Towards an understanding of the process and mechanisms of change in cognitive behavioral therapy: Linking innovative methodology with fundamental questions

Abstract

There is now consistent evidence to support the efficacy of cognitive-behavior therapy (CBT) to reduce clinical symptoms and improve quality of life across a wide variety of clinical problems (Butler, Chapman, Formen, & Beck, 2006). This outcome research typically relies on a pretreatment-posttreatment design and follow-up assessments at fixed intervals beyond post-test. These outcome studies have been important in answering questions about if a treatment works and, to some extent, for whom it works. However, these designs provide much less information about the mechanisms of treatment—why or how an intervention works. There has been a resurgence of interest in studying what happens between the pretreatment and posttreatment assessment—the process of change—and a recognition of the important role of this research in treatment development.