5 108 CHAPTER 5 Text box 5.1: John’s case formulation In childhood, John was constantly bullied by his brother and peers. As a result, he was convinced that he was “worthless and an inadequate loser” and that “others are untrustworthy and will take advantage if they have a chance” (core beliefs). Recently, he committed a foul at soccer and was suspended (situation). Automatically, he thought he was “good for nothing as he let his team down” and that his teammates would think “John is worth nothing and does not deserve a place on the team” (automatic thoughts). John avoids training sessions, subsequent matches, and other social situations (avoidant behavior), and became self-critical and engaged in self-blaming (negative self-talk). The pattern of interrelated automatic thoughts, avoidant behavior, and negative self-talk caused and maintained sad feelings and low energy levels (problem behavior). Based on the (visualization of his) case formulation, John and his therapist decided to focus CBT first on challenging and cognitive restructuring his automatic thoughts and core believes. Behavioral activation will also be deployed to increase Johns’ mood. At a later stage, they will then decide whether trauma therapy is indicated.
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