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Handouts & questionnaires for problem solving & behavioural activation

Here are a series of forms, questionnaires and handouts that I use regularly in my work.  The problem solving diagram is a recurring theme - both at the start of therapy and as a sheet to return to when reviewing and considering additional therapeutic options.  Other sheets are classic variants on the tools used by many cognitive behavioural therapists - with occasional alternatives and additions, that I've come up with over the years, thrown in as well.

Problem solving diagrams - here are half a dozen Powerpoint slides providing different options for the Problem solving diagram I use with nearly all clients who come to see me.  My typical routine at a first session is to gather information.  If the case is relatively straightforward, towards the end of this first session (when I've gathered most of the information I need) I will give them some initial screening and assessment questionnaires to fill in.  While they are doing this, I transfer information that I have been jotting down as they told me their story, onto a problem solving diagram.  I usually use the diagram making up the fifth of the six slides you can download here, but sometimes (with anxiety problems) I will use the sixth slide diagram.  Slides one to four are simpler versions of the same approach.  If I'm pushed for time, I may only fill in the top two thirds of the problem solving diagram at this stage - detailing their "problems & strengths" and their "main wishes & worst symptoms".  If I get the chance though, I will also brainstorm the best supported therapeutic options that they have.  With more complex cases, all this may have to wait until the second session.  I then show them the diagram, make changes if they have further comments, and then photocopy it for them to take away and revise/add to if they want before our next session.  Typically - although I am simply organizing and feeding back the information they have given me - clients usually seem very grateful for this "making sense of" their symptoms and "giving hope" that there are options that can help them.

Rumination assessment - a simple four question way of assessing initial severity and monitoring progress in reducing rumination. 

Rumination, from TRAP to TRAC - classic behavioural activation model of the shift from ruminative Trigger-Response-Avoidance-Pattern TRAP to getting back onto the problem solving Trigger-Response-Alternative-Coping TRAC.  This handout also contains plenty of research back-up for the notion that rumination is largely bad news.

Checklist of potential problem areas - this is a list of a dozen potential problem areas that it can be helpful to show clients to jog their memories for any important issues that they have failed to mention in the initial interview.

Hassles scale - this is the classic 117 items hassles assessment scale.  More minor hassles of everyday living can be as important as major problems in wearing people down.

Psychological & physical difficulties are so common that they're normal - the facts & figures on this sheet are now somewhat dated.  The intention however is clear - to try to reduce a sense of stigma/shame about having difficulties by highlighting how common it is to sometimes struggle with psychological and physical symptoms. 

Initial person-centred outcome measures - assessment measures adapted from the MYMOPS - Measure Yourself Medical Outcome Profile - inititiative. 

Follow-up person-centred outcome measures - adapted MYMOPS follow-up assessment measure.

Disability assessment, 3 areas - this is the classic Sheehan three item disability questionnaire using 0 - 10 scales to assess difficulties with work (including housework), family relationships, and recreational & social functioning.  This type of simple scale can be very helpful for assessment, clarifying appropriate activity challenges, and monitoring progress.  

Disability assessment, 4 areas - this is the Sheehan scale (see above) slightly extended to separate out couple/marriage issues from other family difficulties. 

Disability assessment, 5 areas - the NHS Increasing Access to Psychological Therapies (IAPT) initiative has extended this disability measurement still further, using 0 - 8 scales to assess work, home management, social/leisure activities with others, social/leisure activities on one's own, and family & other relationship activities.

Disability assessment, 8 areas - and the last of these disability scale options is an eight item questionnaire, where the items are typically more narrowly focused and are chosen by client & therapist to focus on issues that are specifically relevant for the client involved. 

Behavioural activation strategies - a handout detailing the kinds of activation strategies to be used in a Jacobson style approach to depression treatment. 

Nourishment, adversity & suffering - a handout giving a simple fairly behavioural view of the development & treatment of depression.

Activity schedule 1 & instructions - slightly adapted classic CBT one page weekly activities record sheet with a second page giving instructions on its use.

Activity schedule 2A and schedule 2B & instructions - here are a couple of slightly more adapted activities record sheets with instructions.  These record sheets are designed to take into account more recent research suggesting that increasing pleasant emotional experiences of various kinds and decreasing unpleasant experiences of various kinds may provide additive benefits for depression and other disorders.


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