CBT Case Formulation (5 Ps)
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.
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.
- 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.
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.