Hayes Steven C, Ciarrochi Joseph, Hofmann Stefan G, Chin Fredrick, Sahdra Baljinder
University of Nevada, Reno, United States.
Australian Catholic University, Australia.
Behav Res Ther. 2022 Sep;156:104155. doi: 10.1016/j.brat.2022.104155. Epub 2022 Jul 3.
The wide variety of "third wave" cognitive behavioral therapy (CBT) methods (e.g., Acceptance and Commitment Therapy or "ACT", Compassion Focused Therapy, Meta-Cognitive therapy, Functional Analytic Therapy, Dialectic Behavior Therapy, Mindfulness-Based Cognitive Therapy) have left a mark on the field that appears to be growing. As ACT enters its 40th year, the present paper examines key features of its development strategy as a ground from which to consider the future of CBT and evidence-based therapy. We discuss four key features of ACT development: universalism, multi-level and multi-dimensional processes linked to basic principles, idiographic concepts and methods, and an evolutionary approach. We argue that these features have facilitated the development of Process-Based Therapy (PBT) and its Extended Evolutionary Meta-Model (EEMM) of processes of change, but that idiographic methods need special contemporary emphasis, because traditional methodological and statistical approaches to processes of change are based on mathematical assumptions that cannot be met and thus limit progress in this area. We argue we need to target multi-level, multi-dimensional biopsychosocial processes of change evaluated via a functional, idionomic approach that begins with frequent idiographic assessment, and then scales to nomothetic (group level) findings when it improves idiographic fit. To identify candidate processes of change, we review the world's literature on mediational findings of randomized trials of psychological interventions for mental health outcomes. After examining nearly 55,000 studies, we identify 72 measures that have successfully mediated intervention outcomes and have been replicated. The EEMM can readily summarize and understand that set of findings, and idionomic statistical methods are available to turn these processes into a new empirical form of functional analysis applicable to the individual's goals and needs. PBT frees intervention science from the unhelpful latent disease model and creates an approach that promises more rapid progress toward a unified, personalized science of human improvement.
各种各样的“第三波”认知行为疗法（CBT）方法（例如，接纳与承诺疗法或“ACT”、慈悲聚焦疗法、元认知疗法、功能分析疗法、辩证行为疗法、基于正念的认知疗法）在该领域留下了印记，且这一印记似乎还在不断扩大。随着ACT迎来其40周年，本文审视了其发展策略的关键特征，以此为基础来思考CBT及循证疗法的未来。我们讨论了ACT发展的四个关键特征：普遍主义、与基本原则相关的多层次和多维度过程、个性化概念与方法以及一种进化方法。我们认为这些特征促进了基于过程的疗法（PBT）及其变化过程的扩展进化元模型（EEMM）的发展，但个性化方法需要当代特别加以强调，因为传统的变化过程方法论和统计方法基于无法满足的数学假设，从而限制了该领域的进展。我们认为，我们需要针对通过一种功能性、个性化方法评估的多层次、多维度生物心理社会变化过程，该方法始于频繁的个性化评估，然后在提高个性化契合度时扩展到一般规律（群体层面）的发现。为了识别变化的候选过程，我们回顾了世界范围内关于心理健康结果的心理干预随机试验中介导结果的文献。在审查了近55000项研究后，我们确定了72项成功介导干预结果且已被重复验证的测量方法。EEMM能够轻松总结和理解那组发现，并且有个性化统计方法可将这些过程转化为适用于个体目标和需求的新的实证功能分析形式。PBT将干预科学从无益的潜在疾病模型中解放出来，并创造了一种有望在朝着统一的、个性化的人类改善科学方向取得更快进展的方法。
