Process-Based Therapy (PBT) - Competencies

Overview

Process-Based Therapy (PBT) has been developed as an alternative to the "protocols for syndromes" approach to diagnosis and treatment. PBT has been described as a return to the functional roots that informed the early practice of behavior therapy (Hofmann and Hayes, 2019). One strand in the development of PBT is a task force report on CBT competencies among doctoral trainees (Klepac et al., 2012). Hayes and Hofmann (2018) elaborated on these CBT competencies from a contextual behavioral science lens that was termed "Process-based CBT." Process-based CBT refers to the use of various change processes identified from mediational research. PBT appears to be a more general form of Process-based CBT that makes more intensive use of an idiographic network diagramming approach (in order to avoid the ergodic error associated with change processes identified from group rather than individual research). Empirical research explicitly focusing on PBT has recently emerged including the development of item pools (Ciarrochi, Sahdra, Hofmann, and Hayes, 2022) and the statistical identification of functional processes that can be interpreted as a case conceptualization (Sanford et al., 2022). PBT is not meant to be considered a specific kind of therapy; rather, it is proposed to be an alternative way to operationalize evidence-based therapy/practice; thus, the use of methods and theories beyond CBT can be accommodated within the PBT approach (although the developers state that the change processes--which may have different names in different clinical traditions--must be empirically-supported "intervention kernels").

Current State of Competencies

Competency in PBT has yet to be formally defined or evaluated. However, the competencies have been described in various publications, and general principles of how PBT competency might be implemented and evaluated are evident from these sources. A few of these publications, most notably the Learning Process-Based Therapy book, include useful work products such as sample network conceptualizations. Additional work products are available on the Processed-Based Therapy SIG listserve.

PBT co-developer Steven C. Hayes (personal communication) described how competency in PBT can be generally conceptualized. Specifically, one must be competent in reading the processes. One must be competent  in developing, monitoring, validating, and re-evaluating the dynamic network of processes. One must also be competent in delivering the intervention kernerls that are likely to move the key processes that have been identified by the network analysis.

The development of analytic methods to assist practitioners in the application of these competencies is an active area of development as of July 2023. Digital tools to collect intensive longitudinal data needed to model individual dynamics are in development. A conceptual approach that may help practitioners target relevant processes is the multi-dimensional, multi-level extended evolutionary meta-model (EEMM) (Hayes, Hoffman, and Ciarrochi, 2020). Empirically, the recent review of all replicated measures that mediate psychological outcomes can by organized with the EEMM to identify processes that may be relevant to target and measure (Hayes et al., 2022).

Several intervention kernels are known (see e.g., Hayes and Hoffman, 2018). The efficacy of existing kernels and newly developed kernels is continually being evaluated. Identifying relevant intervention kernels requires practitioners to stay up to date with the empirical status of each kernel (paying particular attention to meta-analyses). Developing competency with specific kernels is outside the scope of PBT. However, PBT may offer a solution to measuring competency with any chosen kernel by virtue of the fact that the individual network must be specified and changes in the network must be measured, which will provide evidence of the impact of the intervention.

Materials/Assessments/Work Products

For a book length treatment specifically describing therapist competencies, see Hofmann, Hayes, and Lorscheid (2021). The book includes free resources.

There is a Processed-Based Therapy Special Interest Group (SIG) that actively discusses PBT skills.

MindGrapher and PLAN (Personalized Life Analysis Network) are commercially available tools to help with conceptualizing cases using a PBT approach.

References

Ciarrochi, J., Sahdra, B., Hofmann, S. G., & Hayes, S. C. (2022). Developing an item pool to assess processes of change in psychological interventions: The Process-Based Assessment Tool (PBAT). Journal of Contextual Behavioral Science, 23, 200-213.

Hayes, S. C., Ciarrochi, J., Hofmann, S. G., Chin, F., & Sahdra, B. (2022). Evolving an idionomic approach to processes of change: Towards a unified personalized science of human improvement. Behaviour Research and Therapy, 156, 104155. Doi: 10.1016/j.brat.2022.104155

Hayes, S. C., & Hofmann, S. G. (Eds.). (2018). Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. New Harbinger Publications.

Hayes, S. C., Hofmann, S. G. & Ciarrochi, J. (2020). A process-based approach to psychological diagnosis and treatment: The conceptual and treatment utility of an extended evolutionary model. Clinical Psychology Review, 82, 101908. doi: 10.1016/j.cpr.2020.101908

Hayes, S. C., Hofmann, S. G., & Stanton, C. E. (2020). Process-based functional analysis can help behavioral science step up to the challenges of novelty: COVID – 19 as an example. Journal of Contextual Behavioral Science, 18, 128-145. doi: 10.1016/j.jcbs.2020.08.009.

Hayes, S. C., Hofmann, S. G., Stanton, C. E., Carpenter, J. K., Sanford, B. T., Curtiss, J. E., & Ciarrochi, J. (2019). The role of the individual in the coming era of process-based therapy. Behaviour Research and Therapy, 117, 40-53. doi: 10.1016/j.brat.2018.10.005

Hofmann, S. G., & Hayes, S. C. (2019). Functional analysis is dead: Long live functional analysis. Clinical Psychological Science, 7(1), 63-67.

Hofmann, S. G., Hayes, S. C., & Lorscheid, D. N. (2021). Learning process-based therapy: A skills training manual for targeting the core processes of psychological change in clinical practice. New Harbinger Publications.

Klepac, R. K., Ronan, G. F., Andrasik, F., Arnold, K. D., Belar, C. D., Berry, S. L., ... & Strauman, T. J. (2012). Guidelines 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. Behavior Therapy, 43(4), 687-697.

Sanford, B. T., Ciarrochi, J., Hofmann, S. G., Chin, F., Gates, K. M., & Hayes, S. C. (2022). Toward empirical process-based case conceptualization: An idionomic network examination of the process-based assessment tool. Journal of Contextual Behavioral Science.