Disentangling Trait-Like Between-Individual vs. State-Like Within-Individual Effects in Studying the Mechanisms of Change in CBT
Open accessAbstract
Hofmann et al. argued that “[w]hile the clinical field has produced a dizzying number of treatment models and treatment protocols for virtually every psychiatric and psychological problem imaginable, increases in understanding of the processes of change in psychotherapy has been slow to arrive.” We propose that one of the reasons for the slow progress is that prior psychotherapy research conflates trait-like and state-like components of mechanisms of change. Trait-like components can serve as prescriptive or prognostic variables, whereas state-like components reflect within-client processes of change, and may highlight active ingredients of successful treatment. Distinguishing between the two is essential for clarifying the underlying processes of change in psychotherapy, and ultimately identifying empirically-derived individualized treatment targets. We review studies that implement methodological and statistical approaches for disentangling the two. These studies clarified particular mechanisms of change that may operate in a given treatment, highlighted differences in the processes of change between different treatments, and explored the within-individual interplay between different mechanisms of change during treatment. Examples include studies investigating the therapeutic role of behavioral, cognitive, and interpersonal skills, as well as emotional processing. We conclude with suggestions for future research, including attention to diversity, improved measurement to facilitate a reliable and valid estimation of trait-like and state-like components, the use of appropriate statistical approaches to adequately disentangle the two components, integration of theory-driven and data-driven methods of analysis, and the need to experimentally manipulate the state-like changes in a given mechanism of change to strengthen causal inferences.
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In these alternative models, state-like components reflect within-client processes of change and may point to active ingredients of successful treatment, while trait-like components may represent prescriptive or prognostic variables of successful treatment.
“In these alternative models, state-like components reflect within-client processes of change and may point to active ingredients of successful treat ment, while trait-like components may represent pre scriptive or prognostic variables of successful treatment”
From Which emotion regulation strategies are mediating the outcome of acceptance and commitment therapy compared to cognitive-behaviour therapy in the treatment of anxiety symptoms? (2025) · cites this paper as Zilcha-Mano & Webb, 2021
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- Authors
- Zilcha-Mano, S., & Webb, C. A.
- Affiliations
- Harvard University (US)
- ORCID
- Webb, Christian A.
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2021-01-21
- Volume
- 11
- Pages
- 609585-609585
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC7859252
- OpenAlex
- W3124919788
- Cited by
- 25
- References
- 73
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 5 · 2023: 5 · 2022: 7 · 2021: 1
- FWCI
- 3.07
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute of Mental Health (R01MH116969)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- mechanisms of change, cognitive behavioral therapy, within-person change, interindividual variability, therapeutic process, emotional processing, social skills, behavioral skills
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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