CAT SDR Formulation — MRCPsych Paper B MCQ

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HardPsychotherapyCAT SDR FormulationMRCPsych Paper B

During cognitive analytic therapy, a patient describes repeatedly appeasing critical others, becoming resentful, and then withdrawing. The therapist and patient jointly construct a visual map linking a critical-to-criticised reciprocal role with this self-perpetuating procedural sequence and possible exits. Which formal method are they using?

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Correct answer: C — Sequential diagrammatic reformulation

The correct answer is C, sequential diagrammatic reformulation (SDR). The SDR is CAT's collaboratively constructed visual map, linking reciprocal roles with recurrent target problem procedures, traditionally described as traps, dilemmas and snags, and identifying potential exits. The critical-to-criticised relationship and the self-perpetuating appeasement–resentment–withdrawal sequence are characteristic CAT formulation elements. Free association is primarily an unstructured psychoanalytic technique. A thought record examines situations, cognitions, emotions and alternative appraisals within CBT. An exposure hierarchy orders feared situations for graded exposure. Behavioural chain analysis examines antecedents and consequences of behaviour, particularly in behavioural and dialectical behaviour therapy, but does not specifically formulate CAT reciprocal roles.

Reference: NHS England, National Curriculum for Cognitive Analytic Therapy, sections on CAT formulation, target problem procedures, reciprocal roles and SDRs, 2023. https://www.hee.nhs.uk/sites/default/files/documents/National%20Curriculum%20for%20Cognitive%20Analytic%20Therapy%20v1.0%20.pdf