Four Column Threat System Formulation #1

Four Column Threat System Formulation

Formulation is key to all therapeutic approaches. In Compassion Focused Therapy (CFT), one type of formulation – sometimes known as a longitudinal or four column formulation – taps in to the link between four key areas:

our key life experiences
how these have led to the development of key fears and threats
how we have developed certain safety or protective strategies to manage our fears
how our safety strategy has led to various unintended consequences

You can find a chapter on how to do this formulation in The Compassionate Mind Workbook, and here in this free chapter, but below we’ll explore the steps of this formulation, the type of questions you might ask at each step, and an example of Emma’s formulation

Threat System Formulation

In CFT, the four column threat system formulation focuses on the nature of the threats we experience. The formulation focuses on how these threats developed, our efforts to manage them in today (known as safety or protective strategies), and how these strategies can lead to a number of unintended consequences. Finally, the formulation explores how these unintended consequences – through fuelling self-criticism and rumination – can lead to further distress and may create more heat to our key fears.

Let’s look at each of these areas in turn, and they explore a hypothetical example of how this might look.

Step 1: Historical Influences:

The formulation begins with an exploration of a person’s historical experiences and emotional memories, and in particular, events that may have shaped their threat systems. These could involve the following areas:

Relationships: for example, with mum, dad, step/foster-parents, siblings, extended family and friends. These could involve being criticised, blamed, rejected, intruded upon or abused. They may also include an experience that others were absent or unavailable, or that they lacked affection, care or kindness towards you. It may also include the loss of someone, like a loved one. In terms of romantic relationships, it might involve being cheated upon, criticised or sexually mistreated.
School: this could include experiences of difficulties academically, for example not achieving to the level that they (or important other) expected, being bullied or not fitting in with others, or frequently moving schools
Employment: including feeling that we haven’t achieved enough at work, of being bullied by our boss or colleagues, of losing our job or being passed over for promotion

Some of the key questions you might want to ask or consider for this step are:

What was it like growing up? Are there any difficulties memories or experiences that stand out?
Growing up, what were your relationships like with your family members? (parents, siblings, extended family)
Growing up, what were your experiences like with friends or peers? Did you ever experience any difficulties with being bullied or ostracised, or in bullying other people?
Have you had any experiences when you felt physically or emotionally threatened, judged or criticised? Did you ever feel afraid or ashamed because of something about yourself, or something that happened to you?

Step 2: Key Fears and Threats:

The next step of the formulation involves helping people to reflect upon how their historical experiences have shaped how their threat systems operate today. Many of the types of threats and fears we have are archetypal, in that there are certain types of things that human beings generally cause us distress, such as as rejection, abandonment, isolation, shame, and physical/sexual/emotion threat/harm (Gilbert, 2010).

In CFT, we also try and distinguish between external threats and internal threats. External threats involve those things that start in the outside world such as fears of being hurt, rejected, abandoned, criticized or manipulated. Internal threats involve fears about ourselves, our identity or our experiences, such as fears involving our own emotional experiences (e.g. fears of becoming overwhelmed by sadness, anxiety or anger, or of feeling vulnerable or alone), memories (e.g. of past trauma, shame memories, or mistakes), or concerns about our identity (e.g. shame – such as a experiencing oneself as weak, inferior or flawed).

Some common threats include:

External Fears (Our concerns about how others may think, feel or treat us)

Rejection – fearing that others will turn us away, or not accept, our attempts for connection and/or affection and that we will be unwanted
Abandonment – a fear that others will withdraw their connection and support
Exclusion – a sense that others will actively keep us disconnected from them or others (E.g. friends, colleagues)
Distrust – that others cannot be trusted, that they will betray, let us down or be untruthful with us
Harm – that others are agents of physical, sexual or emotional harm
Criticism or ridicule – that other people will be critical, shaming or look down on us

Internal Fears (our concerns about things that arise inside of us)

Identity concerns – for example, feeling that we are unworthy, not good enough or a failure
Emotions/feelings – for example, concerns that your feelings might overwhelm us, or that if we allow ourselves to experience them, they might never end. This may also relate to a sense that emotions are ‘bad’, dangerous or a sign of ‘weakness’
Memories – of bad things that have happened to us in the past that keep intruding in to our mind in the present day
Aloneness – a sense of feeling disconnected or separate from others, but with an underlying wish for connection or ‘wellness’

In terms of questions to ask here, you’re looking at how you can link what you found in Step 1 (historical experiences) to how the persons threat system is working today. So often you can start with a general question:

“Given what you’ve experienced in life, how do you think this might have shaped how your threat system works today?”

This can be followed with more specific questions to try and explore external and internal threats. For external threats, this might include:

Given your experiences in life, what’s your concern about what other people might do to you/how they might treat you?
Given your experiences in life, what’s your concern about what other people might think about you?
Given your experiences in life, what’s your concern about what other people might feel towards you?
Given your experiences in life, do you have any concerns about the world itself or your environment around you (e.g. it’s dangerous, bad things will happen)?

In terms of internal threats, we can also ask some more specific questions if it helps people to reflect on their threat system:

Given your experiences in life, what’s your concern about yourself as a person – for example, that you’re a failure, inferior or an imposter)?
Given your experiences in life, are there any emotions or feelings that you feel concerned or threatened about experiencing or expressing?
Given your experiences in life, are there any difficult memories or experiences that you struggle with?

Note: the importance in how you ask these questions

One of the key things here when helping to explore Step 2 is that it’s understandable that these threats have developed – that almost anyone going through the experiences the person has gone through, would have had their threat systems sensitised and ‘heated up’, likely in similar ways. This is particularly important if the person that you’re working with is struggling with shame and self-criticism.

Step 3: Safety, Protective and Compensatory Strategies

When threatened, animals have a variety of ways to protect themselves (for example, to run away, fight or act submissively). In a similar way, when our threat systems are triggered, we also have ways to try and mitigate these, and keep ourselves safe. Some of these strategies we share directly with those that other animals use, and others are more subtle adaptations. It is important here to separate out protective strategies that are used to manage external threats, and those that manage internal threats. These strategies may have developed earlier in life, or be relatively recent responses to difficulties in the world. They often – to extent at least – have helped people to manage or at least reduce the heat of their threat system.

There are some general protective strategies to look out for, which similar to Step 2, can be split between strategies used to manage external threats, and strategies that help to manage internal threats.

Protective strategies to manage external fears

Avoidance – for example, of getting close to people or anxiety-provoking situations
Relying on self, rather than on others
Submissiveness – ‘keeping your head down’, being passive and not asserting yourself
Hypervigilance – trying to spot external threats as quickly as possible, so that they can be dealt with
Seeking reassurance from, or closeness with, others

Protective strategies to manage internal fears

Suppression of feelings or emotions (trying not to ‘feel’ difficult things)
Strive to succeed to feel like we are worthy (e.g. trying to achieve/be the best)
Self-criticism – we can beat ourselves up for things we don’t like about ourselves (for example, as a way of trying to improve ourselves)
Try to connect with others/be closer to others, to reduce feelings of aloneness

In terms of questions that you’re asking to elucidate safety strategies, some of the following are often helpful:

Given your key threats and fears from Step (column) 2), how have you tried to keep yourself safe?
What do you try to do to protect yourself when your threat system has been triggered?
How do you try and protect yourself from your external threats? (e.g. from your concern about what other people might do to you)
How do you try and protect yourself from your internal threats? (e.g. your thoughts, feelings, memories)

How to navigate this step: similar to Step 2, it’s important to hold in mind how you’re helping people to explore their safety strategies, not just the details that emerge.

One of the key things about protective strategies is to help the person that you’re working with to appreciate that they’re just been trying their best to help manage their threat system. Sometimes if you check with people whether sometimes the strategies they’ve developed to protect themselves have helped, particularly in the short term, often people will agree and give you a sense of how that happens.

You can also emphasise here that there are only a limited number of ways that human beings can navigate their threat system, and that these are in part derived from those that many, many other animals also use.

Step 4: Unintended consequences

Although safety and protective strategies (Step/Column 3) can often be effective in the short-term management of threats and fears (Step/Column 2), over a longer period their use often lead to other difficulties arising. So at this step, we try to help people recognise that although it’s not their fault, that their attempts to help themselves may have led to some unintended, undesirable consequences or side-effects.

It’s key here to try and help the person recognise that these consequences are unintended. This means that when the safety strategies first started being used to functionally manage threat system, the person wasn’t aware that in months or years to come, it would lead to problems. So it’s not that, aged 18, we say to someone “I know that when I start using this safety strategy tomorrow of blocking out my feelings using drugs, so as to not feel so overwhelmed and vulnerable, that by the time i’m 21 i’m addicted to cocaine and have wracked up thousands of pounds of debt”. When the strategies begin, they often start slowly and without an ability to look in to the future to appreciate the consequences.

In terms of unitended consequences, it’s useful to separate these out again between those that arise from external protective strategies, and those that come from internal safety strategies. A few examples of this link between safety strategies (Step 3) and unintended consequences (Step 4) are:

External
• If I try to avoid others (safety strategy), I am left feeling alone and unwanted (unintended consequence)
• If I try to appease other people (safety strategy), this might leave me feeling that my needs are not met
Internal
• Blaming myself for bad things that happen (safety strategy), might leave me feeling low in self-esteem and mood (unintended consequence)
• Suppressing my feelings (safety strategy), leaves me experiencing those feelings more frequently and powerfully (known as the bounce back effect, and in this instance, an unintended consequence)

In terms of the questions that you can ask to facilitate reflection on unintended consequences, some of the following might be helpful:

are there any unintended consequences from using your safety strategies?
are there any downsides from using your protective strategies over these years?
have you noticed any unintended side effects from trying to protect yourself from your fears?

Step 5: Self-to-self relating & feedback loop

When looking at what people have noted in Step/Column 4, it can then be useful to round off the formulation by reflecting on two questions:

• How are you left feeling about yourself (your ‘self-to-self’ relationship) when you read through the unintended consequences in column four?
• What tends to happen to your mood, feelings or symptoms when you read through the list of unintended consequences?
For many people, reading through the list of unintended consequences leads to a sense of self-criticism or rumination – that this is somehow their fault, that they are to blame which in turn, unsurprisingly leads to an increase in threat system emotions and sometimes, low mood or depression.

Questions to guide this process may include:

When you read through the list of unintended consequences, how do you feel about yourself? Do you like yourself?
When you read through the list of unintended consequences, what thoughts do you have about yourself?
What impact do these unintended consequences, along with the way you feel about yourself because of these (e.g. self-critical), have upon your emotions and mood?

If this is then extended further, and the person is asked to take in the entirety of Step 4 and their self-criticism/increase in threat system emotions/low mood, and reflect on what happens to Step/Column 2 in the presence of this, the answer is usually immediate – it heats up, or contributes to a feedback loop in which people have a greater sense of key fears or threats. In turn, this then leads to the need to use more safety strategies (Step/Column 3) and then in turn, more unintended consequences (Step/Column 4). In essence, people can see that there’s the possibility of a self-sustaining threat system feedback loop at play.

Threat System Formulation - Completed Example

Below is an hypothetical example of Emma’s threat system formulation, taken from the Compassionate Mind Workbook. There’s a text description first, followed by a visual representation of this below.

Emma’s Story:

Emma came to therapy as she had been feeling depressed and anxious for the past three months. She recently found out that her partner had been unfaithful to her. She described how she felt overwhelmed by her feelings about this, and that she blamed herself for him cheating, as ‘there must have been something wrong with me for why he did it’. She described feeling like a failure herself and hating herself. She also described feeling very lonely, and a sense that other people couldn’t be trusted, as they had hurt or rejected her in the past.

Emma was born and raised in Edinburgh. She recalled how her parents often argued a lot, and that her Dad was often angry and critical towards her. Whilst her mother was kinder, she was often emotionally detached, and Emma wondered whether she had also suffered from depression. At school, Emma had some friends, but was also bullied, and whilst she achieved good exam results, compared herself negatively to her sister who achieved straight A grades. Emma went to university, but didn’t enjoy the subject she took (business studies) or being away from home. Since graduating, she has been working at a large company as a business consultant, but really dislikes her job, and would like to leave.

During her third session in therapy, Emma was helped to use some of the above information (along with other information she gave about her current and early life) to develop a formulation of how her life experiences had influenced her current difficulties now.

Step 1: Emma’s Historical Influences

To start with, Emma and her therapist identified a number of key experiences in life that she felt might have affected or influenced her.

Early family relationships

Parents argued a lot, Dad was often physically violent and critical
Parents divorced when I was eight years old – felt it was my fault they separated
Mum could be caring but often was detached and emotionally cold. Felt as if her job was more important than me.
Parents favoured my sister because she was smarter than me

School/academic experiences

Enjoyed primary school, but didn’t like secondary school – I was bullied about my appearance and being last in my class to get my period
I did ok in my exams but mum always responded with: ‘almost as good as your sister’
Didn’t enjoy university – others more intelligent and popular than me

Peer/romantic relationships

Fell in love with Steve when 16 – first boyfriend –found out he had been cheating on me whole time

Career experiences

Not enjoying her job – passed over for promotion a number of times

Step 2: Key Fears and Threats

Given Emma’s background, with her therapist they then considered how her threat system might have been shaped to be sensitive to certain key threats or fears

Emma’s external fears/threats (things she feared others might think about her, or do to her) included:

Others can’t be trusted (this was particularly linked to being cheated on by her first boyfriend)
Others will reject me (this was linked to the experience of her dad being absent, and her boyfriend leaving her)
Others will look down on me/are critical of me (this was linked to experiencing her mum being critical, and her peers as shaming)

We were also able to outline a number of key internal fears (things that emerged inside her that were uncomfortable or threatening). These included:

I am not good enough (linked to the experience that her sister was favoured and ‘smarter’)
My emotions are overwhelming and too painful (this was related to her parents being emotionally detached, and to mum criticising her when she expressed strong emotions as a child)
I am alone and lonely (this was linked to feeling that she had always been separate from others – her mum, sister and friends)

Step 3: Safety Strategies

After identifying her key fears and threats, we went on to outline ways that had helped to protect herself from these.

To protect herself from her external fears that others could not be trusted, that others would reject her, and that others would look down on her/be critical, Emma reported:

Keeping my distance from others
Keeping on guard and vigilant of what others might do/think
Trying to please other people so they won’t hurt or reject me

To protect herself from her internal fears of not being good enough, having overwhelming emotions, and feeling alone, Emma identified:

Trying not to strive or push myself, for fear that I’ll fail if I did
Suppressing and keeping my feelings to myself
Using food and alcohol as a way to not feel distress

Step 4: Unintended Consequences

After identifying her safety strategies, we then went on to help Emma identify whether these strategies had any unintended consequences. Following her strategies of keeping her distance from people, staying on guard and pleasing others so as to manage her external fears, Emma identified the following unintended consequences:

The more I keep distance from others, the more lonely I feel
The more I stay on guard, the more suspicious I am of other peoples’ intentions
The more I try and please others, the more my own needs don’t get met

We also looked at the unintended consequences that followed from the safety strategies that she uses – not pushing herself, suppressing her feelings and self-harm – to manage her internal fears. Emma identified:

The more I don’t push myself, the more I feel like a failure
The more I suppress my feelings, the more I get overwhelmed with strong feelings
When I self-harm, I get scars and these leave me feeling ashamed

Step 5: Feedback Loops

So looking at the fourth column of your formulation, it can be useful to reflect on two questions:

How are you left feeling about yourself – what ‘self-to-self’ relationship is – when you read through the unintended consequences in column four?
What tends to happen to your mood, feelings or symptoms when you read through the unintended consequences?

As you can see from Emma’s formulation example (below) the unintended consequences in her life (column four) left her feeling more critical of herself – she disliked herself and, at times, even described hating the person that she had become. Understandably, the combination of her unintended consequences as well as this critical way of thinking about herself, left her feeling lower in mood.

Emma's Formulation

When we simplified Emma’s information down, we added it in to the formulation diagram below. For a blank version of the formulation to use yourself, click here

This formulation has been adapted from the wonderful work of Paul Gilbert – find out more at www.compassiontemind.co.uk