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During an LICBT assessment, the practitioner employs a range of common factor and questioning skills (Chapter 5; Richards and Whyte, 2011) to gain an understanding of features associated with the patient presentation in the here and now (Chapter 2). This informs the cognitive-behavioural model shared with the patient and informs selection of the appropriate CBT self-help intervention (Chapter 4). Within HICBT, however, a greater range of questioning skills, such as the downward arrow technique (Beck, 1995) is employed to inform a longitudinal cognitive-behavioural formulation that extends beyond the here and now (Figure 1.1).

Figure 1.1 High- and low-intensity CBT formulation

A longitudinal formulation seeks to appreciate the influence of enduring cognitive distortions, such as intermediate – rules, attitudes, assumptions – and core beliefs, on the cognitive model that accounts for the way the presenting problem is impacting on the patient in the here and now (Beck, 1995).