In plain language
Psychotherapy research has spent decades and hundreds of millions of dollars testing standardized treatment packages for diagnosed disorders. This commentary, written in response to a target article by Hayes and Hofmann in World Psychiatry, asks whether that dominant "protocol-for-disease" approach has run its course. Meta-analyses show psychotherapy effect sizes are modest (around .30 compared with placebo or treatment as usual) and, most worryingly, appear to have stagnated.
Ciarrochi outlines three core problems with the protocol-for-disease paradigm. First, decades of research have failed to identify psychological "diseases" that exist independently of their symptoms—unlike, say, cancer, depression is diagnosed from the very experiences it is then said to cause. Two clients with the same depression diagnosis may have entirely different causal patterns (one withdrawing after bereavement, another after workplace bullying) and should not automatically receive the same treatment. Second, the approach ignores context: a technique like structured mindfulness helps some clients and is anxiety-provoking for others. Third, it focuses on trademarked packages rather than the evidence-based processes those packages share.
The proposed alternative is a process-based approach: instead of matching protocols to diagnoses, practitioners use functional analysis to identify which processes of change—spanning cognition, affect, attention, self, motivation, and overt behaviour—are actually helping a particular person in a particular context, and emphasize those. Ciarrochi argues this shift amounts to changing the rules of the game entirely, and that, like the shift from the Ptolemaic to the Copernican system, it will involve missteps before it pays off—but it offers a path beyond twenty more years of showing protocols beat placebo without beating each other.
Key findings
- Psychotherapy effect sizes are modest (about .30 versus placebo or treatment as usual) and meta-analytic evidence suggests they have stagnated over time.
- Decades of research have failed to identify psychological diseases that exist independently of their symptoms, undermining the medical-model assumption behind the protocol-for-disease paradigm.
- Two clients with the same diagnosis can have very different causal symptom networks in context, implying they should receive different interventions rather than the same protocol.
- Therapeutic procedures are not uniformly effective: for example, structured mindfulness practice helps some clients but is anxiety-provoking and unhelpful for others.
- A process-based framework gives all therapy approaches a common language focused on cognition, affect, attention, self, motivation, and overt behaviour, and uses functional analysis to tailor interventions to the individual.
- Current academic incentives (fast publication within safe paradigms) work against this paradigm shift, so the field should expect null results and missteps as personalized intervention science develops.
How to cite
APA
Ciarrochi, J. (2021). The coming revolution in intervention science: from standardized protocols to personalized processes. World Psychiatry, 20(3), 385–386. https://doi.org/10.1002/wps.20892
BibTeX
@article{ciarrochi2021coming,
author = {Ciarrochi, Joseph},
title = {The coming revolution in intervention science: from standardized protocols to personalized processes},
journal = {World Psychiatry},
year = {2021},
volume = {20},
number = {3},
pages = {385--386},
doi = {10.1002/wps.20892}
}
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 via the DOI above.