Moving from protocols to idionomic processes of change: process-based therapy as the future of psychosis psychotherapy

Background The role of psychotherapy in treatment for psychotic disorders is established as a core component of standard care in international guidelines. Recent reviews of outcome trials have, however, indicated these interventions have smaller-than-anticipated effect sizes and wide variation in outcomes across persons. This is in part because psychotherapy protocols tend to rely on nomothetic outcome evidence and latent disease models that undercut the diversity of human well-being and suffering.Methods In this commentary, we outline the application of the process-based therapy (PBT) framework in psychotherapy for psychosis.Results We present an argument that the emerging PBT framework offers a novel solution to the limitations imposed by protocols for syndromes by embracing individual complexity and enabling a more precise, personalized application of evidence-based interventions for psychotic disorders. We also present brief case studies to illustrate how applying the PBT approach can enhance person-centered treatment of psychosis.Discussion Using the PBT framework, we advocate for a change in how researchers and clinicians think about, research, and provide psychotherapy for psychosis.