Spanish validation of the PBAT and cross-country mapping of process-outcome networks using link community analysis

The Process-Based Assessment Tool (PBAT) was developed within the framework of process-based therapy, an alternative to symptom-focused diagnostic models, to monitor biopsychosocial change processes and support personalized therapeutic interventions. This cross-sectional study validated the Spanish PBAT by replicating the original U.S. study protocol in 602 Spanish adults. We also aimed to compare predictive process-outcome networks across Spain, the U.S., Sweden, and Poland using link community network analysis. Structural validity was assessed through inter-item correlations, and criterion validity through associations between PBAT items and clinical outcomes and need satisfaction/frustration. The Boruta algorithm identified the most predictive items for each outcome. Results confirmed the structural and criterion validity of the Spanish PBAT. Link community network analysis revealed country-specific differences in which processes most strongly predicted distress: difficulties finding appropriate emotional outlets were most central in Spain, perceived inability to change ineffective behavior was relatively prominent in the U.S., and cognitive interference and attentional difficulties were most prominent in Sweden, while Poland showed a more distributed pattern across these three processes. Future research could extend this approach to individual longitudinal data, potentially enabling clinicians to identify and target core psychological processes based on a person's unique profile.

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