Abstract
The identification of fundamental mechanisms is an important scientific pursuit in many fields of enquiry. With regard to the development of psychological treatments, understanding the mechanisms through which change occurs such that psychological distress resolves, can enable us to develop more effective and efficient interventions. In the field of psychotherapy, mechanisms are often identified either statistically or conceptually. The most powerful and useful mechanisms, however, are functional rather than statistical or conceptual. More specifically, with regard to mechanisms relevant to psychotherapy, it is difficult to identify what any of these mechanisms actually do in a mechanistic sense. That is, the mechanics of putative mechanisms are generally unspecified. In order to obtain a rigorous and comprehensive account of the current mechanisms in psychotherapy, as well as to evaluate their usefulness, a systematic scoping review was conducted. The systematic scoping review did not yield any mechanisms that were expressed in functional terms. We argue that, in order for psychotherapy to improve its effectiveness and efficiency, the standard for what is accepted as a useful mechanism needs to be substantially raised. Only functional mechanisms that express plausible actions consistent with known biological processes should be used to inform therapeutic interventions.
Highlights
In the field of psychotherapy, the term “mechanism” refers to an explanation of how psychotherapeutic interventions translate into events that lead to the desired outcome [1]
There is evidence that psychotherapy is helpful for many people who report psychological distress, there is considerable variation between individuals in terms of the amount of change experienced as a result of engaging with therapy [4]
Of the 154 articles selected for full-text examination, 70 were excluded for not being primary research, 66 for the research not examining functional mechanisms, 10 were systematic reviews, 2 focused on pediatric publications, 2 were not quantitative research, 2 were drug studies, 1 was a study protocol, and 1 article had been withdrawn by the publisher
Summary
In the field of psychotherapy, the term “mechanism” refers to an explanation of how psychotherapeutic interventions translate into events that lead to the desired outcome [1]. There is evidence that psychotherapy is helpful for many people who report psychological distress, there is considerable variation between individuals in terms of the amount of change experienced as a result of engaging with therapy [4] Part of this variation no doubt reflects the different ways in which change is defined such as by differences in scores on outcomes measures or reduction or increases in identified behaviors. At present, we do not understand whether there is a single mechanism through which psychotherapy effects change, or whether there are multiple mechanisms involved This is an important distinction to make in terms of promoting the most effective and efficient methods to assist in the alleviation of psychological distress. A more sophisticated understanding of mechanisms, would contribute to the development of psychological therapies that facilitate change in the most efficient and effective way possible
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