ABSTRACT
Within the CBT literature, formulation is described in two ways, a protocol-driven intervention and a case formulation-driven intervention. The concept of a protocol-driven intervention comes directly from the evidence base on which the CBT model is based. What this means is that when a CBT treatment is tested in a randomized controlled trial the intervention is delivered following a protocol. The protocol is written before the trial begins and basically identifies which CBT interventions will be used in what order and how each one will be delivered. This means that the CBT treatment is broken down into a series of individual interventions and each patient receives each intervention in a stepwise way in a specified order over a predetermined number of sessions. No other interventions are offered apart from those described in the protocol. This method is adopted in order to ensure the reliability and validity of the intervention and to be able to draw conclusions from the results, based on the principle that each patient has received the same CBT intervention. This protocol method of treatment originally used in research trials has been translated into treatment packages for the anxiety disorders and depression. The CBT literature referred to in this book describes many of these (see Hawton et al., 1989: Wells,
1997) and clinical experience tell us these are highly effective with many patients, particularly when they present with mild to moderate problems with no or low levels of comorbidity. This method is closely aligned to the concept of making a diagnosis of a patient’s problem, and typically protocols are described as the ‘CBT protocol for panic disorder’ or the ‘CBT protocol for acute depression’. This originates from the fact that all randomized controlled trials traditionally use inclusion and exclusion criteria and diagnosis is the method for guiding this decision-making process.
