In plain language
For fifty years, mental health care has largely worked by matching treatment protocols to psychiatric labels such as “major depression” or “generalised anxiety disorder” — as if these labels named underlying diseases. This landmark review argues that this syndrome-based approach, while giving the field a common language, has failed to deliver on its ultimate promise: it has not told clinicians what actually needs to change for a particular person, or how to change it.
The authors lay out an alternative: process-based therapy (PBT), which targets empirically established biopsychosocial processes of change — the things research shows are functionally important to a person’s long-term goals and outcomes. To organise these processes into a coherent, usable system, they propose an extended evolutionary meta-model (EEMM). The EEMM applies core evolutionary concepts — variation, selection and retention in context — to six psychological dimensions (affect, cognition, attention, motivation, self, and overt behaviour), nested within sociocultural and biophysiological levels.
The result is a “meta-model” that can accommodate evidence-based change processes from any therapy orientation, and that treats both problems and strengths: health is more than the removal of pathology. The paper offers a preliminary but concrete alternative to psychiatric nosologies — an idiographic, functional-analytic way of diagnosing what maintains an individual person’s suffering and what could move them toward prosperity.
Key findings
- The syndrome-based (DSM-style) approach to mental health diagnosis is argued to be inadequate: hypothesised latent disease entities remain unproved, and the approach has failed to achieve conceptual and treatment utility.
- Process-based therapy (PBT) is proposed as an alternative that targets empirically established biopsychosocial processes of change functionally tied to a person’s long-term goals and outcomes.
- The extended evolutionary meta-model (EEMM) organises change processes using the evolutionary concepts of context-appropriate variation, selection, and retention.
- Six psychological dimensions are identified — affect, cognition, attention, motivation, self, and overt behaviour — nested within sociocultural and genetic/physiological levels of organisation.
- The EEMM examines both maladaptive and adaptive processes, because intervention should build human prosperity, not just eliminate pathology.
- The model is orientation-neutral: it can accommodate any set of evidence-based change processes, offering a common language for an idiographic, functional-analytic alternative to psychiatric nosological systems.
How to cite
APA
Hayes, S. C., Hofmann, S. G., & Ciarrochi, J. (2020). A process-based approach to psychological diagnosis and treatment: The conceptual and treatment utility of an extended evolutionary meta model. Clinical Psychology Review, 82, 101908. https://doi.org/10.1016/j.cpr.2020.101908
BibTeX
@article{hayes2020process,
author = {Hayes, Steven C. and Hofmann, Stefan G. and Ciarrochi, Joseph},
title = {A process-based approach to psychological diagnosis and treatment: The conceptual and treatment utility of an extended evolutionary meta model},
journal = {Clinical Psychology Review},
year = {2020},
volume = {82},
pages = {101908},
doi = {10.1016/j.cpr.2020.101908}
}
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.