It’s really a way of combining shared formulation with brief psychotherapy so it could be tried in many areas - particularly where acceptance and understanding of causal mechanisms has therapeutic value - but there’s no evidence for it outside of FND. Did you have something in particular in mind?

Ok thanks- I may be thinking a step too far. We developing methods for realist evaluation to better incorporate the views & experiences of people with cognitive impairment. Dementia is our ‘case example’ but we hope this work will be more broadly applicable. @drhannahwheat.bsky.social

I think it’s interesting for our team to think about formulation - maybe it could shed light on diverse experiences and needs

We used various qualitative approaches with the 29 adults with FND who donated their time to these studies. I do recommend patient-verified formulation as part of constructing a context-mechanism-outcome theory for realist evaluation. It’s always a theory but can be refined iteratively.

You could even use SIFT! Happy to collaborate if you think that might work for your population.

We used various qualitative approaches with the 29 adults with FND who donated their time to these studies. I do recommend patient-verified formulation as part of constructing a context-mechanism-outcome theory for realist evaluation. It’s always a theory but can be refined iteratively.

All but one of these is open access and I can provide an authors copy of the SIFT pilot. I hope the fourth will be published soon! Personally, I think a qualitative measure is needed in FND which is a disorder of meaning / interpretation as well as of function. Formulation may fill this role.

There are several published clustering analyses showing a group with FND reporting high levels of psychological distress and another with low levels. This seems to suggest different coping strategies / schemas and this paper (submitted) supports that, using patient-validated formulations.

I’m not a cognitive expert and these results are from FND. I think formulation can contextualise various health problems, and I suspect schemas mediate many therapy outcomes,
especially where beliefs and relationships are involved, but I can’t use this data to make claims about that population.

This research is limited to people with FND, which may present with tremor. I think formulation can identify the factors contributing to many health problems but I haven’t collected data for other diagnoses.

Analysis of 24 co-written formulations identified exposures, schemas, activations, and mechanisms. Two groups suggested different pathophysiology but did not predict outcome: over-vigilance and body focus (n=10), and other-directedness and dissociation (n=14). 5/5 (submitted)

Analysing 22 exit interviews, SIFT helped participants to explore and make sense of experiences leading to ongoing recovery and growth. Some were ambivalent and those who found it challenging were less likely to recommend but no less likely to benefit. 4/5 doi.org/10.1002/capr...

Shared Individual Formulation Therapy (SIFT) is a brief treatment developed to address heterogeneity in FND. The pilot with 29 participants showed improvement and high ratings. Formulation letters were co-written to aid communication and treatment. 3/5 doi.org/10.1007/s004...

A systematic review of psychotherapy for FND showed probable benefit across a range of symptoms from CBT and PDT in 19 studies. I proposed that the lack of conclusive evidence may relate to the heterogeneity of FND requiring tailored treatment. 2/5 doi.org/10.1136/jnnp...