Elucidating the process-based emphasis in cognitive behavioral therapy

Abstract

This paper delves into the examination of cognitive behavioral therapy (CBT), a therapeutic modality reliant on both longitudinal and cross-sectional biopsychosocial data regarding the client, through the lens of evolutionary language within a process-based therapy (PBT) framework. The exposition commences with an elucidation and delineation of pivotal features and assumptions underpinning CBT, encompassing its philosophical foundations, postulated change processes, and the empirical research substantiating these processes. We posit ideas for clinicians to enhance their case formulation by incorporating process-based principles into CBT, invoking concepts such as variation, selection, retention, and contextual fit. Furthermore, we offer a case illustration and a treatment plan utilizing a network-based approach. In conclusion, we explore potential strengths, barriers, and future trajectories for PBT. Although CBT has predominantly undergone scrutiny as a treatment protocol in group-level outcome studies, we assert that CBT inherently operates as a process-driven model, as evidenced by established metrics assessing therapist competence in its implementation. Specifically, we illustrate how the judicious selection and utilization of specific procedures (techniques) targeting change processes emanate from an individualized and integrative case formulation. This formulation is rooted in the evidence supporting the chosen procedure, aligned with the client's preferences and goals, and embedded within the in-session process of selecting, planning, and reviewing between-session homework. CBT, therefore, emerges as a model for clinical practice and training characterized by inherent pragmatism, integrativeness, and transtheoreticism. It aligns seamlessly with the emphasis on process-informed, person-centered, evidence-based treatment within the PBT framework.