5 ps formulation example

Seminars in the Psychotherapies , pp. Twelve-step attendance is most beneficial with inpatient substance use and misuse treatment (Karriker-Jaffe et al., 2018). We then move onto Perpetuating which looks at what factors are contributing to the remain of the problems the person is facing. The last P looked at is Protective which as the name suggest looks at ways to prepare the client so that relapse is unlikely, this is done by looking at the strengths of the client as a platform to build on. Research on the success of family-based interventions has methodological challenges, such as small sample sizes and the difficulty of examining long-term outcomes (Rowe, 2012). hA 4-`76>m{dKs. This factor has generally been underutilized despite being shown as beneficial to clients (Kuyken et al., 2009). Current Drug Abuse Reviews, 4(1), 427. 0000119085 00000 n 0000239101 00000 n In addition, aspects of narrative therapy may provide an opportunity for Dax to re-author a unique outcome that gives meaning and provides a functional identity to him as a father and husband, thus building a sense of optimism (White & Epston, 1990). Cognitive behavioral therapy for substance use disorders. Aldao, A., & Nolen-Hoeksema, S. (2013). It should be noted that the strategies and interventions applied here are used as illustrations and are specific to Dax and his concerns. He is confident that he does not have a problem and that counseling should be reserved for those who cannot stop drinking. 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. (Rachman & de Silva 1978, Salkovskis & Harrison 1984, sited in Tarrier et al. (Persons, 1998). Sara is unequivocal in her confidence in Zoes cardiologist and his competence. https://doi.org/10.1377/hlthaff.2013.0879 B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). Perpetuating Factors 0000200735 00000 n Murphy, C. M., & Ting, L. (2010). https://doi.org/10.1093/oxfordhb/9780199935291.013.57 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! 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. In J. R. Brandell (Ed. This likely led to an attachment style that was likely insecure and disorganized. Substance use and misuse also has a negative impact on intimate partners, such as assuming increased responsibility and navigating unpredictability (Hussaarts et al., 2012). For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. PREDISPOSING FACTORS: What led to the problem starting? https://www.apa.org/pubs/journals/pas/index 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). https://doi.org/10.1016/j.janxdis.2015.09.005 Alcohol Research Current Reviews, 31(2), 111118. He is also adamant that he does not have a problem with alcohol. 0000004344 00000 n Registered office: Creative Tower, Fujairah, PO Box 4422, UAE. The Five Ps can be used in a variety of settings such as a community mental health agency, primary care clinic, and inpatient or residential treatment centers. Dax presents as extremely frustrated and embarrassed at being mandated to attend counseling sessions. The patient appears to have adopted self-harming as a primitive coping strategy by early adulthood, and these have continued on in adulthood. https://doi.org/10.3389/fpsyt.2018.00095 However, there are others who use substances to such an extent that it causes significant distress and impairment in their lives, a phenomenon clinically referred to as a substance use disorder (SUD). There was a parental divorce at age 5. Journal of Public Health, 38(3), e282e291. Here you can choose which regional hub you wish to view, providing you with the most relevant information we have for your specific region. (2013). - attachment theory, cognitive behavioural therapy, dialectical behavioural therapy, interpersonal therapy, psychodynamic therapy). (2019). Early attachment experience and recovery from psychosis. Aggression and Violent Behavior, 15(5), 325333. The ball in the pool metaphor (i.e., holding a beach ball under the water works temporarily, but eventually it pops back up) can be compared to alcohol temporarily holding those painful emotions down, eventually to resurface. Presenting problems are concerns that clients find difficult to manage. Henkel, D. (2011). endstream endobj 1263 0 obj <>/Filter/FlateDecode/Index[262 927]/Length 50/Size 1189/Type/XRef/W[1 1 1]>>stream The CBHSQ report: Substance use and substance use disorder by industry. It is systematic, while allowing for flexibility and creativity. 5 Ps narrative table, from Comprehensive Care Resource Guide: 4 : The Integrated Formulation : The Integrated formulation builds on the familiarity of the '5Ps', with the aim of specifically integrating that . Effects of treatment type on alcohol consumption partially mediated by Alcoholics Anonymous attendance. Liao, J.-Y., Huang, C.-M., Lee, C. T.-C., Hsu, H.-P., Chang, C.-C., Chuang, C.-J., & Guo, J.-L. (2018). While being mandated to attend counseling, Dax shares concerns that he is afraid of what his daughters test results will show. Journal of Addiction Medicine, 11(1), 39. Protective factors move away from the problem areas that need interventions to hope and optimism and look to future success and competence (Macneil et al., 2012). All rights reserved. Episodic future thinking in generalized anxiety disorder. Clinical problem solving: the case of Matthew, part 1. https://doi.org/10.1016/S0740-5472(03)00212-5 Dallos, R. and Vetere, A., 2018. https://doi.org/10.1016/j.addbeh.2006.09.008 Again let's fill out the easiest parts of the table first: Now here is one potential example of a predisposing social and psychological formulation of psychosis (again, there are no right or wrong ways to formulate, it depends on the patient you have in front of you!). +O1\lp#\ The effects of treatment for substance use problems on intimate partner violence: A review of empirical data. These are historical psychological, biological, developmental, and socio-cultural factors that increased the person's vulnerability to their current problems. Keys to solution in brief therapy. 0 Etoom, Y., & Ratnapalan, S. (2014). One of the weakness of this formulation is identifying that the clients strength is not included the initial assessment and data collection. SAGE. She subsequently planned to overdose on her medications. There are limitations to the Five Ps framework as a way to formulate and intervene with clients substance use and misuse. 0000187506 00000 n 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. Type. Patterns: Study what Worked in the Past and What can be Replicated. A formulation is a joint effort between you and the psychologist to summarise your difficulties, to explain why they may be happening and to make sense of them. 0000004306 00000 n Such a framework may enhance the effectiveness of the aforementioned interventions (Wormer & Davis, 2018). https://doi.org/10.1111/j.1521-0391.2011.00187.x The Diagnostic and Statistical Manual of Mental Disorders (5th ed. The emphasis here is on features that continue the presenting problem. Moreover, the Five Ps align with SAMHSAs recommendation that clinicians tailor treatment to each client because no single treatment is particularly superior (SAMHSA, 2020). W. W. Norton. Winters, N. C., Hanson, G., & Stoyanova, V. (2007). Once the protective factors are identified, the ensuing conversation provides opportunities to imagine future outcomes in which protective factors may come into play should situations occur that the client finds problematic. Surgeon General Vivek Murthy reported that more than 20 million Americans have an SUD (U.S. Department of Health and Human Services, 2016). Routledge.21-37). Journal of Anxiety Disorders, 36, 18. 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! Case formulation, also referred to as conceptualization, is a skill new counselors often lack (Liese & Esterline, 2015). Are mindfulness-based interventions effective for substance use disorders? 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. 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. The Five Ps is a systematic way to look at clients and their presentation, and its idiographic construction takes clients uniqueness into account. Looking for a flexible role? Even weekly status meetings or things of that nature should have a clearly defined purpose. Here the clinician may utilize strategies drawn from acceptance and commitment therapy related to his control strategy of using alcohol to avoid his emotions (Harris, 2019). They may also present in the form of family, friends, or hobbies. 0000238450 00000 n The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. The persons resilience and strengths that help maintain emotional health. Predisposing Factors A review of CBT treatments for substance use disorders. 0000003178 00000 n This can be both positive or negative but they have a direct correlation to how the person is today. Novice clinicians, who often have a more limited repertoire of strategies, may find the Five Ps valuable because of its systematic framework to clients. Results from the 2016 National Survey on Drug Use and Health: Detailed tables. xref For example, the clinician may ask Dax if they can share how genes are passed on and expressed, like genes for eye color or hypertension. Journal of Substance Abuse Treatment, 26(3), 151158. Here, a conversation about what counseling entails as well as psychoeducation related to the effects of alcohol on executive functioning may prove beneficial (Day et al., 2015). She has several early developmental and pathogenic psychological factors, including growing up in a family characterized by invalidation, with parents who were distant and unavailable. 0000200485 00000 n This is an essential step. Dick, D. M., & Agrawal, A. A course of action you intend to take or a series of guidelines you intend to follow. Planning is an essential part of the strategy formulation process, so take time to Brainstorm new opportunities. B., Lemle Becker, V., & Tompkins, M. A. https://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014.htm Poorolajal, J., Haghtalab, T., Farhadi, M., & Darvishi, N. (2016). Family therapy and the treatment of substance use disorders: The family matters model. Now what? https://doi.org/10.1016/j.drugalcdep.2014.06.012 Journal of Mental Health Counseling, 30(1), 6794. Conflict of Interest and Funding Disclosure Journal of Marital and Family Behind bars II: Substance abuse and Americas prison population. 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. 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. 0000016707 00000 n The idiographic/nomothetic dichotomy: Tracing historical origins of contemporary confusions. What are perpetuating factors? 0000200305 00000 n or funding contributions for the development Following is a case illustration demonstrating how the Five Ps may be helpful in formulating and engaging in a clinical application. (e.g. The genetics of alcohol and other drug dependence. Here, the clinician may use reality-based strategies that address choice and consequences (Wubbolding & Brickell, 2017). https://doi.org/10.1177/0009922813488653 This may open the door to a conversation regarding how his substance use and misuse may progress to alcohol use disorder and its definition as a pattern of alcohol use leading to clinically significant problems, including increase in use, failed attempts to stop, and use leading to an impaired ability to meet role obligations (American Psychiatric Association, 2013). 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). This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. For example, many precipitating and perpetuating factors may overlap and fit in other boxes. Hypotheses are generated about the origins and causes of a patient's symptoms. The most common and clinically practical way to formulate is through the biopsychosocial approach, first described in 1980 by George Engel. Concept mapping: A supervision strategy for introducing case conceptualization skills to novice therapists. The "5 Ps" we recommend include: Purpose: Every meeting should have a reason. The next step Precipitating is used to look at both internal and external factors and discover where they are linked, from this you get a greater picture of the overall problem. Mindfulness-based strategies are not as effective when used alone as when used with other approaches (Sancho et al., 2018). People with paranoia tend to avoid these situations which would lead to distress (Clark et al 2005). Formulation for beginners. Unemployment and substance use: A review of the literature (19902010). To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). Based on these factors, the following [treatment and management] would be the most helpful for this patient. It is important to remember that not everything will fit neatly into each box. Chiesa, A., & Serretti, A. https://www.samhsa.gov/treatment For example, some interventions use an individual lens, such as cognitive behavioral therapy, which examines connections between thoughts, feelings, and behaviors (Morin et al., 2017). (Johnstone & Dallos 2009). 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. Case conceptualization research in cognitive behavior therapy: A state of the science review. Participants: The leader of a meeting should carefully consider who he or she invites. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860452/ He denies any significant increase in alcohol use or any other substance use. %PDF-1.4 % Introduction to formulation. A, & Otto, M. W. (2010). Other approaches observe substance use and misuse from a family or systems perspective, looking at familial patterns such as communication and normalization of substance use (Bacon, 2019). All work is written to order. Addictive Behaviors, 32(7), 13311346. Using a framework to assist in case formulation may prove useful to beginning counselors. Jane could benefit from accessing support from her company's HR department to understand what options she has after her job termination, Substance use groups such as Alcoholic's Anonymous, Increasing connections to her friends and social supports, Biopsychosocial Model and Case Formulation, The Parable of Panic: Suffocation, Social Attachment, and the Critical Role of an Integrative, Biopsychosocial Formulation, family act and what is the family structure, Childhood exposure to maternal depression, domestic violence, late adoption, temperament mismatch, or marital conflicts, Family history of mental disorders and substance use, Early parental divorce, unstable home life, history of trauma. Receipt of services for behavioral health problems: Results from the 2014 National Survey on Drug Use and Health. (Ed.). Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety. Clinical Pediatrics, 53(2), 111117. Stressor that activate one or more psychological processes: Loss of or separation from close family, partner, or friends, Do they have a chronic illness, functional impairment caused by. Another weakness is that sometimes the client might not want to disclose some information in their past which might assist the therapist in making the client understand that sometimes important part of their history in fluence the way they view the world. Wu, J. Q., Szpunar, K. K., Godovich, S. A., Schacter, D. L., & Hofmann, S. G. (2015). 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. Note that this table is extremely comprehensive and long, and not everything will (or should!) Current dose of sertraline is subtherapeutic, Ongoing discord in her romantic relationship, Good interpersonal support from her best friend who brought her to hospital, Re-experienced these feelings of abandonment after being fired from work. The American Journal on Addictions, 21(1), 3846. Second, it also tends to shift the conversation toward what is present and going well in their lives and away from those areas that cause distress and suffering (de Shazer, 1985). Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. <<6D17E8AF19023D4BAD06A1AFD23B08FB>]/Prev 415012/XRefStm 2760>> 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. Hussaarts, P., Roozen, H. G., Meyers, R. J., van de Wetering, B. J. M., & McCrady, B. S. (2012). 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. [1][2] Biopsychosocial formulation combines biological, psychological, and social factors to understand a patient, and uses this to guide both treatment and prognosis. https://doi.org/10.1097/NCM.0b013e318253f029 The counselor may also assist Dax in emotional regulation, which may prevent the initiation of arguments (Aldao & Nolen-Hoeksema, 2013). Day, A. M., Kahler, C. W., Ahern, D. C., & Clark, U. S. (2015). What can be done, realistically speaking. The patient may have a strong family history of the disease, a sedentary job, environmental exposures, and/or a nutritionally-poor diet. 0000240043 00000 n Goldman, R. and Greenberg, L.S., 1997. It has been said that the experiences, incidents and or events in our life has an affect on both how we feel and behave. However, an important skill that they should try to perform is to assess a situation before jumping to conclusions. The 5 P which I will be mentioning are: presenting issues, precipitating, perpetuating, predisposing and protective factors. Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. Clinical Psychology 5 P Case Formulation (Macneil et al., 2012) Your mindset for intervention should be geared towards CBT - in NHS IAPT services this would be 'your' approach along with assessment as part of your case formulation. 0000004656 00000 n https://www.centeronaddiction.org/addiction-research/reports/behind-bars-ii-substance-abuse-and-americas-prison-population For example, type II diabetes does not develop because of a single pathophysiological cause. Lack of adaptive coping mechanisms resulted in using self-harm to cope and avoid further emotional dysregulation. and Clark, D.M., 1989. Substance use and misuse is exceedingly common and has numerous implications, both individual and societal, impacting millions of Americans directly and indirectly every year. (2011). Problem areas reported by substance abusing individuals and their concerned significant others. The essay will describe Greg's case study using 5P's model. 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. Do they have ability to be reflective or modulate their affect? The 4 Ps formulation table can be a very rigid and systematized way of presenting a formulation. 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. In addition, the vast majority of those with an SUD never receive treatment (Han et al., 2015). 0000119448 00000 n This can be even more problematic given the lack of health care access for large numbers of Americans (Schoen, 2013). Han, B., Hedden, S. L., Lipari, R., Copello, E. A. P., & Kroutil, L. A. Within the 'Presenting issues stage' its about looking at the current problems or issues the person is facing, to get a clear understanding of what they are and then set goals or . Bacon, M. 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). " [Formulation is] The lynch pin that holds theory and practice together" (Butler, 1998). The following pages describe two approaches to documenting the formulation using the 5Ps structure, including a narrative and flowchart. Further, substance use and misuse is a significant risk factor for suicidality (Poorolajal et al., 2016). Guilford. The clinician may also discuss strategies to help Dax regulate his reactions using emotion-focused interventions such as positive reframing to ameliorate the stress of his daughters cardiac condition (Plate & Aldao, 2017). Drug and Alcohol Dependence, 142(1), 350353. 0000006666 00000 n https://doi.org/10.1016/j.avb.2010.01.006 This is where you'll need to be creative and also think more in-depth about your patient. What it wants to Achieve. 0000241121 00000 n To explain your difficulties and make sense of them, you and the psychologist have to come up with a formula. The Canadian Journal of Psychiatry, 38(5), 351-358. After being told she was fired from her job, she went home and self-harmed to cope with the distress of this loss. The patient has genetic vulnerabilities for mental illness in her family history, a history of anxious temperament, ongoing substance use, and subtherapeutic medication levels. Easden, M. H., & Kazantzis, N. (2018). 0000008644 00000 n Ingram, B. L. (2012). 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. Johnstone & Dallos (2010) suggest a framework for CBT formulation which refers to the levels and process of formulation in regards to the five Ps; presenting issues, precipitating factors, perpetuating factors and protective factors presenting issues which define the current problems in term of emotions thoughts and . She experienced, Brief summarizing statement that includes demographic information, chief complaint, and presenting problems from patient's perspective and signs and symptoms (onset, severity, pattern), Integrative statement: how these factors interact to lead to the current situation and level of functioning, prognosis, and potential openings for intervention. Drugs and drug policy: What everyone needs to know. In addition, the interventions demonstrated are not to be assumed the only ones that can be applied to Dax. Barriers and facilitators affecting the implementation of substance use screenings in primary care clinics: A qualitative study of patients, providers, and staff. She also drank 10 beers prior to arriving in the hospital.

Aurora State Airport Hangars, Stem Cell Therapy Cost In Colombia, Crest Tartar Control Regular Paste Discontinued, Articles OTHER