“Third-wave” cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry

Panic patients who believed that they had control over the amount of CO2 they inhaled by turning an inoperative dial were less likely to panic than individuals who knew that they had no control over it.

“Furthermore, panic patients who believed that they had control over the amount of CO 2 they inhaled by turning an inoperative dial were less likely to panic than individuals who knew that they had no control over it 26”

• cites [26] 26. Hofmann SG, Asnaani A, Vonk JJ et al. The effi- cacy of cognitive behavioral therapy: a review of meta-analyses. Cogn Ther Res 2012;36:427-40. sourceCould not verify

  The Results > Anxiety Disorders section discusses treatments for panic disorder, but not an experiment involving inhaled CO2, an inoperative dial, or perceived control. Searches for the dial experiment and for perceived control during CO2 inhalation found no passage addressing the claimed comparison. No page number is available in our copy. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Biomedical treatments are becoming more generic rather than more specific.

“biomedical treatments are becoming more generic rather than more specific”

• cites [3] 3. Andrews PW, Kornstein SG, Halberstadt LJ et al. Blue again: perturbational effects of antidepres- sants suggest monoaminergic homeostasis in major depression. Front Psychol 2011;2:159. sourceCould not verify

  The Study Overview and Discussion address antidepressant drugs, treatment resistance, and relapse, not whether biomedical treatments are becoming more generic rather than more specific. Searches for that wording and for treatment specificity found no passage addressing the claimed trend; page numbers were not available in our copy. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Effect size improvements for both psychosocial and biomedical interventions are minimal or absent.

“effect size improvements for both psychosocial and biomedical interventions are minimal or absent 3”

• cites [3] 3. Andrews PW, Kornstein SG, Halberstadt LJ et al. Blue again: perturbational effects of antidepres- sants suggest monoaminergic homeostasis in major depression. Front Psychol 2011;2:159. sourcePartly supported

  The Discussion’s “Modest efficacy of ADMs during acute therapy” section says antidepressant drugs have limited efficacy during acute treatment. It does not establish minimal or absent effect-size improvements for psychosocial interventions, or for biomedical interventions generally (page not provided in our copy). (LLM, conf=0.83)

  Experimental — accuracy not yet measured

A consensus appears to be emerging that what is most needed is enough healthy psychological distance from thought, so that beliefs and cognitive constructions are not excessively entangling, either through avoidance and suppression, or attachment and rigid adoption.

“A consensus appears to be emerging that what is most needed is enough healthy psychological distance from thought, so that beliefs and cognitive constructions are not excessively entangling, either through avoidance and suppression, or attachment and rigid adoption 81,82 .”

• cites [81] 81. Vowles KE, McCracken LA, Eccleston C. Patient functioning and catastrophizing in chronic pain: the mediating effects of acceptance. Health Psy- chol 2008;27:136-43. sourceNot checked — no full text of the source
• cites [82] 82. Kalia V, Knauft K. Emotion regulation strate- gies modulate the effect of adverse childhood experiences on perceived chronic stress with implications for cognitive flexibility. PLoS One 2020;15:0235412. sourcePartly supported

  The Introduction describes reappraisal as changing how one frames an event, and the Discussion links expressive suppression to inflexible appraisal of stressors. These passages support a preference for flexible reappraisal over suppression, but they do not establish an emerging consensus that healthy psychological distance from thought is what is most needed, or address attachment to beliefs and their rigid adoption. Page numbers are unavailable in our copy. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

In a multidisciplinary, multicomponent, group-based CBT program for adults with chronic pain, pre-treatment measures of psychological flexibility predicted ultimate outcomes.

“In a multidisciplinary, multicomponent, group-based CBT program for adults with chronic pain, pre-treatment measures of psychological flexibility (the core process target of ACT) predicted ultimate outcomes, and change in each of the aspects of psychological flexibility measured in the study (acceptance, cognitive defusion, values, committed action) separately mediated outcomes 58 .”

• cites [58] 58. Klepac RK, Ronan GF, Andrasik F et al. Guide- lines for cognitive behavioral training within doctoral psychology programs in the United States: report of the inter-organizational task force on cognitive and behavioral psychology doctoral education. Behav Ther 2012;43:687-97. sourceCould not verify

  The Overall Framework for Clinical Training lists defusion, acceptance, and values clarification as clinical training topics, but does not report a chronic-pain study or its outcomes (page unavailable). Searches for chronic pain, pre-treatment psychological flexibility, and the described group-based CBT program found no passage stating that baseline measures predicted outcomes. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

The majority of known behavioral targets have roots in early behavior therapy, such as restriction of safety behaviors, behavioral activation, problem-solving, social skills, planning, or reductions in impulsivity.

“However, the majority of known behavioral targets have roots in early behavior therapy, such as restriction of safety behaviors, behavioral activation, problem-solving, social skills, planning, or reductions in impulsivity 106 .”

• cites [106] 106. Dietz LJ, Weinberg RJ, Brent DA et al. Family- based interpersonal psychotherapy for de- pressed preadolescents: examining efficacy and potential treatment mechanisms. J Am Acad Child Adolesc Psychiatry 2015;54:191-9. sourcePartly supported

  The Method > Treatment Conditions passage (page not provided) describes problem-solving, rehearsed communication skills for peer interactions, and a plan for depression recurrence. It does not say that these are among the majority of known behavioral targets or trace them to early behavior therapy; the cited passages also do not address safety behaviors, behavioral activation, or impulsivity. (LLM, conf=0.79)

  Experimental — accuracy not yet measured

Cognitive defusion appears to mediate depression outcome for ACT more than for CBT.

“For example, cognitive defusion appears to mediate depression outcome for ACT more than for CBT 56 , while outcomes of traditional CBT for chronic pain are mediated by pain acceptance, even though this is not deliberately targeted by traditional CBT protocols 57 .”

• cites [56] 56. Åkerblom S, Perrin S, Fischer MR et al. The me- diating role of acceptance in multidisciplinary cognitive-behavioral therapy for chronic pain. J Pain 2015;16:606-15. sourceSupported

Social processes that can vary between cultural groups, such as forms of social support, or styles of family functioning, are known empirically to mediate outcomes.

“Social processes that can vary between cultural groups, such as forms of social support, or styles of family functioning, are known empirically to mediate outcomes 112 .”

• cites [112] 112. Acosta MC, Possemato K, Maisto SA et al. Web- delivered CBT reduces heavy drinking in OEF- OIF veterans in primary care with symptomatic substance use and PTSD. Behav Ther 2017;48: 262-76. sourcePartly supported

  The Results (Mediation analyses; page not provided) report that social support partially mediated the treatment effect on heavy-drinking days among OEF-OIF veterans. The paper does not report mediation by family functioning or examine variation between cultural groups, so it supports only the social-support example, not the broader claim. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

DBT skills include methods of self-regulation mediating outcomes of the therapy in the area of suicidality.

“For example, DBT skills include methods of self-regula-tion mediating outcomes of the therapy in the area of suicidality 104 .”

• cites [104] 104. Neacsiu AD, Rizvi SL, Linehan MM. Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behav Res Ther 2010;48:832-9. sourceSupported

Processes of change such as emotional acceptance are themselves mediated by the connectivity strength between brain areas known to relate to difficult emotional responses.

“It is also known that processes of change such as emotional acceptance are themselves mediated by the connectivity strength between brain areas known to relate to difficult emotional responses 109 .”

• cites [109] 109. Eack SM, Newhill CE, Keshavan MS. Cognitive Enhancement Therapy improves resting-state functional connectivity in early course schizo- phrenia. J Soc Soc Work Res 2016:7;211-30. sourcePartly supported

  The Results section (page unavailable) reports that changes in connectivity mediated CET-related improvements in emotion perception and emotion regulation in people with early-course schizophrenia. The paper does not examine emotional acceptance or establish the broader claim about difficult emotional responses; its mediation finding concerns specific treatment outcomes. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

CBT was better for persons with social phobia if they had very high levels of initial psychological inflexibility.

“while CBT was better for persons with social phobia if they had very high levels of initial psychological inflexibility 53 .”

• cites [53] 53. Niles AN, Burklund LJ, Arch JJ et al. Cognitive mediators of treatment for social anxiety disor- der: comparing acceptance and commitment therapy and cognitive-behavioral therapy. Behav Ther 2014;45:664-77. sourceSupported

In that chronic pain CBT program, change in each measured aspect of psychological flexibility (acceptance, cognitive defusion, values, committed action) separately mediated outcomes.

“In a multidisciplinary, multicomponent, group-based CBT program for adults with chronic pain, pre-treatment measures of psychological flexibility (the core process target of ACT) predicted ultimate outcomes, and change in each of the aspects of psychological flexibility measured in the study (acceptance, cognitive defusion, values, committed action) separately mediated outcomes 58 .”

• cites [58] 58. Klepac RK, Ronan GF, Andrasik F et al. Guide- lines for cognitive behavioral training within doctoral psychology programs in the United States: report of the inter-organizational task force on cognitive and behavioral psychology doctoral education. Behav Ther 2012;43:687-97. sourceCould not verify

  The Overall Framework for Clinical Training lists defusion, acceptance, and values clarification as training topics, but does not report a chronic-pain CBT program or mediation results. Searches for chronic pain and psychological flexibility, and for the four named aspects, found no passage addressing whether changes in those aspects separately mediated outcomes. Page numbers were unavailable in our copy. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Particularly well-supported change processes from newer forms of CBT include cognitive defusion and non-reactivity.

“Particularly well-supported change processes from newer forms of CBT include cognitive defusion 74 (which is the ability to experience thoughts with a sense of distance from them, so as to diminish their automatic behavioral impact) and non-reactivity 75,76 (which is allowing cognitive or other experiences to come and go without reacting in an effort to change them).”

• cites [74] 74. Garland EL, Gaylord SA, Palsson O et al. Thera- peutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. J Behav Med 2012;35:591-602. sourcePartly supported

  The Results (page not provided) associate mindfulness training with increased nonreactivity and link nonreactivity to reduced visceral sensitivity and pain catastrophizing in people with IBS. The Discussion calls nonreactivity a therapeutic mechanism, but also describes the analysis as exploratory and distinguishes mindfulness training from CBT. This supports the nonreactivity portion to which this citation is attached, not the broader characterization of it as a particularly well-supported process across newer forms of CBT. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [75] 75. Zou Y, Li P, Hofmann SG et al. The mediating role of non-reactivity to mindfulness training and cognitive flexibility: a randomized controlled trial. Front Psychol 2020;11:1053. sourceSupported
• cites [76] 76. Manne SL, Winkel G, Rubin S et al. Mediators of a coping and communication-enhancing intervention and a supportive counseling inter- vention among women diagnosed with gyne- cological cancers. J Consult Clin Psychol 2008; 76:1034-45. sourceCould not verify

  The Methods section measures acceptance of cancer-related events, not non-reactivity to thoughts or other experiences. The Discussion reports that acceptance did not mediate the intervention’s effects; neither that section nor the passages retrieved for non-reactivity and related terms address whether non-reactivity is a well-supported change process. (LLM, conf=0.75)

  Experimental — accuracy not yet measured

ACT's focus on a commitment to the creation of patterns of values-based actions has some empirical support.

“ACT's focus on a commitment to the creation of patterns of values-based actions has some empirical support 105 .”

• cites [105] 105. Scott W, Hann KEJ, McCracken LM. A com- prehensive examination of changes in psy- chological flexibility following acceptance and commitment therapy for chronic pain. J Con- temp Psychother 2016;46:139-48. sourceSupported

Negative affect has been shown to be most behaviorally harmful when it kicks off processes of suppression and avoidance.

“For example, negative affect has been shown to be most behaviorally harmful when it kicks off processes of suppression and avoidance 91 .”

• cites [91] 91. Shallcross AJ, Troy AS, Boland M et al. Let it be: accepting negative emotional experiences pre- dicts decreased negative affect and depressive symptoms. Behav Res Ther 2010;48:921-9. sourcePartly supported

  The paper’s opening discussion says avoiding unpleasant feelings might be harmful, and its section on the benefits of acceptance reports less negative affect after an anxiety-provoking film with acceptance than with suppression. This supports a link between avoidance or suppression and worse emotional outcomes, but the cited passages do not establish that negative affect is *most* harmful when it triggers those processes, or that the harm is behavioral. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Socially focused processes from modern CBT are important, including such issues as interpersonal compassion, perspective taking, prosociality and empathy.

“Socially focused processes from modern CBT are also important, including such issues as interpersonal compassion, perspective taking, prosociality and empathy 86 .”

• cites [86] 86. Farris SG, Leyro TM, Allan NP et al. Distress in- tolerance during smoking cessation treatment. Behav Res Ther 2016;85:33-42. sourceCould not verify

  The Abstract and Discussion address distress intolerance during smoking cessation treatment, including cognitive-behavioral strategies for tolerating physical distress. A search of our copy for compassion, perspective taking, prosociality, empathy, and socially focused CBT processes found no passage addressing the attributed claim. Page numbers are not available in our copy. (LLM, conf=0.77)

  Experimental — accuracy not yet measured

Biologically relevant behavior change is important in such area, including diet, exercise and sleep.

“Biologically relevant behavior change is also known to be important in such area, including diet, exercise and sleep 110,111 .”

• cites [110] 110. Peltz JS, Daks JS, Rogge RD. Mediators of the as- sociation between COVID-19-related stressors and parents' psychological flexibility and inflex- ibility: the roles of perceived sleep quality and energy. J Contextual Behav Sci 2020;17:168-76. sourcePartly supported

  The Discussion > Implications section recommends sleep-hygiene changes and exercise as ways parents may protect sleep and manage stress during the pandemic. The Conclusion also emphasizes maintaining health behaviors, but the paper does not address diet as one of the proposed behavior changes. Page numbers are unavailable in our copy. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [111] 111. Firth J, Solmi M, Wootton RE et al. A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry 2020;19:360-80. sourceSupported

The most frequently supported affective process is acceptance.

“The most frequently supported is acceptance 82,84,85 -the willingness to experience affect without needless escape, avoidance or constraint.”

• cites [82] 82. Kalia V, Knauft K. Emotion regulation strate- gies modulate the effect of adverse childhood experiences on perceived chronic stress with implications for cognitive flexibility. PLoS One 2020;15:0235412. sourceCould not verify

  The Introduction’s “Emotion regulation strategies” section discusses cognitive reappraisal and expressive suppression, but does not identify acceptance as an affective process or compare how frequently processes are supported. Searches for acceptance and its description as willingness to experience affect found no passage addressing the claim. The indexed passages provide no page numbers. (LLM, conf=0.74)

  Experimental — accuracy not yet measured
• cites [84] 84. Hayes SC. Constructing a liberated and modern mind: six pathways from pathology to euthymia. World Psychiatry 2020;19:51-2.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [85] 85. Ong CW, Barney JL, Barrett TS et al. The role of psychological inflexibility and self-compassion in acceptance and commitment therapy for clin- ical perfectionism. J Contextual Behav Sci 2019; 13:7-16. sourceNot checked — no full text of the source

When negative affect does not kick off suppression and avoidance, the capacity to notice and describe negative emotional experiences can predict positive clinical trajectories even in the presence of stressful emotions as defined by their mere form.

“When it does not, the capacity to notice and describe negative emotional experiences can predict positive clinical trajectories even in the presence of stressful emotions as defined by their mere form 92 .”

• cites [92] 92. Goldin PR, Morrison A, Jazaieri H et al. Group CBT versus MBSR for social anxiety disorder: a randomized controlled trial. J Consult Clin Psy- chol 2016;84:427-37. sourcePartly supported

  The Results (Mediators of CBGT and MBSR Effects; page not provided) report that increased mindfulness skills and decreased safety behaviors each mediated reductions in social anxiety symptoms. The Methods (Measures; page not provided) include observing and describing among the mindfulness skills measured, but the paper does not establish that those particular skills predict improvement when negative affect does not trigger suppression or avoidance, or despite stressful emotions. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

Over time, a recursive idionomic process-based functional analytic strategy would build a body of empirical nomothetic categories with known treatment utility.

“Over time, this recursive idionomic process-based functional analytic strategy would build a body of empirical nomothetic categories with known treatment utility [120][121][122] .”

• cites [120] 120. Eells TD. Handbook of psychotherapy case for- mulation. New York: Guilford, 2010. sourceNot checked — no full text of the source
• cites [121] 121. Fernandez KC, Fisher AJ, Chi C. Development and initial implementation of the Dynamic As- sessment Treatment Algorithm (DATA). PLoS One 2017;12:e0178806. sourcePartly supported

  The Introduction’s ‘Utility of a person-specific approach’ section says that individual symptom dynamics can inform personalized interventions. But the ‘From diagnoses to dimensions’ section distinguishes this approach from nomothetic analysis, and the paper does not say that repeated use would build empirical nomothetic categories with known treatment utility. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [122] 122. Bonow JT, Follette WC. "Idionomographic" as- sessments: the future of clinical behavior ana- lytic research and practice? Denver: Association for Behavior Analysis International, 2011.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Studies have already suggested the empirical superiority of deploying evidence-based treatment modules or kernels to target person-specific maladaptive processes of change, over global protocols targeting global syndromes.

“Studies have already suggested the empirical superiority of deploying evidencebased treatment modules or kernels to target person-specific maladaptive processes of change, over global protocols targeting global syndromes 118,119 .”

• cites [118] 118. Burke JD, Loeber R. Mechanisms of behavioral and affective treatment outcomes in a cognitive behavioral intervention for boys. J Abnorm Child Psychol 2016;44:179-89. sourcePartly supported

  The passage on treatment mechanisms (page unavailable) reports that CBT components aimed at problem solving and anger regulation were associated with improved outcomes in a meta-analysis. The Abstract also reports that SNAP included individualized intervention. Neither passage establishes that person-specific modules or kernels outperform global protocols targeting syndromes. (LLM, conf=0.78)

  Experimental — accuracy not yet measured
• cites [119] 119. Chorpita BF, Weisz JR, Daleiden EL et al. Long- term outcomes for the Child STEPs randomized effectiveness trial: a comparison of modular and standard treatment designs with usual care. J Consult Clin Psychol 2013;81:999-1009. sourceNot checked — no full text of the source

The assumption that mental problems reflect the expression of a latent disease entity has dominated psychiatric nosology.

“The assumption that mental problems reflect the expression of a latent disease entity has dominated psychiatric nosology, with the distinction being one of tactics, whether it is using psychoanalytic principles as in the early days of the DSM, or identifying syndromes, or developmental neurobiology as in the case of the Research Domain Criteria 124 .”

• cites [124] 124. Insel T, Cuthbert B, Garvey M et al. Research Domain Criteria (RDoC): toward a new classifi- cation framework for research on mental disor- ders. Am J Psychiatry 2010;167:748-51. sourcePartly supported

  In the RDoC assumptions section (Am J Psychiatry 167:7, July 2010; page not specified in our copy), the paper conceptualizes mental illnesses as brain-circuit disorders, supporting the claim as applied to RDoC. It does not establish that a latent-disease assumption dominated psychiatric nosology historically or describe early DSM psychoanalytic principles as an instance of that assumption. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

There was inconsistent evidence of change processes using measures derived from traditional theoretical models.

“They also included inconsistent evidence of change processes using measures derived from traditional theoretical models 34,35”

• cites [34] 34. Morgenstern J, Longabaugh R. Cognitive-behav- ioral treatment for alcohol dependence: a review of evidence for its hypothesized mechanisms of action. Addiction 2000;95:1475-90. sourceNot checked — no full text of the source
• cites [35] 35. Tang TZ, DeRubeis RJ. Reconsidering rapid early response in cognitive behavioral therapy for de- pression. Clin Psychol 1999;6:283-8. sourceNot checked — no full text of the source

CBT protocols for specific psychiatric syndromes were more effective than psychological control conditions, placebo treatments, and active pharmacotherapies.

“Although these protocols were more effective as compared to psychological control conditions, placebo treatments, and even active pharmacotherapies”

• cites [27] 27. National Health Service. Adult Improving Ac- cess to Psychological Therapies program, 2020. https://www.england.nhs.uk/mental-health/ adults/iapt/.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Empirical issues included the unexpected relative success of more narrowly focused and overtly behavioral methods in comparison to full CBT protocols, such as modern forms of behavioral activation in the treatment of depression.

“These included empirical issues such as the unexpected relative success of more narrowly focused and overtly behavioral methods in comparison to full CBT protocols, such as modern forms of behavioral activation in the treatment of depression 30”

• cites [30] 30. Dimidjian S, Hollon SD, Dobson KS et al. Ran- domized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol 2006;74:658-70. sourceNot checked — no full text of the source

Large component analysis studies of CBT found that cognitive components were not key to outcomes.

“the unexpected results from large component analysis studies of CBT 31,32 in which cognitive components were not found to be key to outcomes”

• cites [31] 31. Jacobson NS, Dobson KS, Truax PA et al. A com- ponent analysis of cognitive-behavioral treat- ment for depression. J Consult Clin Psychol 1996; 64:295-304. sourceNot checked — no full text of the source
• cites [32] 32. Ilardi SS, Craighead WE. The role of nonspecific factors in cognitive-behavior therapy for depres- sion. Clin Psychol 1994;1:138-56. sourceNot checked — no full text of the source

There was unexplained response to CBT protocols in early sessions, before putatively critical elements within the model were presented.

“the unexplained response to CBT protocols in early sessions, before putatively critical elements within the model were presented 33”

• cites [33] 33. Bieling PJ, Kuyken W. Is cognitive case formu- lation science or science fiction? Clin Psychol 2003;10:52-69. sourceNot checked — no full text of the source

In a group of mixed anxiety disorders, ACT was better for those with initial high levels of behavioral avoidance.

“for example, in a group of mixed anxiety disorders, ACT was better for those with initial high levels of behavioral avoidance 52”

• cites [52] 52. Craske MG, Niles AN, Burklund LJ et al. Ran- domized controlled trial of cognitive behavioral therapy and acceptance and commitment thera- py for social phobia: outcomes and moderators. J Consult Clin Psychol 2014;82:1034-48. sourceNot checked — no full text of the source

If processes of change are normal, they cannot be adequately construed as diseases.

“If processes of change are normal, they likewise cannot be adequately construed as diseases, latent or otherwise.”

Full genomic mapping of hundreds of thousands of persons is failing to support a prominent role of genes in the etiology of common mental conditions.

“Full genomic mapping of hundreds of thousands of persons is failing to support a prominent role of genes in the etiology of common mental conditions 5”

• cites [5] 5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington: American Psychiatric Association, 2013.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

If the patient's tendency to interpret bodily sensations catastrophically is not changed, discontinuation of drug treatment is likely to be associated with a high rate of relapse.

“However, if the patient's tendency to interpret bodily sensations catastrophically is not changed, discontinuation of drug treatment is likely to be associated with a high rate of relapse.”

Further advancement in efficacy and dissemination of CBT has been inhibited by a failure to focus on processes of change.

“further advancement in efficacy and dissemination has been inhibited by a failure to focus on processes of change”

Differences within the family of CBT interventions reflected differences in a priori assumptions and philosophy of science in such areas as units of analysis or truth criteria.

“It gradually became clear that some differences within the family of CBT inter-ventions reflected differences in a priori assumptions and philosophy of science in such areas as units of analysis or truth criteria 37”

• cites [37] 37. Jacobson NS. Can contextualism help? Behav Ther 1997;28:435-43.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The use of functional analysis and case formulation is at the core of the behavioral tradition.

“The use of functional analysis and case formulation is at the core of the behavioral tradition 73,115 , but an empirical complex network approach based on ecological momentary assessment data drawn from the last 40 years of processbased research is a substantial expansion, elaboration and further development of this early tradition.”

• cites [73] 73. Bach P, Gaudiano BA, Hayes SC et al. Accept- ance and commitment therapy for psychosis: intent to treat hospitalization outcome and me- diation by believability. Psychosis 2013;5:166-74. sourceNot checked — no full text of the source
• cites [115] 115. Hayes SC, Hofmann SG, Stanton CE et al. The role of the individual in the coming era of process- based therapy. Behav Res Ther 2019;117:40-53. sourceNot checked — no full text of the source

The newer methods of CBT have virtually all focused on principles of change that deal more with the context and function of psychological events rather than their content.

“The newer methods of CBT have virtually all focused on principles of change that deal more with the context and function of psychological events (e.g., thoughts, feelings, and overt action) rather than their content.”

The newer forms of CBT have not hesitated to try to address a wide variety of complex human issues historically more characteristic of humanistic, existential, analytic, or system-oriented approaches than CBT.

“The newer forms of CBT have not hesitated to try to address a wide variety of complex human issues historically more characteristic of humanistic, existential, analytic, or system-oriented approaches than CBT.”

The newer forms of CBT, especially ACT, have added an emphasis on chosen values as a key mediator of change.

“The newer forms of CBT, especially ACT, have added an emphasis on chosen values as a key mediator of change 84,103 .”

• cites [84] 84. Hayes SC. Constructing a liberated and modern mind: six pathways from pathology to euthymia. World Psychiatry 2020;19:51-2.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [103] 103. Viskovich S, Pakenham KI. Randomized con- trolled trial of a web-based acceptance and commitment therapy (ACT) program to pro- mote mental health in university students. J Clin Psychol 2020;76:929-51. sourceNot checked — no full text of the source

It is not possible to move to a process-based era staying entirely at the psychological level.

“It is not possible to move to a processbased era staying entirely at the psychological level.”

Almost all of the newer methods of CBT take time to apply intervention to the practitioner, not just the client.

“Almost all of the newer methods of CBT take time to apply intervention to the practitioner, not just the client.”

More recent methods of CBT have been relatively broadly focused.

“It is characteristic of the more recent methods that they have been relatively broadly focused.”

The progress of evidence-based intervention science is slow when measured against the magnitude of human needs.

“The slow progress of evidence-based intervention science, when measured against the magnitude of human needs 60 , demands an end to excessively narrow strategic assumptions that cause the field of mental and behavioral health to lurch from one oversimplification to another.”

• cites [60] 60. Hayes SC, Villatte M, Levin M et al. Open, aware, and active: contextual approaches as an emerg- ing trend in the behavioral and cognitive thera- pies. Annu Rev Clin Psychol 2011;7:141-68. sourceNot checked — no full text of the source

Cognitive defusion and non-reactivity alter the impact of human cognition by changing the person's relationship to his or her own thoughts, rather than trying to change the form, frequency, or situational sensitivity of thought itself.

“Both of these processes alter the impact of human cognition by changing the person's relationship to his/ her own thoughts, rather than trying to change the form, frequency, or situational sensitivity of thought itself.”

A focus on specific syndromes has rapidly broken down in the last 15 years of CBT development.

“In part as a result, a focus on specific syndromes has rapidly broken down in the last 15 years of CBT development, and that in turn has set the stage for the transition we are suggesting is taking place to a process-based model of evidence-based intervention.”

The Association for Behavioral and Cognitive Therapies launched a consensus building process that is a clear example of change in focus within CBT.

“A consensus building process launched by the Association for Behavioral and Cognitive Therapies is a clear example of this change in focus within CBT.”

• cites [59] 59. Kazdin AE, Blasé SL. Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspect Psychol Sci 2011;6:21- 37. sourceNot checked — no full text of the source

Results such as these have caused a major move toward treatment competencies and processes of change in CBT.

“Results such as these have caused a ma-jor move toward treatment competencies and processes of change in CBT.”

There is no body of science that could justify the unintended outcome produced by a latent disease construction.

“There is no body of science that could justify such an unintended outcome of a latent disease construction.”

The latent disease entity assumption has significantly altered modern culture in dangerous ways.

“This assumption appears to be inhibiting the effective search for processes of change and has significantly altered modern culture in dangerous ways.”

Data have increasingly emerged that reveal the wisdom of a process approach as it applies to the understanding of traditional and newer-wave CBT methods.

“Data have increasingly emerged that reveal the wisdom of a process approach 61 as it applies to the understanding of traditional and newer-wave CBT methods.”

• cites [61] 61. Segal ZV, Teasdale JD, Williams JMG. Mindful- ness-based cognitive therapy: theoretical ration- ale and empirical status. In: Hayes SC, Follette VM, Linehan MM (eds). Mindfulness and ac- ceptance: expanding the cognitive behavioral tradition. New York: Guilford, 2004:45-65.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The emerging paradigm is questioning the biomedicalization of human psychological suffering because of its poor validity and clinical utility.

“This paradigm is questioning the biomedicalization of human psychological suffering due to its poor validity and clinical utility.”

By 2007, more than 60% of people with psychological conditions were using medication alone.

“By 2007 more than 60% of people with psychological conditions were using medication alone 125 .”

• cites [125] 125. Olfson M, Marcus SC. National trends in out- patient psychotherapy. Am J Psychiatry 2010;167: 1456-63. sourceNot checked — no full text of the source

An empirical complex network approach based on ecological momentary assessment data drawn from the last 40 years of process-based research is a substantial expansion, elaboration and further development of the early behavioral tradition of functional analysis and case formulation.

“The use of functional analysis and case formulation is at the core of the behavioral tradition 73,115 , but an empirical complex network approach based on ecological momentary assessment data drawn from the last 40 years of processbased research is a substantial expansion, elaboration and further development of this early tradition.”

The latent disease entity assumption appears to be inhibiting the effective search for processes of change.

“This assumption appears to be inhibiting the effective search for processes of change and has significantly altered modern culture in dangerous ways.”

When the latent disease construction enters the developing world, care can deteriorate rather than improve.

“global health specialists point out that, when this construction enters into the developing world, care can deteriorate rather than improve 126 .”

• cites [126] 126. Jacob KS, Patel V. Classification of mental disor- ders: a global mental health perspective. Lancet 2014;383:1433-5. sourceNot checked — no full text of the source

In the US between 1998 and 2007, the number of people using psychological approaches along with medications fell by about 30%.

“In that time, the number of people using only psychosocial change methods to address their problems fell by nearly 50%, while the number of those persons using psychological approaches along with medications fell by about 30%.”

• cites [125] 125. Olfson M, Marcus SC. National trends in out- patient psychotherapy. Am J Psychiatry 2010;167: 1456-63. sourceNot checked — no full text of the source

In the US between 1998 and 2007, the number of people using only psychosocial change methods to address their psychological problems fell by nearly 50%.

“In that time, the number of people using only psychosocial change methods to address their problems fell by nearly 50%, while the number of those persons using psychological approaches along with medications fell by about 30%.”

• cites [125] 125. Olfson M, Marcus SC. National trends in out- patient psychotherapy. Am J Psychiatry 2010;167: 1456-63. sourceNot checked — no full text of the source