The Future of Intervention Science: Process-Based Therapy
Stefan G. Hofmann and Steven C. Hayes
The medical illness model, which assumes that symptoms reflect a latent disease that should be targeted with a specific therapy protocol, has been the norm in clinical science, but this seems to be changing. Hoffman and Hayes consider the developments in the field that allow for a move toward process-based therapy (PBT), especially in cognitive-behavioral therapy. A concern for principles and models, with emphasis on the centrality of processes of change along with research identifying moderators and psychological processes, makes this move toward PBT possible. PBT targets the processes responsible for the effectiveness of treatment that are identified theoretically and supported by research. By moving away from the traditional link between treatment protocol and syndrome, clinical science might see a decline in named therapies in favor of procedures linked to processes, a rise of testable models and mediation and moderation studies, as well as a focus on the individual, the context, and new forms of therapeutic relationship and care.
Davison comments on Hofmann and Hayes’ article on process-based therapy (PBT) in which they suggest the use of functional analysis and PBT in clinical science. PBT targets the processes responsible for the effectiveness of treatment that are supported by theory and research, moving away from the traditional link between treatment protocol and syndrome. Davison provides a historical and conceptual context for Hofmann and Hayes’ article and suggests that their views are not new but have been around for more than 60 years. He mentions the importance of change mechanisms in therapy and the departure from simply applying categorized schemes, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and treatment manuals, as well as the challenges of applying general psychological principles to individual cases. Despite considering that Hoffman and Hayes’ proposal is not entirely new, Davison suggests that it is important for the development of clinical psychological science to remind researchers and practitioners of the importance of functional analyses.
Process Trumps Protocol: What I Liked About Hofmann and Hayes
Steven D. Hollon
In this commentary, Hollon shows his support for Hofmann and Hayes’ urge to move toward process-based therapy (PBT), which targets the processes responsible for the effectiveness of treatment that are identified theoretically and supported by research. PBT allows moving away from the traditional link between treatment protocol and syndrome and allows identifying mediators of the actual processes that underlie behavior. Hollon argues for the importance of identifying these processes for clinical practice rather than relying on protocols. He gives the example of young counselors in India who learned only basic processes instead of full treatment protocols and were able to decrease depression rates and domestic violence among their clients. According to Hollon, this example supports Hofmann and Hayes’ proposal for the use of PBT and functional analysis in clinical practice and research.
Teachman comments on the 2018 article by Hofmann and Hayes which noted lack of progress in reducing the burden and prevalence of mental illness, and challenged the clinical field to recognize that empirically supported processes of change should guide treatment planning. Hofmann and Hayes named this solution process-based therapy, in opposition to the usual treatment packages. Teachman discusses questions that will arise in shifting from one-size-fits-all treatment packages to more personalized process-based therapy, and suggests some steps to facilitate this shift. These include the need for more systematic reviews on processes of change, and more investment in processed-based therapy research. Improving access to resources for providers with minimal jargon (e.g., videos, handouts) is another factor that might facilitate the shift to process-based therapy. Teachman also identifies the need to view treatment planning as a dynamic process that should occur with the patients’ knowledge and informed consent.
The Promise of a Participatory Approach in Clinical Psychology
Leah Anne Teeters and Sona Dimidjian
Teeters and Dimidjian offer for consideration a participatory approach to Hofmann and Hayes’ proposal of using process-based therapy (PBT) instead of category-based therapies (i.e., theories specific for a syndrome). A participatory approach is a set of methods that allows for partnerships among researchers, practitioners, and community members. Participatory approaches usually result in the design and implementation of sustainable interventions. By considering individuals’ contexts and cultures, a participatory approach would prevent PBT from becoming overly individualistic and detached from context. Thus, Teeters and Dimidjian propose that clinical psychologists explore the relevance of participatory approaches, which allow for the incorporation of individual and social factors into the design and dissemination of therapeutic processes. Participatory approaches along with Hofmann and Hayes’ recommendations will likely accelerate the progress of clinical psychology, they say.
Hofmann and Hayes react to the commentaries on their article “The Future of Intervention Science: Process-Based Therapy.” Each commentary seemed to agree with their message that clinical interventions must move away from the traditional link between treatment protocol and syndrome and toward process-based treatments (PBTs) targeting the processes theoretically identified and supported by research. Hofmann and Hayes agree that functional analysis and PBT are old ideas but call attention to the fact that research and practice related to these ideas seems to have been stagnant for at least 20 years. The authors also discuss the benefits of considering the social and cultural context of an individual when examining psychological processes. They suggest that research and practice communities are now ready to use functional analysis, intervention science, and PBT to study human complexity.