Process Based Therapy (PBT)

This article reviews the central theoretical claims found in the various psychotherapeutic approaches broadly referred to as the existential therapies. Despite substantial differences across existential packages, these therapies broadly arise from the theoretical position that the pain and suffering common to our species arises, not from illnesses hypothesized in traditional medical and psychiatric accounts, but rather from a set of existential concerns that all humans must face. These ‘givens’ of existence include death, identity, isolation, meaning, and freedom. From this theoretical perspective, all branches and brands of psychotherapy need to include some procedures to address these issues. Evidence for the importance of these constructs in human experience is presented, followed by evidence for existential therapies themselves. A dearth of quality research trials establishing a strong evidence base for this branch of therapy was noted. Further, process-based research in this area was shown to be weak. That is, few researchers have sought to show that the hypothesized processes are responsible for the changes observed in existential therapy. We describe how viewing existential therapy through a Process-Based Therapy (PBT) framework and the Extended Evolutionary Meta-Model (EEMM) will encourage: (1) a greater examination of the processes of change occurring; (2) an expansion in the way in which existential therapies operate, enabling the inclusion of procedures drawn from other therapeutic modalities; and (3) more nuanced targeting of existential processes in any given case.

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This article is part of a special issue in the Journal of Contextual Behavioral Science devoted to process-based therapy (PBT) or a process-based approach to therapy and the role it plays in harmonizing existing evidence-based treatments. In the present discussion, we focus on acceptance and commitment therapy (ACT) and how it fits into the PBT framework. We describe how viewing ACT through a PBT framework and its organizing rubric—the extended evolutionary meta-model (EEMM)—provides fertile ground to expand the ACT and psychological flexibility models, transforming ACT into a more inclusive and flexible version of itself and giving clinicians wider berth with respect to delivering ACT. The PBT approach allows ACT to incorporate therapeutic elements that are not traditionally part of the framework, including include cognitive reappraisal, interpersonal therapy dynamics, physiological downregulation, and the principle of nonattachment. Importantly, ACT maintains its foundational principles throughout this integration. We provide a case example of how to use PBT methods to conceptualize an ACT case, to illustrate PBT-infused ACT in practice. Finally, we outline possible future directions for ACT as it continues to evolve inside of PBT.

To find the full text version of this article and other JCBS articles (as well as download a full text pdf.), ACBS members need to login and then access the JCBS ScienceDirect homepage here. Click here if you'd like to learn more about joining ACBS.