For decades, cognitive and behavioral therapies (CBTs) have been tested in randomized controlled trials for specific psychiatric syndromes that were assumed to represent expressions of latent diseases. Although these protocols were more effective as compared to psychological control conditions, placebo treatments, and even active pharmacotherapies, further advancement in efficacy and dissemination has been inhibited by a failure to focus on processes of change. This picture appears now to be evolving, due both to a collapse of the idea that mental disorders can be classified into distinct, discrete categories, and to the more central attention given to processes of change in newer, so-called “third-wave” CBTs. Here we review the context for this historic progress and evaluate the impact of these newer methods and models, not as protocols for treating syndromes, but as ways of targeting an expanded range of processes of change. Five key features of “third-wave” therapies are underlined: a focus on context and function; the view that new models and methods should build on other strands of CBT; a focus on broad and flexible repertoires vs. an approach to signs and symptoms; applying processes to the clinician, not just the client; and expanding into more complex issues historically more characteristic of humanistic, existential, analytic, or system-oriented approaches. We argue that these newer methods can be considered in the context of an idiographic approach to process-based functional analysis. Psychological processes of change can be organized into six dimensions: cognition, affect, attention, self, motivation and overt behavior. Several important processes of change combine two or more of these dimensions. Tailoring intervention strategies to target the appropriate processes in a given individual would be a major advance in psychiatry and an important step toward precision mental health care.

中文翻译：

---

“第三波”认知和行为疗法以及基于过程的精神病学干预方法的出现


几十年来，认知和行为疗法（CBT）已经在随机对照试验中进行了测试，用于治疗被认为代表潜在疾病表现的特定精神综合症。尽管这些方案比心理控制条件、安慰剂治疗甚至主动药物疗法更有效，但由于未能关注变化过程，功效和传播的进一步进步受到抑制。这种情况现在似乎正在演变，一方面是因为精神障碍可以分为不同的、离散的类别的观念崩溃了，另一方面是因为新的所谓“第三波”的变化过程得到了更加集中的关注CBT。在这里，我们回顾这一历史性进展的背景，并评估这些新方法和模型的影响，不是作为治疗综合症的方案，而是作为针对扩大范围的变化过程的方法。强调了“第三波”疗法的五个关键特征：注重背景和功能；认为新模型和方法应建立在 CBT 其他方面的观点；注重广泛而灵活的手段，而不是针对体征和症状的方法；将流程应用于临床医生，而不仅仅是客户；并扩展到历史上更具有人文主义、存在主义、分析性或系统导向方法特征的更复杂的问题。我们认为，可以在基于过程的功能分析的具体方法的背景下考虑这些新方法。变化的心理过程可以分为六个维度：认知、情感、注意力、自我、动机和外在行为。几个重要的变革过程结合了这些维度中的两个或多个。 针对特定个体的适当过程定制干预策略将是精神病学的重大进步，也是迈向精准心理保健的重要一步。