Process-based therapy

Domain II · Behavioural & cognitive · Hofmann, Hayes, Ciarrochi · 2018

What it is

PBT is a framework, not a single therapy. Its authors call it a "model of models" and say it is not primarily a specific treatment approach. It has no fixed protocol: the clinician builds an individual (idiographic) model of what keeps this person stuck, then picks evidence-based procedures from…

Format

• Phases. PBT does not prescribe a session count. The phases below are drawn from the published case (Amy: 18 sessions, GAD) and the research protocol; treat numbers as examples, not rules.
• Format. Individual, weekly in both published examples. Network review with the client is a standing agenda item; homework is tied to functional goals; consequences are tracked. Monitoring options: brief experience-sampling items (Amy: four times daily about the past three hours, later reduced;…

Who practises it, and how they are trained or regulated

• The slides also list the mediators with best support per row (e.g., cognition: beliefs, defusion, reappraisal; affect: acceptance, anxiety sensitivity, self-compassion; attention: mindfulness, rumination/worry, acting with awareness; self: self-efficacy, self-regulation; motivation: values, intentions, goals; behaviour: coping skills, activation, avoidance; biophysiological: diet, exercise; sociocultural: parenting,…

Evidence status, as the guide reports it

• PBT is a framework, not a single therapy. Its authors call it a "model of models" and say it is not primarily a specific treatment approach. It has no fixed protocol: the clinician builds an individual (idiographic) model of what keeps this person stuck, then picks evidence-based procedures from…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• defending your first model.
• use as distraction or safety behaviour.
• eclectic drift (techniques without a target).
• steps too big (repeated failure) or too small (boredom).
• pushing (arguing for change provokes argument against it).

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.