CBT Case Formulation (5 Ps): Map What Causes, Triggers, and Maintains a Problem
Map the whole picture behind a problem using the 5 Ps: what's happening now, what made you vulnerable, what set it off, what keeps it going, and what protects you.
Reviewed by Michael Callans, MSW 
About this tool
Case formulation is how therapists move from a list of symptoms to an understanding of a person. The 5 Ps framework is one of the most widely taught structures for it, because it organizes a complicated story into five clear questions. Rather than asking only 'what is wrong,' it asks how a difficulty developed, what set it off, and crucially, what is keeping it going now.
The five factors are predisposing (what made you vulnerable in the first place, such as temperament, early experiences, or biology), precipitating (what triggered the problem or a recent flare), presenting (the symptoms and difficulties you are dealing with now), perpetuating (the patterns, often understandable coping strategies like avoidance, that keep the problem alive), and protective (your strengths, supports, and resources). Together they form a balanced map rather than a deficit list.
The most useful column for change is usually perpetuating factors. Predisposing and precipitating factors are in the past and cannot be undone, but the things that maintain a problem in the present are often workable. Avoidance, rumination, withdrawal, and safety behaviors frequently keep difficulties going long after the original trigger has passed, and these are exactly what CBT targets.
This worksheet is a self-reflection tool, not a clinical assessment. Filling it in can give you a clearer, more compassionate picture of your situation and help you spot leverage points. If you are working with a therapist, bringing your version can make sessions more focused, since formulation is meant to be a shared, evolving map rather than a fixed verdict.
Once you have filled in the five categories, look for connections between them instead of reading each one in isolation. A predisposing factor like early criticism might explain why a specific precipitating event, a critical remark at work, hit so hard, and why a perpetuating pattern of overworking to prove yourself keeps the cycle going. The final section, what stands out, is meant to turn that map into one workable target rather than leaving it as a list.
A self-made formulation can sharpen your thinking, but it does not replace the back-and-forth of working with a therapist, who can test your hypotheses against what actually changes your symptoms over time. If your difficulties are severe, safety-related, or have not shifted despite your own efforts, bring this worksheet to a licensed mental-health professional trained in CBT, or use the Psychology.com therapist directory to find one.
References
- Persons JB. The Case Formulation Approach to Cognitive-Behavior Therapy. Guilford Press; 2008.
- Macneil CA, et al. Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice. BMC Med. 2012;10:111.
Cite this source
Psychology.com. (2026, September 14). CBT Case Formulation (5 Ps). Psychology.com. https://psychology.com/tools/cbt-formulation
CBT Case Formulation (5 Ps) FAQ
What are the 5 Ps in CBT?
They are five categories that organize an understanding of a problem: predisposing factors (what made you vulnerable), precipitating factors (what triggered it), presenting factors (the current difficulties), perpetuating factors (what keeps it going), and protective factors (your strengths and supports).
Why is the perpetuating column so important?
Past factors cannot be changed, but the patterns that maintain a problem in the present often can. Avoidance, rumination, and safety behaviors frequently keep difficulties alive, and these are exactly what CBT works to shift.
Is this the same as a diagnosis?
No. A formulation explains how and why a problem developed and persists for you specifically. It complements a diagnosis but is more individual and points more directly toward what to change.
Is my information saved?
No. Everything stays in your browser. Your entries are never uploaded or stored, and the PDF is generated on your own device.
How is a case formulation different from a treatment plan?
A formulation explains how and why a problem developed and what keeps it going. A treatment plan uses that understanding to lay out specific goals, techniques, and a timeline for addressing it. Most CBT treatment plans are built directly from a formulation like the 5 Ps.
Can I do a case formulation without a therapist?
Yes, as a self-reflection exercise. This worksheet can help you see patterns in your own life more clearly. A licensed CBT therapist adds trained judgment, checks your formulation against what evidence-based treatment predicts, and can adjust it as therapy progresses.