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Alternative Action Formulation
Alternative Action Formulation

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Description
The Alternative Action Formulation is a CBT case conceptualisation (formulation) worksheet. The purpose of a formulation is for the client

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and therapist to come to a shared understanding of a problem. This formulation template follows a Problem > Coping strategy > Unintended

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consequence format and is designed to encourage a focus on alternative (more adaptive) behavioural strategies.

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Instructions
Start by identifying the client’s current difficulties and the strategies that they use to cope with these. The consequences of the current coping

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strategies are then explored (look out for short-term gains and long-term costs). Clients are then encouraged to consider alternate coping

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strategies.

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References

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Eells, T. D. (Ed.). (2011). Handbook of psychotherapy case formulation. Guilford Press.
Johnstone, L., & Dallos, R. (2013). Formulation in psychology and psychotherapy: Making sense of people’s problems. Routledge.

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Kuyken, W., Padesky, C. A., & Dudley, R. (2008). Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. Guilford Press.

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Persons, J. B. (2012). The case formulation approach to cognitive-behavior therapy. Guilford Press.
Tarrier, N., & Johnson, J. (Eds.). (2015). Case formulation in cognitive behaviour therapy: The treatment of challenging and complex cases. Routledge.
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Alternative Action Formulation

Problems & difficulties Vulnerabilities

List all of the problems that you are having What makes you more likely to experience this problem than someone else?

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Triggers
What made these problems so bad now?

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Coping strategies Effects of these coping strategies Alternative actions
What do you do to cope with these problems? How do these strategies make you feel in the short-term, If your current solutions aren’t completely effective,
What makes you feel better, at least temporarily? and in the long-term? what else could you try?
What are the advantages and disadvantages?

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Consider common CBT mechanisms: avoidance, cognitive bias,

conditioning, rumination, safety behaviours, selective attention

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Copyright © 2020 Psychology Tools Limited. All rights reserved.
Alternative Action Formulation

Problems & difficulties Vulnerabilities

List all of the problems that you are having What makes you more likely to experience this problem than someone else?

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List problems. Consider biopsychosocial predisposing factors: biological

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Ask client to order them in terms of severity - vulnerability, social support (or lack of), and intrapersonal

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factors (e.g. beliefs).

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focus on the most severe first.

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Triggers
What made these problems so bad now?

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What events, thoughts, emotions, or behaviours precipitated the
current episode? What previously protective factors are absent?

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Coping strategies Effects of these coping strategies Alternative actions
What do you do to cope with these problems? How do these strategies make you feel in the short-term, If your current solutions aren’t completely effective,
What makes you feel better, at least temporarily? and in the long-term? what else could you try?
What are the advantages and disadvantages?

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Look out for and ask about common CBT Look for patterns of short-term gain and Clients often initially find it difficult to generate
maintenance mechanisms such as: t
long-term cost – we often take action alternatives. Helpful questions might include:
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• Avoidance / safety behaviours geared towards short-term sensations such • If you had a friend who was in this situation
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• Ruminating / dwelling as relief which can end up being what might you advise them to try?
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• Seeking relief / reassurance which is a counterproductive. • (Empathise) It looks like your best efforts to
powerful reinforcer (conditioning) cope are intended to make you feel better
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• Selective attention in the short-term but they’re not making the

problem go away. What other things could we
try that might help us take a step towards
beating it in the long term? (encourage
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incremental solutions rather than one-shot

Consider common CBT mechanisms: avoidance, cognitive bias,
conditioning, rumination, safety behaviours, selective attention efforts)

PSYCHOLOGYT LS
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Copyright © 2020 Psychology Tools Limited. All rights reserved.
Alternative Action Formulation

Problems & difficulties Vulnerabilities

List all of the problems that you are having What makes you more likely to experience this problem than someone else?

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Horrible memories of being attacked by my ex-partner that My ex-partner was violent and he had a history of being

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I can’t get out of my mind. violent.

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Feeling scared all the time.

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Triggers
What made these problems so bad now?

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I didn’t feel this way when I was with him because I was more focused
on keeping safe. Now we’re separated I have more head-space.

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Coping strategies Effects of these coping strategies Alternative actions
What do you do to cope with these problems? How do these strategies make you feel in the short-term, If your current solutions aren’t completely effective,
What makes you feel better, at least temporarily? and in the long-term? what else could you try?
What are the advantages and disadvantages?

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Try to push the memories away - Short-term - feels better to distract myself, Try to fix these memories so I can put it
by keeping really busy or distracting t
better than thinking of what happened. behind me once and for all - therapist says
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myself with tv. Long-term - nothing really changes and I keep we can try to ‘process’ them with exposure.
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having these memories. Feel like I haven’t

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got any control over my own mind.
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Never being alone - always ask my Short-term - feel safer when she is with me, • Ask other people to help me.
daughter to come with me when I need it means I can get some things done. • Gradually try to do more alone.
to go out. Long-term - I don’t feel safe when I’m alone, • Practise relaxation or mindfulness.
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it’s draining for her and I worry she will resent • Do an experiment to find out whether the
Consider common CBT mechanisms: avoidance, cognitive bias,
conditioning, rumination, safety behaviours, selective attention me. I feel helpless and dependent. worst really does happen.

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Copyright © 2020 Psychology Tools. All rights reserved.
Alternative Action Formulation

Problems & difficulties Vulnerabilities

List all of the problems that you are having What makes you more likely to experience this problem than someone else?

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Depressed - I feel useless and worthless. Never been very good at making friends.

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Tired.

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Not sleeping well - can’t get to sleep, racing thoughts.

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Triggers
What made these problems so bad now?

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Struggling at work and my girlfriend left me.

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Coping strategies Effects of these coping strategies Alternative actions
What do you do to cope with these problems? How do these strategies make you feel in the short-term, If your current solutions aren’t completely effective,
What makes you feel better, at least temporarily? and in the long-term? what else could you try?
What are the advantages and disadvantages?
Dwell on my problems and ask lots of Short-term - feels like I’m trying to do

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• Try to solve my problems systematically
“why me?” questions.
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something to solve problems.
with a pen and paper for a set period of
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Long-term - haven’t managed to solve them
time rather than just going over them in my
so far.
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head.
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Think about all the ways that I’m defective Short-term - being systematic like that works • Be fair to myself - think about what I’m
so that I can try to fix them. when trying to solve problems in other areas of good at and do more based on my strengths.
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my life. • Go out and stay active - give myself a

Long-term - not working, makes me sad. chance to have nice experiences.
Stay in more so I have time to think. Short-term - feels easier than going out and
facing people.
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Consider common CBT mechanisms: avoidance, cognitive bias, Long-term - nothing good is happening to me.
conditioning, rumination, safety behaviours, selective attention

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Resource details
Title: Alternative Action Formulation
Language: English (GB)

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Translated title: Alternative Action Formulation
Type: Worksheet

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Document orientation: Landscape
URL: https://www.psychologytools.com/resource/alternative-action-formulation/

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Terms & conditions
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be found at: https://www.psychologytools.com/terms-and-conditions/

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Disclaimer
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Your use of this resource is not intended to be, and should not be relied on, as a substitute for professional medical advice, diagnosis, or treatment. If you are suffering
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complete, reliable or suitable for any purpose. As a professional user, you should work within the bounds of your own competencies, using your own skill and knowledge,
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Copyright
Unless otherwise stated, this resource is Copyright © 2020 Psychology Tools Limited. All rights reserved.
Copyright © 2020 Psychology Tools Limited. All rights reserved.