Hofmann et al. argued that “[w]hile the clinical field has produced a dizzying number of treatment models and treatment protocols for virtually every psychiatric and psychological problem imaginable, increases in understanding of the processes of change in psychotherapy has been slow to arrive.” We propose that one of the reasons for the slow progress is that prior psychotherapy research conflates trait-like and state-like components of mechanisms of change. Trait-like components can serve as prescriptive or prognostic variables, whereas state-like components reflect within-client processes of change, and may highlight active ingredients of successful treatment. Distinguishing between the two is essential for clarifying the underlying processes of change in psychotherapy, and ultimately identifying empirically-derived individualized treatment targets. We review studies that implement methodological and statistical approaches for disentangling the two. These studies clarified particular mechanisms of change that may operate in a given treatment, highlighted differences in the processes of change between different treatments, and explored the within-individual interplay between different mechanisms of change during treatment. Examples include studies investigating the therapeutic role of behavioral, cognitive, and interpersonal skills, as well as emotional processing. We conclude with suggestions for future research, including attention to diversity, improved measurement to facilitate a reliable and valid estimation of trait-like and state-like components, the use of appropriate statistical approaches to adequately disentangle the two components, integration of theory-driven and data-driven methods of analysis, and the need to experimentally manipulate the state-like changes in a given mechanism of change to strengthen causal inferences.
Bibliographical noteFunding Information:
The writing of this article was supported by two grants from the Israeli Science Foundation (Grant 186/15; 395/19 to SZ-M). CW was partially supported by R01 MH116969, the Tommy Fuss Fund, and a NARSAD Young Investigator Grant from the Brain & Behavior Research Foundation. The opinions and assertions
Funding. The writing of this article was supported by two grants from the Israeli Science Foundation (Grant 186/15; 395/19 to SZ-M). CW was partially supported by R01 MH116969, the Tommy Fuss Fund, and a NARSAD Young Investigator Grant from the Brain & Behavior Research Foundation. The opinions and assertions contained in this article should not be construed as reflecting the views of the sponsors.
© Copyright © 2021 Zilcha-Mano and Webb.
- between-individual effects
- mechanisms of change
- personalized treatment
- process of change
- within-individual effect
ASJC Scopus subject areas
- Psychiatry and Mental health