequently arrested him for driving while intoxicated. At the end of his workday, he and his wife got into an argument over the phone about an upcoming diagnostic test and the possible results. It is believed that CBT receives government support and funding because it is cheap and quick, even though the empirical evidence for it is weak (Hussain 2009). We would anticipate when engaging in treatment, the patient may have [resistance/transference/countertransference]. Cognitive and Behavioral Practice, 20(4), 399409. Additionally, its holistic and creative style provides opportunities to address concerns at various points with a variety of strategies and interventions that will best suit clients unique situations. It also appears they may have had difficulty with [drives], stemming from [psychoanalytic concept], These experiences impacted the patient's view of themselves as being [view of self], and this has continued into adulthood based on [experiences]., The patient appears to have adopted [defense mechanisms] as coping strategies by early adulthood, and these have continued on, The patient's interpersonal relationships appear to be [give examples of patterns of relationships], These underlying factors may have precipitated the patient's [current presentation]. Acknowledging that his reticence is due to being obligated to attend counseling may assist in relationship building (Tahan & Sminkey, 2012). Oftentimes, when the topic of protective factors is used in substance use and misuse, it is related to deterrence of substance use, notably with adolescents (Liao et al., 2018). The Five Ps is a systematic way to look at clients and their presentation, and its idiographic construction takes clients uniqueness into account. (e.g. Seminars in the Psychotherapies , pp. Here the focus is on investigating resources and/or supports that may help prevent client substance use and misuse from further becoming problematic. Societally, substance use and misuse consequences exceed $400 billion in crime, health, and lost productivity (U.S. Department of Health and Human Services, 2016, p. 2). It is important to remember that not everything will fit neatly into each box. 0000186690 00000 n The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. In implementing the Five Ps framework with Dax, the clinician chose to use psychoeducation and strategies borrowed from acceptance and commitment, reality, Bowenian family systems, and solution-focused brief therapies to assist Dax with his substance use and misuse. Those who engage in substance use and misuse often have higher rates of unemployment (Compton et al., 2014; Dieter, 2011). The clinician can provide a variety of potential spousal responses, allowing for more adaptability and flexibility in Daxs responses. Goldman, R. and Greenberg, L.S., 1997. Based on these factors, the following [treatment and management] would be the most helpful for this patient. It has been said that the experiences, incidents and or events in our life has an affect on both how we feel and behave. It will make your job of formulating much easier. Health Affairs, 32(12), 22052215. Sara is unequivocal in her confidence in Zoes cardiologist and his competence. https://doi.org/10.1016/j.drugalcdep.2014.06.012 Additionally, he reports significant stress and conflict in his marriage as well as concerns over some upcoming diagnostic tests for their daughter related to a heart murmur. Cengage. Our academic experts are ready and waiting to assist with any writing project you may have. Cognitive behaviour therapy for psychiatric problems: A practical guide. Studies utilizing the Five Ps with mandated clients may demonstrate its efficacy, notably with agencies that require substance-related counseling. 0000200485 00000 n Your formulation of a patient evolves and changes as you collect more information. Finally, the number of U.S. adults with a comorbid SUD and mental illness has been shown to be almost 8 million, with only about 5% receiving treatment for both (SAMHSA, 2017). There was a parental divorce at age 5. He denies any significant increase in alcohol use or any other substance use. )jB' */NNM;2=Kc.w}9XXtj+%]{IF UA_ The case formulation in child and adolescent psychiatry. Dallos, R. and Vetere, A., 2018. ), Cover every box in the 4 Ps just for the sake of doing it (not all boxes will always apply!). Among those are 12-step programs (Humphreys et al., 2004), mindfulness-based interventions (Chiesa & Serretti, 2014), evidence-based approaches such as cognitive behavioral therapy (McHugh et al., 2010), and family counseling (OFarrell & Clements, 2012). 0000004805 00000 n Formulation: A multiperspective model. There are numerous methods and combinations of methods to address substance use and misuse, such as family therapy, cognitive behavioral therapy, and self-help groups. 0000010086 00000 n The following samples can be taken as basic templates for case conceptualization, in the context of Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and family therapy. A good biopsychosocial formulation allows you to come up with a comprehensive and holistic treatment plan for your patient. Frontiers in Psychiatry, 9, 19. In mental health, when there is a group of consistent symptoms seen in a population, these symptoms can be categorized into a distinct entity, called a diagnosis (this is what the DSM-5 does). Registered office: Creative Tower, Fujairah, PO Box 4422, UAE. The Biopsychosocial Model and Case Formulation (also known as the Biopsychosocial Formulation) in psychiatry is a way of understanding a patient as more than a diagnostic label. In spite of these limitations, there may be several potential areas of inquiry. Design of individualized behavioral treatment programs using functional analytic clinical case models. This could be achieved with more specific and in depth trauma therapy, but given the acuity of her symptoms, this is something that would follow after DBT. (2017). Idiographic case formulation can be useful for complicated cases, such as those encountered with clients engaged in substance use and misuse (Haynes et al., 1997). The image (. Plan A good strategy must have a plan. For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. Becks States that life experiences play a part in people dysfunctional beliefs and assumptions about themselves, others and the world around them (Beck 1967, 1979). BMC Medicine, 10(111), 13. Impact of case formulation in cognitive behaviour Counselling with reality therapy (2nd ed.). Alcohol, cannabis, and opioid use disorders, and disease burden in an integrated healthcare system. (2013). 0000187506 00000 n hA 4-`76>m{dKs. Plate, A. J., & Aldao, A. He then withdraws and becomes sullen for a few days. For Dax, he shares that when he and his wife argue, it follows a very predictable pattern. The 4 Ps formulation table can be a very rigid and systematized way of presenting a formulation. What are the 5 Ps of case formulation? Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. https://doi.org/10.1016/S0740-5472(03)00212-5 Hawton, K.E., Salkovskis, P.M., Kirk, J.E. ,"Sb.&;.+Y&&_{} G|ku!dKMwU*jMdDN https://doi.org/10.1016/j.avb.2010.01.006 Strategy as a Plan Planning comes naturally to many managers and as such, has become the default first step. The patient may have a strong family history of the disease, a sedentary job, environmental exposures, and/or a nutritionally-poor diet. Substance use and misuse in the United States is extremely common. 0000239180 00000 n As mentioned previously, novice counselors often lack sufficient case formulation skills (Liese & Esterline, 2015). <<6D17E8AF19023D4BAD06A1AFD23B08FB>]/Prev 415012/XRefStm 2760>> In S. G. Hofmann & G. J. G. Asmundson (Eds. Furthermore, the Five Ps helps clients and counselors explore relationships between each factor and the presenting problem. And that's okay! Here are some examples: A good formulation should be integrative, and let you understand how all of the patient's factors interact to lead to the current situation. We're here to answer any questions you have about our services. These are historical psychological, biological, developmental, and socio-cultural factors that increased the person's vulnerability to their current problems. However, formulation tells us how the person became depressed as a result of their genetics, personality, psychological factors, biological factors, social circumstances (childhood adverse events and social determinants of health), and their environment. Johnstone, L. and Dallos, R., 2013. Harris, R. (2019). Good interpersonal support from her best friend who brought her to hospital. Hussaarts, P., Roozen, H. G., Meyers, R. J., van de Wetering, B. J. M., & McCrady, B. S. (2012). This is often the opportunity for the client to share what may help them move forward, what their assets are, who can support them, and any other self-identified skills (de Shazer, 1985). Worrell, M. (2015). The American Journal on Addictions, 21(1), 3846. Introduction to formulation. There are several approaches to managing client substance use and misuse that have demonstrated effectiveness. 0000003178 00000 n - Eriksonian developmental stages, psychodynamic defenses, and dialectical behavioural): Yet another way to present a formulation is in chronological order, starting from birth until present time: Having certain common phrases to use can be helpful to structure your presentation. Family history of mental disorders and substance use, Fears of abandonment which developed early in childhood, Early parental divorce, unstable home life, history of trauma, Increase in alcohol use in the last 3 months, Re-experienced these feelings of invalidation and abandonment after being fired from work, Her lack of adaptive coping mechanisms resulted in using self-harm to cope. This conversation can lead to investigating strategies for how each can be heard, including short role-plays with opportunities to practice (Worrell, 2015). might you consider? Note that this table is extremely comprehensive and long, and not everything will (or should!) Dax was quite upset, cursed at her, and then hung up the phone. Rowe, C. L. (2012). 5 Ps narrative table, from Comprehensive Care Resource Guide 0000200610 00000 n Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. It should be noted that several evidence-based substance use and misuse approaches were integrated in an eclectic approach throughout the case example to demonstrate the idiographic nature of the Five Ps. 0000002964 00000 n What level of care is required (outpatient or inpatient)? Cognitive therapy in practice: A case formulation approach. Winters, N. C., Hanson, G., & Stoyanova, V. (2007). SAGE. Annals of Family Medicine. Oxford Handbooks Online, 149. 0000243959 00000 n Mindfulness training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface. The night he was pulled over, he had had two additional beers and one additional shot of whiskey on top of his usual consumption after a telephone argument with his wife, Sara. Addressing the potential genetic link to substance use and misuse may prove beneficial in raising Daxs awareness (Dick & Agrawal, 2008). Clinical case formulations: Matching the integrative treatment plan to the client (2nd ed.). https://doi.org/10.17744/mehc.30.1.j40256207h0581t1 She subsequently planned to overdose on her medications. 0000200185 00000 n Johnstone, L., & Dallos, R. As you do more formulation, you will notice that patients tend to present in templates, that is, certain diagnoses tend to follow a certain common theme of predisposing, precipitating, and perpetuating factors. Most learners will use this method as it is the most simple. It is usually presented as Predisposing Precipitating Perpetuating Protective factors. The patient has genetic vulnerabilities for mental illness in her family history, a history of anxious temperament, ongoing substance use, and subtherapeutic medication levels. Client substance use and misuse is a significant problem in the United States, and it continues to cause difficulty for individuals, families, and society. (2018, August 31). They may also present in the form of family, friends, or hobbies. Precipitating factors are those that proximally bring about substance use and misuse and its resulting difficulties. Copyright 2003 - 2023 - UKEssays is a trading name of Business Bliss Consultants FZE, a company registered in United Arab Emirates. (2003) noted, examining positive client experiences may be one way to discover how to increase client participation in substance use and misuse treatment. Han, B., Hedden, S. L., Lipari, R., Copello, E. A. P., & Kroutil, L. A. Kleiman, M. A. R., Caulkins, J. P., & Hawken, A. https://www.samhsa.gov/treatment In addition, there are frameworks that use a formulation model examining various aspects of clients (Johnstone & Dallos, 2013) such as causal, contributing, environmental, and personal features, providing a much more expansive view of clients concerns. The goal here is to build Daxs competence in communicating, both in listening and expressing. Therapy, 38(1), 5981. W. W. Norton. Having a framework for understanding of different psychological treatments and psychological theories can be helpful in making your psychological formulation flow intuitively (e.g. Bahorik, A. L., Satre, D. D., Kline-Simon, A. H., Weisner, C. M., & Campbell, C. I. Family therapy for drug abuse: Review and updates 20032010. Morin, J.-F. G., Harris, M., & Conrod, P. J. Nothing gets resolved, and this cycle appears once again when they have conflict. - attachment theory, cognitive behavioural therapy, dialectical behavioural therapy, interpersonal therapy, psychodynamic therapy). They conceptualized a way to look at clients and their problems, systematically and holistically taking into consideration the (1) Presenting problem, (2) Predisposing factors, (3) Precipitating factors, (4) Perpetuating factors, and (5) Protective factors. In the Five Ps context, protective factors are used to potentially prevent substance use and misuse from having more negative impact as well as to increase client resilience. Keys to solution in brief therapy. Case Formulation DSM-5 Criteria Sets DSM-5 Background Information Treatment Planning Best practice guidelines are often tied to a diagnosis DSM-5 measures to monitor progress . Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). If your specific country is not listed, please select the UK version of the site, as this is best suited to international visitors. Humphreys, K., Wing, S., McCarty, D., Chappel, J., Gallant, L., Haberle, B., Horvath, A. T., Kaskutas, L. A., Kirk, T., Kivlahan, D., Laudet, A., McCrady, B. S., McLellan, A. T., Morganstern, J., Townsend, M., & Weiss, R. (2004). Abnormal and normal obsessions. 300 words (2017). Fig. In psychiatry, formulation appears more complicated because human behaviour and the brain itself is extraordinarily complex. Wubbolding, R. E., & Brickell, J. https://www.apa.org/pubs/journals/pas/index Substance use and misuse has been correlated with both higher rates of absenteeism and workplace injuries (Bush & Lipari 2015). Implementing the Five Ps: The Case of Dax. The meaning of anxiety. Planning is an essential part of the strategy formulation process, so take time to Brainstorm new opportunities. Note that in this example, since the precipitating cause for acute psychosis (also applies to manic episodes) is more biological, it may be harder to identify underlying psychological factors (but that's OK too even the most biological psychiatric disorders can often be precipitated by psychosocial stressors). 1264 0 obj <>stream https://doi.org/10.1111/j.1752-0606.2011.00242.x A systematic review of the evidence. It would be difficult to say which formulation is correct, and if there is such a thing as a correct one, since everyone has an individual view of what is right or wrong. or funding contributions for the development 1. 0000009229 00000 n Surgeon General Vivek Murthy reported that more than 20 million Americans have an SUD (U.S. Department of Health and Human Services, 2016). Using case formulation in clinical practice. Novice clinicians, who often have a more limited repertoire of strategies, may find the Five Ps valuable because of its systematic framework to clients. startxref 0000004656 00000 n https://www.samhsa.gov/data/report/results-2016-national-survey-drug-use-and-health-detailed-tables Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. She notably has a past history of childhood trauma and abuse. Family therapy: Systemic approaches to practice. Looking for a flexible role? Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. Facing addiction in America: The Surgeon Generals report on alcohol, drugs, and health. 0000011422 00000 n Executive functioning in alcohol use studies: A brief review of findings and challenges in assessment. Karriker-Jaffe, K. J., Klinger, J. L., Witbrodt, J., & Kaskutas, L. A. If he cannot identify a time, simple role-plays in which Dax does not interrupt or yell and instead experiences different outcomes may provide optimism to Dax. Example of the 5 P's of Marketing John is considering operating a jet ski shop catering to travelers and tourists. (2017). Health Education Journal, 77(7), 749761. Review of outcome research on marital and family therapy in treatment for alcoholism. One such framework is the Five Ps (Macneil et al., 2012). New York: WW Norton. Based on these factors, dialectical behavioural therapy would be the most helpful for this patient. The formulation can be used by the psychiatrist, therapist, treating team and patient, and when constructed, at times it can be similar to a piece of art or poetry - capturing the essence of the patient's difficulties and providing a deep insight in a condensed form. Scott W. Peters, PhD, LPC-S, is an associate professor at Texas A&M University San Antonio. PREDISPOSING FACTORS: What led to the problem starting? https://doi.org/10.3109/10826084.2013.770027 They conceptualized a way to look at clients and their problems, systematically and holistically taking into consideration the (1) Presenting problem, (2) Predisposing factors, (3) Precipitating factors, (4) Perpetuating factors, and (5) Protective factors. van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). This gives you a sense of their current level of functioning, prognosis, and guides your direction for treatment and management decisions. 0000241723 00000 n Journal of Anxiety Disorders, 36, 18. https://www.ncbi.nlm.nih.gov/books/NBK343542 Hypotheses are generated about the origins and causes of a patient's symptoms. low mood) %PDF-1.4 % Thus, there exists a need to concurrently examine and address the potentially complex nature of client substance use and misuse. Their effectiveness has been well researched, and this paper does not propose a superior way to address substance use and misuse. The implementation of the Five Ps with clients with mild substance use and misuse and those with more significant substance use and misuse, possibly using the DSM-5 diagnosis for SUD, may be another area to explore. It also provides opportunities for a variety of interventions and strategies targeted to clients and their substance use and misuse or contributing factors. 2004;2(6):576-582. doi:10.1370/afm.245. 58 - 65. However, patient has the following [protective factors], which may be a good prognostic factor. Mindfulness-based interventions for the treatment of substance and behavioral addictions: A systematic review. Psychotherapy, 52(2), 190194. 0000006923 00000 n The following readings below are excellent resources to further develop your formulation skills: As you can see in the table above, it's a lot of questions to ask and a lot of things to think about! This framework is idiographic in nature, as it looks at clients individually and holistically (Marquis & Holden, 2008). (2017). In the context of this article, the word abusable indicates substances that when taken are pleasurable enough to result in excessive dosing or increased frequency of intake (Linden, 2011). The emphasis here is on features that continue the presenting problem. Another potential limitation is that the Five Ps may not be particularly beneficial for substance use and misuse in which there is clinical evidence of an SUD that includes significant withdrawal symptoms. Furthermore, clients like Dax who are mandated to attend substance-related counseling may have service plans that are not congruent with the Five Ps framework. The need for a new medical model: a challenge for biomedicine. 0000119626 00000 n From a biological perspective, the patient is vulnerable because, The patient's early childhood and developmental history suggest, Used substances as a coping style in [the past], and now this is occurring again (or there is a relapse) due to [social factor]., Used substances as a coping style in [the past], and now this is occurring again (or there is a relapse) due to [psychological vulnerability]., I wonder if [psychological factor] is contributing to [current symptoms/struggles], Tell a story and narrative that is unique to your patient, Be specific and demonstrate your understanding of the patient as a, Use words like precipitating, protective, and perpetuating factors to anchor your listener, Focus on the most salient features and be concise, Try and use a psychological theory (but only if you understand it), Try to be perfect only to overwhelm yourself, Be generic (your formulation needs to be unique to your patient), Tell the patient's whole story all over again, Mention life events or trauma without an understanding of its meaning or impact, Try to formulate a grand unified theory of the patient and over-reach with your theory (if it doesnt fit, it doesnt fit! Bush, D. M., & Lipari, R. N. (2015, April 16). The systematic but flexible nature of this framework affords clinicians numerous ways to address substance use and misuse. She also drank 10 beers prior to arriving in the hospital. One versus many: Capturing the use of multiple emotion regulation strategies in response to an emotion-eliciting stimulus. Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. Walsh, F. (2014). (Rachman & de Silva 1978, Salkovskis & Harrison 1984, sited in Tarrier et al. These approaches can be accomplished via outpatient counseling, partial hospitalization programs, inpatient and medically managed substance treatment programs, as well as residential and therapeutic communities. This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. 0000008363 00000 n 0000238450 00000 n Unemployment and substance use: A review of the literature (19902010). The "5 Ps" we recommend include: Purpose: Every meeting should have a reason. May, R. (1950). 0000239964 00000 n Currently, there are a variety of empirically based interventions for treating clients who engage in substance use and misuse. Molecular psychiatry, 17(4), 377-388. By examining and exploring clients use or misuse within the context of a multidimensional framework, interventions can be personalized, and areas of concern can be targeted. Fundamental Changes in DSM-5 Dimensional Approach The conundrum with categories In addition, the vast majority of those with an SUD never receive treatment (Han et al., 2015). This is intended to inspire the identification of more in-depth interventions that aim to sustain change and prevent relapse (i.e., promote long-term behavioural adjustment). Journal of Public Health, 38(3), e282e291. The biopsychosocial model considers the 4 Ps for each of the biological, psychological, and social factors: The 4 Ps can be laid out in a 3 x 4 table to systematically do formulation and identity factors. Treating substance use disorders in the criminal justice system. 2009). The essay will now look at the key ideas underpinning the process of CBT. This involves explaining that interactions can act as a kind of back-and-forth loop of actionreactionaction without any resolution, leaving both parties feeling unheard, misunderstood, and frustrated. (2012). Previous studies using frameworks to formulate have often used cognitive behavioral therapy as the primary intervention (Chadwick et al., 2003; Persons et al., 2013). Chiesa, A., & Serretti, A. For some, receiving substance use and misuse services can be stigmatizing. 0000180256 00000 n Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Do they have ability to be reflective or modulate their affect? 2. https://doi.org/10.1377/hlthaff.2013.0879 Participants should be people who can . Ploy: The Strategy has to analyze What Tactics can be Implemented. Linden, D. J. It should be noted that several evidence-based substance use and misuse approaches were integrated in an eclectic approach throughout the case example to demonstrate the idiographic nature of the Five Ps. Given the variations in substances, the extent of use, functional impairment, concomitant onset with other mental disorders, and inherent differences between clients, an idiographographically sound framework seems particularly appropriate for this population. https://doi.org/10.1080/02699931.2012.739998 It is open to modification any time during the treatment period and any new evidence that crop up at any time will be discussed with the client. Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638323/pdf/nihms734766.pdf (2017, September 7). https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf Drug and Alcohol Dependence, 142(1), 350353. Another potential area of study might involve comparing novice counselors to more experienced counselors. For example, type II diabetes does not develop because of a single pathophysiological cause. Here is an example of a set of treatment recommendations for Jane Doe: For good measure, here is another sample formulation for someone with a diagnosis of schizophrenia. Formulation for beginners. https://doi.org/10.1186/s13722-018-0110-8 Case formulation in process-experiential therapy. SAMHSA (2020) pointed out the significance of addressing clients individually based on their distinctive needs in order to provide the best chance for recovery from substance use and misuse.