Study type: Conceptual commentary with two fictional clinical illustrations.
In plain language
People who receive the same psychosis diagnosis can have very different experiences and needs. Stiles, Fraser, and Ciarrochi outline how process-based therapy (PBT) could organize assessment and treatment around those differences. The emphasis is on understanding interacting psychological, biological, and social processes in a person’s context, then selecting relevant evidence-based treatment components.
The commentary develops two fictional clinical cases. Both involve hearing voices, reduced motivation, and social withdrawal, but the proposed maintaining patterns differ. For Robert, threat, bodily tension, vigilance, and avoidance are prominent. For Sally, shame, self-criticism, and feelings of inferiority play a central role. The examples show why similar symptoms might lead to different treatment priorities.
The authors use the extended evolutionary meta-model (EEMM) and conceptual network maps to organize these patterns. They describe treatment planning as a collaborative process: identify what is important, central, impairing, and feasible to address; select suitable treatment components; and revise the formulation as understanding develops.
Key points
- The formulation guides the treatment targets. The examples show how the functional relationships surrounding symptoms can suggest different priorities even when a diagnostic description looks similar.
- Interventions can draw on several traditions. For the threat-focused illustration, the authors discuss relaxation and cognitive approaches; for the shame-focused illustration, they discuss compassion-focused methods. These are examples of reasoning from a formulation, rather than tested prescriptions for all people who hear voices.
- Network maps make hypotheses explicit. Maps represent proposed links and feedback loops among experiences, actions, and contexts. They can help the clinician and client discuss how difficulties may be maintained.
- Personalized assessment needs empirical testing. The authors propose ecological momentary assessment to examine whether perceived relationships appear in repeated daily-life observations, and to evaluate the usefulness of adapting treatment from such information.
What the paper does and does not establish
- This is a conceptual commentary, not a clinical trial. The fictional cases do not demonstrate treatment effectiveness or superiority over existing psychosis therapies.
- The maps are perceived causal networks. The authors explicitly caution that a client’s understanding of what influences what may differ from actual causal relationships.
- Feasibility, effects on recovery, and benefits of updating treatment from individual data remain questions for future research.
How to cite
APA 7
Stiles, B. J., Fraser, M. I., & Ciarrochi, J. (2026). Moving from protocols to idionomic processes of change: Process-based therapy as the future of psychosis psychotherapy. Psychosis. Advance online publication. https://doi.org/10.1080/17522439.2026.2704562
BibTeX
@article{stiles2026process,
title = {Moving from protocols to idionomic processes of change: Process-based therapy as the future of psychosis psychotherapy},
author = {Stiles, Bryan J. and Fraser, Madeleine I. and Ciarrochi, Joseph},
journal = {Psychosis},
year = {2026},
doi = {10.1080/17522439.2026.2704562}
}
Related work
- Clinician perspectives on process-based therapy
- Process-based therapy: a common ground for therapeutic practices
- One size fits none: A call for an idionomic revolution
- All publications by Joseph Ciarrochi
Summary based on the full published article supplied by the author. Published online 18 August 2026; cited as an advance online publication because the supplied version has no assigned volume or issue. The case examples are fictional, not treatment-outcome evidence. Summary prepared from the full paper on 29 September 2026. Please cite the published article linked above.