Person‐specific validation and testing of functional relations in cognitive‐behavioural case formulation: Guidelines and options

Abstract

Although a number of manuals describe how to develop a cognitive-behavioural case formulation (CBCF) to assist the clinician in developing and implementing tailored CB treatment for complex or comorbid cases, methods to evaluate and test functional hypotheses in the formulation for a particular case are not widely known or used. Thus, formulation-based, tailored treatments for such cases are likely to be guided by case formulations of uncertain validity. The present article presents guidelines and choices available to the clinical trainee, researcher, or practitioner planning to use a person-specific (PS) approach to testing CBCF hypotheses about functional relations between triggers, cognitions, and distress or dysfunction. This approach involves repeated assessments completed by the client using an individualized questionnaire that includes both nomothetic and idiographic items of greatest relevance to the client. Guidelines and options for developing this questionnaire and for data collection within the context of a collaborative therapist-client relationship are described. PS data analyses are then used to test case formulation hypotheses that vary in complexity from simple bivariate relations to complex dynamic mediation. A case example using this PS approach is described. Simpler options for the PS evaluation of a CBCF usable by practitioners and trainees as well as more complex options for clinical researchers are included.

Perceived Causal Problem Networks: Reliability, Central Problems, and Clinical Utility for Depression

“…This would indicate at least clinical utility. Another option, suggested by Mumma et al (2018) is to validate the PECAN against EMA methods. Again, intervention effects should not be expected to spread in a linear fashion across the network, and simulation of networks is likely needed to predict what treatment effects can be expected ( Burger et al, 2020 ; Henry et al, 2020 ).…”

Integrating theory-based and data-driven methods to case conceptualization: A functional analysis approach with ecological momentary assessment

“…FA can be used for assessment and treatment planning (Mumma et al, 2018), to decrease dysfunctional behavior, and to increase functional behavior, for example, in dialecticbehavioral therapy (Linehan, 1993), cognitive-behavioral analysis system therapy (McCullough, 2003), and nonsuicidal self-injury (Bentley et al, 2017). Since then, numerous theoretical models have been developed to explain the development and maintenance of different disorders that could serve as basis for case conceptualization (e.g., Beck, 1987;Ehlers & Clark, 2000).…”

A proposed model for the psychometric evaluation of clinical case formulations with quantified causal diagrams.

“…We do not present specific strategies of validity evaluation in this article but Mumma and colleagues (Mumma, 2004(Mumma, , 2011Mumma & Fluck, 2016;Mumma et al, 2018) have outlined applicable multivariate time-series measurement strategies. David, Marshall, Evanovich, and Mumma (2018) discussed concepts and methods of evaluating hypothesized behavior problems and causal relations in individualized CCFs through longitudinal multivariate intraindividual dynamic network analysis (IDNA).…”

“…A multivariate time-series measurement strategy could also help identify and quantify the effect of moderating variables—the degree to which the relation between couple conflict and obsessive thoughts varies with the client’s concurrent life stressors, medication use, or social settings. Mumma and colleagues (2018) also illustrated how these measurement strategies can clarify the role of mediating variables and temporal dimensions such as the latency of causal effects. The latency of impact of a causal variable is an important element in treatment decisions because it could, in addition to the strength of causal relations, affect the selection of initial treatment foci.…”

“…The recognition of individual differences in the expressions and causes of behavioral problems highlights the potential benefits of tailoring empirically supported interventions to each person’s unique conditions and life contexts, strengths, and limitations. The importance of individual differences also emphasizes the benefits of idiographic, individualized, and person-specific assessment for case formulation, treatment planning, and treatment–outcome measurement strategies (see discussions and examples of idiographic, individualized, and person-centered clinical assessment in Barlow, Bullis, Comer, & Ametaj, 2013; Haynes, Mumma, & Pinson, 2009; Haynes, O’Brien et al, 2011; Molenaar, 2004; Mumma, Marshall, & Mauer, 2018; Sanghera, Rudnick, & Corring, 2011; Weisz et al, 2011). 2 Additionally, CCFs can help communicate the rationale, foci, and treatment methods to clients, supervisors, caretakers, teachers, institutional staff members, medical personnel, insurance providers, and other professionals.…”