From clinic to research and back

In a recent editorial for the Journal of Behavioral and Cognitive Therapy, I called for a return to a strong interaction between clinical practice and fundamental research.

Constitutive of CBT, this dialogue between research and clinic tends to fade away. For quite some time now, CBT appoints research the role of validating the effectiveness of the techniques it employed. In short, clinicians are developing a method or a technique, and research’s “only” function is to test whether this new technique is more effective than another, or effective at all. This is fine. We can do better however. In particular, we can isolate what components are at work in effective techniques, that is to say, experimentally test their active ingredients.

The work of Mairéad Foody and her colleagues is exemplary in this respect. They studied how one can lead a patient to distance himself from his thoughts about himself. They tested experimentally what could be the active ingredient of two perspective-taking exercises (such exercises are used in ACT to lead the patient seeing himself or herself as the context in which his or her thoughts appear, rather than as the thoughts themselves).

The exercises traditionally offered by ACT to achieve this goal correspond to movements either of distinguishing the subject from his or her thoughts (“You are not the thoughts you have about yourself”), or to establish a hierarchy between the subject and his thoughts (“You are more than the thoughts you have of yourself”). The questions posed by this research is to know which process- hierarchy or distinction- is most effective in achieving a change of perspective on oneself.

I do not describe here these therapeutic exercises or research results (which are so important for clinical practice that they will be treated for themselves in a future article), to focus on the fact that researchers have started from clinical practices, have systematized them in order to test them experimentally, and have managed to isolate the psychological processes that are really effective.

Research such as that of Mairéad Foody and its collaborators allows us to revive the tradition of exploring the reasons for the efficacy of our clinical practices. Indeed, we can no longer be contented with simply showing that our clinical approaches are effective, as is the current evidence-based tradition in which CBT legitimately fits. We equally need to understand why what we do works, in order to systematize change processes and target them directly, to be even more effective.

The complete article is available online

Translated by Chelsea Davis-Laurin

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Foody, M., Barnes-Holmes, Y., Barnes-Homes, D., & Luciano, C (2013). An Empirical Investigation of Hierarchical versus Distinction Relations in a Self-based ACT Exercise. International Journal of Psychology and Psychological Therapy, 13(3), 373-388.

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