Skills Class 26 - Identifying the Maintaining Mechanisms of a Cognitive-behavioral Case Formulation

Maintaining mechanisms are the psychological factors (e.g., cognitions, behaviors, and skills deficits) and/or events (e.g., reinforcers) that maintain a patient’s symptoms, problems, or disorders. Maintaining mechanisms are a key element of the case formulation because they identify the primary targets of treatment; if the maintaining mechanisms are eliminated, we expect the patient’s symptoms and problems to remit. Following a brief didactic presentation in which we describe the elements of the cognitive-behavioral case formulation and describe common maintaining mechanisms in CBT, we lead interactive exercises in which we teach and participants practice the skills of identifying maintaining mechanisms based on prompts we provide. We will allow time for brief discussion of each exercise. Exercises include: Using the Thought Record to identify key cognitions and behaviors, linking cognitions and behaviors, using the downward arrow technique to identify core beliefs, and self-monitoring and the behavioral chain analysis to identify antecedents and consequences of problem behaviors.