Defining and Measuring Mechanisms of Change in Psychological Therapies: The Path Not Taken

Abstract

Metcalf and Dimidjian (this issue) have provided an important review of the current evidence base for mindfulness-based cognitive therapy (MBCT) and presented a helpful summary of the proposed mechanisms of change. It is necessary to engage in a continuous dialogue regarding the evidence base for change mechanisms, and the article by Metcalf and Dimidjian highlights an important barrier of concern to the field of treatment outcome research. The present commentary aims to expand the discussion regarding the definition, measurement, and evaluation of "mechanisms of change." Using MBCT as an example, this commentary addresses the ambiguity surrounding the definition and operationalisation of these mechanisms in research on psychological therapies and how the method of measurement may impact the results obtained in clinical trials. It is argued that a potentially fruitful avenue of future research would involve investigation of techniques, important client-therapeutic processes, and mechanisms in a single study in order to comprehensively evaluate how change occurs.

Integrating Between‐Session Interventions (Homework) in Therapy: The Importance of the Therapeutic Relationship and Cognitive Case Conceptualization

“…In designing between‐session interventions, the therapist considers the client's case conceptualization, in terms of both the content and the process of their design, planning, and review. Rarely do clients present with a single diagnosis, and so there is generally a need to integrate interventions from two or more empirically supported approaches in the practice of CBT (Clark & Beck, 2009; Norton & Philipp, ; Petrik & Cronin, ). Because this article takes a process focus, we will spend the remainder focusing on the how the case conceptualization guides the process of designing between‐session interventions.…”

The Effectiveness of a Centering Meditation Intervention on College Stress and Mindfulness: A Randomized Controlled Trial

“…A second recommendation would be to examine the underlying mechanisms of centering meditation. The underlying, theoretical factors through which an intervention leads to therapeutic outcomes are known as mechanisms of change (Petrik and Cronin, 2014 ). If mental health professionals begin using centering meditation as an evidence-based CAM intervention for college students, it is vital to have a deeper understanding of its mechanisms (Petrik and Cronin, 2014 ).…”

Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT

“…ST) on an outcome (e.g. symptom severity) [ 58 , 59 ]. When it comes to the research of mediators of psychotherapy for MDD, so far, mostly cognitive factors, such as dysfunctional attitudes, automatic thoughts, or rumination have been examined in mostly cognitive-behavioral treatment approaches [ 60 – 62 ].…”