The Future of Intervention Science: Process-Based Therapy
Open accessAbstract
Clinical science seems to have reached a tipping point. It appears that a new paradigm is beginning to emerge that is questioning the validity and utility of the medical illness model, which assumes that latent disease entities are targeted with specific therapy protocols. A new generation of evidence-based care has begun to move toward process-based therapies to target core mediators and moderators based on testable theories. This could represent a paradigm shift in clinical science with far-reaching implications. Clinical science might see a decline of named therapies defined by set technologies, a decline of broad schools, a rise of testable models, a rise of mediation and moderation studies, the emergence of new forms of diagnosis based on functional analysis, a move from nomothetic to idiographic approaches, and a move toward processes that specify modifiable elements. These changes could integrate or bridge different treatment orientations, settings, and even cultures.
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Traditional approaches evaluating effectiveness of generic interventions by comparing aggregated group data are limiting because they overlook individual differences in training needs and outcomes.
“traditional approaches evaluating the effectiveness of generic interventions by comparing aggregated group data are limiting as they overlook important information regarding individual differences in training needs and outcomes [69-71].”
From Evaluation of an App-Delivered Psychological Flexibility Skill Training Intervention for Medical Student Burnout and Well-being: Randomized Controlled Trial (2023) · cites this paper as [71]
In “From Nomothetic to Idiographic Approaches” (page unavailable), the paper says syndrome-based CBT protocols largely ignored differences between individuals. It supports the concern about generic interventions, but does not specifically say that comparisons of aggregated group data overlook individual training needs and outcomes; its focus is clinical treatment. (LLM, conf=0.84)
Experimental — accuracy not yet measuredEvaluating psychological flexibility and inflexibility separately provides a stronger understanding of intervention methodologies that can address heterogeneity.
“evaluating them separately provides a stronger understanding of intervention methodologies that can address this heterogeneity [70,71].”
From Evaluation of an App-Delivered Psychological Flexibility Skill Training Intervention for Medical Student Burnout and Well-being: Randomized Controlled Trial (2023) · cites this paper as [71]
In “The Quest to Link Treatment to Syndrome” (page unavailable), the paper identifies client heterogeneity as a problem, and “A Move toward Process-Based Therapy” links therapeutic processes to intervention strategies. It does not say that evaluating psychological flexibility and inflexibility separately improves understanding of interventions; that specific recommendation is unsupported. (LLM, conf=0.82)
Experimental — accuracy not yet measuredBuilding matrices of change and change procedures represented a valuable method to ensure change mechanisms were precisely defined and effectively linked to therapeutic applications.
“Building matrices of change and change procedures represented a valuable method to ensure our change mechanisms were precisely defined (148) and got effectively linked to therapeutic applications (75).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [75]
In the Abstract (page unavailable), Hofmann and Hayes define therapeutic processes as change mechanisms and distinguish them from therapeutic procedures. In “The Rise of Mediation and Moderation Studies” (page unavailable), they call for processes of change to be specified and linked to interventions. Our copy does not describe building matrices as the method for defining those mechanisms; the citation to this paper is attached to the precise-definition part of the citing sentence. (LLM, conf=0.83)
Experimental — accuracy not yet measuredSCEDs provide evidence of the effectiveness of interventions, drawing on substantially fewer participants than nomothetic approaches such as RCTs.
“In doing this, SCEDs provide evidence of the effectiveness of interventions, drawing on substantially fewer participants than nomothetic approaches (such as RCTs) [51,52,53,54,55,56,57,58].”
From Brief and Telehealth Acceptance and Commitment Therapy (ACT) Interventions for Stress in Inflammatory Bowel Disease (IBD): A Series of Single Case Experimental Design (SCED) Studies (2022) · cites this paper as [58]
The “From Nomothetic to Idiographic Approaches” section identifies single-case experimental designs as tools for studying change in individuals, while “The Quest to Link Treatment to Syndrome” describes randomized trials as a way to test interventions. The paper does not say that SCEDs establish intervention effectiveness with substantially fewer participants than RCTs. (LLM, conf=0.84)
Experimental — accuracy not yet measuredACT, as a contextual-behavioral approach proposed by the latest process-based evolutionary meta-model, allows for the inclusion of social and environmental factors (e.g., school, family, peers) in case conceptualization and therapeutic process.
“This contextual-behavioral approach, as proposed by the latest process-based evolutionary meta-model (Hofmann and Hayes, 2019), allows for the inclusion of social and environmental factors (e.g., school, family, peers), in case conceptualization and therapeutic process.”
From Process of change and efficacy of acceptance and commitment therapy (ACT) for anxiety and depression symptoms in adolescents: A meta-analysis of randomized controlled trials. (2025) · cites this paper as Hofmann and Hayes, 2019
In “The Importance of Context” (page unavailable), the paper says process-based therapy must attend to historical, social, and situational context, supporting the inclusion of social and environmental factors in treatment. But “The Decline of Named Therapies” describes ACT only as a possible example of a process-based approach, not as an approach proposed by a process-based evolutionary meta-model. The paper does not specifically discuss school, family, or peers in this connection. (LLM, conf=0.84)
Experimental — accuracy not yet measured
The intervention directly targets hypothesized change mechanisms instead of specific symptom content and follows a current paradigm shift in intervention science toward process-based treatments.
“Firstly, our intervention directly targets hypothesized change mechanisms instead of specific symptom content and hence follows a current promising paradigm shift in intervention science toward process-based treatments (13, 75, 144).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [75]
It has been suggested that researchers consider a more idiographic approach to identify underlying processes of clinical change, using high temporal density and contextualized measurement applied at the level of the person.
“It has been suggested that researchers consider a more idiographic approach in order to identify underlying processes of clinical change, using high temporal density and contextualized measurement applied at the level of the person (Ciarrochi et al., 2021; Hofmann and Hayes, 2019).”
From Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment (2022) · cites this paper as Hofmann and Hayes, 2019
The use of an idiographic approach with the time-extensive collection of repeated process and outcome measures provided a wealth of information useful in understanding treatment effects linked to processes of change with a small sample, in line with a process-based therapy (PBT) framework.
“The use on an idiographic approach with the time-extensive collection of repeated process and outcome measures provided a wealth of information useful in understanding treatment effects linked to processes of change with a small sample, in line with a process-based therapy (PBT) framework (Hayes and Hofmann, 2018; Hofmann and Hayes, 2019).”
From Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment (2022) · cites this paper as Hofmann and Hayes, 2019
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A review of approaches and models in psychopathology conceptualization research
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Self-citationAnticipatory Threat Responding: Associations With Anxiety, Development, and Brain Structure
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Self-citationUnderstanding anxiety symptoms as aberrant defensive responding along the threat imminence continuum
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Moral injury: An overview of conceptual, definitional, assessment, and treatment issues
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A randomized controlled trial of acceptance and commitment therapy for clinical perfectionism
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Self-citationMeasuring the active elements of cognitive-behavioral therapies
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Self-citationComplexity in psychological self-ratings: implications for research and practice
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Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review
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The future of psychological treatments: The Marburg Declaration
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Integrating and differentiating personality and psychopathology in cognitive behavioral therapy
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A complex network approach to clinical science
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Self-citationIntegrating a functional view on suicide risk into idiographic statistical models
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Self-citationA Comprehensive Model of Homework in Cognitive Behavior Therapy
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ACT: A Process-Based Therapy in Search of a Process
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Do we need a novel framework for classifying psychopathology? A discussion paper
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Self-citationProcess-based therapy: A personalized approach to treatment
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What Makes an Intervention a Life Course Intervention?
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Self-citationCognitive Behavior Therapy at the Crossroads
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Clinical psychology is an applied evolutionary science
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Self-citationFrom relaxed beliefs under psychedelics (REBUS) to revised beliefs after psychedelics (REBAS)
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Elucidating the process-based emphasis in cognitive behavioral therapy
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- Authors
- Hofmann, S. G., & Hayes, S. C.
- Affiliations
- Boston University (US)
- University of Nevada, Reno (US)
- Corresponding author
- Hofmann, Stefan G.
- Venue
- Clinical Psychological Science
- Publisher
- SAGE Publications
- Published
- 2018-05-29
- Volume
- 7
- Issue
- 1
- Pages
- 37-50
- ISSN
- 2167-7026 (ISSN-L)
- 2167-7034
- PMC
- PMC6350520
- OpenAlex
- W2807203549
- Semantic Scholar
- 83e462c52031103055115209eafb3a9b92f622a3
- Cited by
- 888
- References
- 67
- Citations by year
- 2026: 145 · 2025: 114 · 2024: 121 · 2023: 128 · 2022: 134 · 2021: 114 · 2020: 80 · 2019: 39 · 2018: 13
- FWCI
- 72.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Psychological Science (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH099021, R34MH099311, U01MH108168)
- National Center for Complementary and Integrative Health (R01AT007257)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › General Psychology › Academic and Historical Perspectives in Psychology
- Keywords
- process-based therapy, intervention research, evidence-based care, mediating and moderating effects
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