Advice and development

Using CBT to improve self-awareness and resilience

Nursing student Lauren Ferrier shares her tips on how to cope with stress by creating a ‘formulation’ to analyse where your emotions come from

Nursing student Lauren Ferrier shares her tips on how to cope with stress by creating a ‘formulation’ to analyse where your emotions come from

Two of the most important skills we can develop as nursing students are self-awareness and resilience.

The CBT technique ‘formulation’ identifies factors contributing to a problem
by analysing the source of emotions. Picture: iStock

To provide effective care for others, it is essential we first protect ourselves from becoming overwhelmed by stress. As a mental health nursing student, I undertook a placement with a team of cognitive behavioural therapists last year.

Not only did the experience provide an opportunity to enhance my counselling skills and have more meaningful interactions with patients, it also taught me a lot about myself. 

One CBT technique I learned was how to create a ‘formulation’, to identify factors contributing to a problem – in this case stress.

Formulation is designed to analyse where emotions come from, in order to gain insight and anticipate situations that may trigger the problem.

Writing a formulation for yourself requires honesty and self-analysis. Using the headings below, it is possible to identify some personal characteristics.

Perpetuating factors – things that keep you stressed
  • Think about biological factors. Are you healthy? Do you sleep well? Do you have any unhealthy habits?
  • Psychological factors are equally important. Do you often think about things in a negative way? Are you self-critical? 
  • Contextual factors are external factors that may perpetuate stress. For example, do you have a good system in place to keep you organised? Do you have a support network at university? Do you have too much on your plate?
Predisposing factors – how your personality and physicality contribute to your stress
  • Identify any biological, psychological and contextual factors that may make you prone to stress.
  • For example, have you ever suffered a trauma? Are there any stressors outside of your nursing course? Is this your first time away from home?
​Precipitating factors – things that trigger your stress
  • You may already know some of the things that trigger your stress, but over time it is helpful to notice when you are getting stressed and identify possible causes. 
  • Try to identify which aspects of nursing are most stressful for you and ask yourself why these are particularly stressful. For example, if you find essays more stressful than placement, do you struggle with writing or do you have difficulty with time management?
Protective factors – things that help you deal with stress
  • Identify any attributes that are helpful. As a nursing student, you should have a good understanding of how to maintain good health. You will likely have good self-awareness, an internal locus of control and, having gained a place at university, a high IQ. All of these things are assets that will be helpful in addressing stressful situations.


Now that your formulation has highlighted the perpetuating, predisposing, precipitating and protective factors which contribute to your stress, you will be more empowered to deal with it and will hopefully be inspired to further research CBT.

About the author

Lauren Ferrier is a third-year mental health nursing student at Robert Gordon University in Aberdeen

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