In plain language
For decades, mental health care has followed a "protocols-for-syndromes" strategy: give a person a DSM diagnosis such as depression or social anxiety, then apply the treatment protocol matched to that label. This closing chapter of the book Beyond the DSM argues that this era has run its course — treatment effect sizes have been falling for thirty to forty years, and few intervention scientists believe that yet more protocols for yet more syndromes will move the field forward.
The authors propose an alternative: process-based diagnosis. Instead of treating psychological problems as expressions of a hidden latent disease, they define psychopathology as a set of self-sustaining biopsychosocial processes that restrict healthy variation, selection, or retention of behavior in a given context. Their organizing framework, the Extended Evolutionary Meta-Model (EEMM), crosses six psychological dimensions (affective, cognitive, attentional, self, motivational, and overt behavioral) plus physiological and sociocultural levels with the four evolutionary concepts of variation, selection, retention, and context.
Practically, the chapter shows how clinicians can begin with a complex-network analysis of an individual client — mapping their specific problems as connected nodes, often in the client's own words — and then use the EEMM to identify which change processes to target. This idiographic, person-first approach aims to answer the classic question of what treatment, by whom, is most effective for this individual, with that specific problem, under which set of circumstances.
Key findings
- Evidence indicates psychotherapy effect sizes have fallen over the last three to four decades, suggesting the syndrome-focused, protocols-for-syndromes strategy has stagnated.
- Psychopathology is redefined as context-specific problems in variation, selection, and retention of behavior — self-sustaining processes rather than person-invariant expressions of a latent disease.
- The Extended Evolutionary Meta-Model (EEMM) organizes adaptive and maladaptive change processes across six psychological dimensions plus physiological and sociocultural levels, crossed with variation, selection, retention, and context.
- Useful processes of change must be high in precision, scope, and depth; repeatedly measurable; vetted idiographically (at the level of the individual), and functionally important to outcomes.
- Complex network analysis of an individual client's problems — nodes and edges, tipping points, and self-sustaining vicious cycles — provides a practical starting point for process-based functional analysis and diagnosis.
- The chapter illustrates the approach with a real clinical case network and shows how models like psychological flexibility can be organized within the EEMM.
How to cite
APA
Hayes, S. C., Hofmann, S. G., & Ciarrochi, J. (2020). Building a process-based diagnostic system: An extended evolutionary approach. In S. C. Hayes & S. G. Hofmann (Eds.), Beyond the DSM: Toward a process-based alternative for diagnosis and mental health treatment. Oakland, CA: Context Press.
BibTeX
@incollection{hayes2020building,
title = {Building a process-based diagnostic system: An extended evolutionary approach},
author = {Hayes, Steven C. and Hofmann, Stefan G. and Ciarrochi, Joseph},
booktitle = {Beyond the DSM: Toward a Process-Based Alternative for Diagnosis and Mental Health Treatment},
editor = {Hayes, Steven C. and Hofmann, Stefan G.},
publisher = {Context Press},
address = {Oakland, CA},
year = {2020}
}
Related work
- All publications by Joseph Ciarrochi (searchable, with free PDFs)
- Process-Based Therapy & Idionomic Analysis
- The Process-Based Assessment Tool (free download)
Author: Joseph Ciarrochi (ORCID 0000-0003-0471-8100). Free copy hosted with permission for scholarly use. Please cite the published version.