Process-Based Cognitive Behavioral Therapy: A Framework for Conceptualization and Treatment

Abstract

Process-Based Cognitive Behavioral Therapy (PB-CBT) is the integration of biological, psychological, and social factors into idiographic structural models used to conceptualize patient problems and select transdiagnostic, evidence-based procedures for clinical intervention to improve well-being. Despite the clinical utility and applicability of this transdiagnostic approach to case conceptualization and treatment, little research or formal guidance exists on how to create individualized structural models in clinical practice. Traditional clinical psychology, on the contrary, employs a diagnosis to treatment matching system. While useful, diagnosis to treatment models of intervention neglect contextual factors that contribute to patient problems and have led to a proliferation of treatment manuals for specific diagnoses. The current case study described a college male who coped with emotional difficulties through avoidance, isolation, food restriction, and alcohol use. In addition to psychopathology, the patient also identified as bisexual in a predominantly homophobic social environment, which exacerbated psychological distress. These various factors were integrated into a structural model that aided the selection of transdiagnostic interventions. At the conclusion of treatment, the patient reported meaningful reductions in psychological symptoms, in addition to various functional gains consistent with his values, such as an increased ability to tolerate difficult emotions, increased mindfulness skills, and an openness to discuss emotions with peers. Structural models and transdiagnostic interventions may help conceptualize patients presenting with multiple forms of psychopathology.