Beyond the DSM , livre ebook

“A broad and deep consensus exists, even among the framers of DSM criteria, that alternative paradigms for diagnosis and treatment of psychological disorders must be developed if the field is to advance. But just what approach will be best? In this forward-looking volume, Hayes and Hofmann assemble the most sophisticated treatment models—all of which emphasize process, dimensionality, a functional analysis of behavior, and the ability to individualize and personalize diagnosis. Every mental health professional will benefit from these developments.”
—David H. Barlow, PhD, ABPP , professor of psychology and psychiatry emeritus, and founder of the Center for Anxiety and Related Disorders (CARD) at Boston University
“Syndromal diagnosis provides a starting point for the classification of mental health disorders, but one that is inherently limited in terms of tracking underlying etiological pathways and principles of change. This volume describes a process-based approach that provides a far more compelling basis for organizing the causal processes underlying the etiology of mental health problems, be they diseases or disorders or the adaptations themselves that evolved to enhance reproductive fitness.”
—Steven D. Hollon, PhD , Gertrude Conaway Vanderbilt professor of psychology at Vanderbilt University with a long-standing interest in the treatment and prevention of depression
“I LOVE this book. A surefire way to get a headache is to try to provide evidence-based care using empirically supported treatments for DSM syndromes while also attending to the evidence-based processes described in the basic science literature that appear to account for the struggles of the individual I’m caring for right now. This book addresses that dilemma, offering creative ideas for a unified science of psychopathology, its classification, and its treatment.”
—Jacqueline B. Persons, PhD , director of the Oakland Cognitive Behavior Therapy Center; clinical professor in the department of psychology at the University of California, Berkeley; and author of The Case Formulation Approach to Cognitive-Behavior Therapy
“The DSM-based approach is unlikely to create a better understanding of, or more effective treatments for, mental health problems. Hayes and Hofmann offer a path forward. Open to various therapeutic traditions, based in science, and sensitive to client individuality, this book lays out multiple exemplars of understanding and treating mental health concerns based on the processes that create and maintain the problems—rather than the categories that describe them. This is a thought-provoking book that should be on the shelves of all clinicians and clinical researchers.”
—Douglas W. Woods, PhD , dean of the Graduate School, and professor of psychology at Marquette University
“This impressive volume is a genuine advance in our efforts to understand psychological dysfunction. Hayes, Hofmann, and their contributing authors present exciting alternatives to traditional categorical diagnosis à la DSM and ICD—drawing from research that spans neuroscience, learning, coping, and culture. These new ideas can enrich the search for mechanisms that underlie psychopathology, guiding identification of treatment targets and the construction of principle-guided, individually tailored interventions . ”
—John R. Weisz, PhD, ABPP , is professor of psychology at Harvard University, and director of the Harvard Lab for Youth Mental Health, specializing in developing and testing transdiagnostic interventions for young people
“One would certainly expect Hayes and Hofmann to provide a thoughtful and integrative compendium on process-based approaches to assessing, diagnosing, and treating psychological problems. In this edited volume, they assemble cutting-edge thought leaders to effectively deliver on this expectation. Chapters provide a depth and breadth of focus that is detailed yet easy to consume, laying a solid foundation from which researchers and practitioners of various theoretical orientations can better understand and help shape a process-based future for psychotherapy.”
—Gordon J. G. Asmundson, PhD , professor of psychology at the University of Regina, development editor for Clinical Psychology Review , and editor in chief of Journal of Anxiety Disorders


Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought.
Distributed in Canada by Raincoast Books
Copyright © 2020 by Steven C. Hayes and Stefan G. Hofmann
Context Press
An imprint of New Harbinger Publications, Inc.
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Oakland, CA 94609
www.newharbinger.com
The contributions to Beyond the DSM by authors who are employees of the National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, were prepared as part of their official duties as employees of NIH and are works of the United States Government. The copyright status of these contributions is governed by 17 USC Section 105.
Cover design by Sara Christian; Acquired by Catharine Meyers; Edited by Jenessa Jackson; Indexed by James Minkin
All Rights Reserved
Library of Congress Cataloging-in-Publication Data on file
Names: Hayes, Steven C, editor. | Hofmann, Stefan G, editor.
Title: Beyond the DSM : toward a process-based alternative for diagnosis and mental health treatment / [edited by] Steven C. Hayes, Stefan G. Hofmann.
Identifiers: LCCN 2020008075 (print) | LCCN 2020008076 (ebook) | ISBN 9781684036615 (trade paperback) | ISBN 9781684036622 (pdf) | ISBN 9781684036639 (epub)
Subjects: LCSH: Diagnostic and statistical manual of mental disorders. | Mental illness--Classification. | Mental illness--Diagnosis. | Mental illness--Treatment.
Classification: LCC RC455.2.C4 B494 2020 (print) | LCC RC455.2.C4 (ebook) | DDC 616.89/075--dc23
LC record available at https://lccn.loc.gov/2020008075
LC ebook record available at https://lccn.loc.gov/2020008076


Contents
Chapter 1: Creating an Alternative to Syndromal Diagnosis
Chapter 2: The NIMH Research Domain Criteria Project
Chapter 3: Shifting Paradigms
Chapter 4: Psychological Vulnerabilities and Coping Responses
Chapter 5: Expectations and Related Cognitive Domains
Chapter 6: Learning, Language, and Derived Behaviors
Chapter 7: Cultural and Social Influences on Individual Variation in Emotion Processes
Chapter 8: What a Complex Systems Perspective Can Contribute to Process-Based Assessment and Psychotherap y
Chapter 9: Psychological Flexibility in Chronic Pain
Chapter 10: A Multilevel, Multimethod Approach to Testing and Refining Intervention Targets
Chapter 11: Building a Process-Based Diagnostic System
Index
Chapter 1: Creating an Alternative to Syndromal Diagnosis
Needed Features of Processes of Change and the Models that Organize Them
Steven C. Hayes, PhD
University of Nevada, Reno
Stefan G. Hofmann, PhD
Boston University
Joseph Ciarrochi, PhD
Australian Catholic University
For decades, intervention science has followed a primary analytic strategy—that of syndromal diagnosis—which has created a robust and progressive field but has now reached a dead end. Few now believe that an adequate field of evidence-based therapy will emerge from researchers continuing to evaluate psychosocial protocols and lists of approved medications focused on psychiatric syndromes. We must find a new strategy and way forward. The only question remaining is: “What will that strategy be?”
The Diagnostic and Statistical Manual of Mental Disorders ( DSM; American Psychiatric Association, 2013) and the International Classification of Diseases and Related Health Problems (ICD; World Health Organization, 2018) have dominated the field for decades and left it with an intellectual hangover as it considers its future. Our discussion here will primarily focus on the DSM, but the same controversies also apply to the ICD.
Clinical programs have trained generations of students to take a topographical approach to human suffering based on the biomedical conviction that syndromes—collections of signs (things you see) and symptoms (things people complain of)—will lead to a deep, functional understanding of psychopathology. Students are trained to remember criteria, such as “five out of nine” or “four out of seven” signs and symptoms, and then pick the right set of organized techniques from approved lists of treatment protocols, all vetted by clinical randomized controlled trials (RCTs). In the minds of many, clinical skills mean the adherent delivery of techniques inside evidence-based protocols. Evidence-based therapy is synonymous with this “protocols-for-syndromes” strategy.
All of that is now changing—rapidly. After reviewing 30 years of effort on syndromal classification, the planning committee for the fifth version of the DSM (American Psychiatric Association, 2013) reached the conclusion that the entire enterprise is unlikely to ever lead researchers to the identification of functional entities: “All these limitations in the current diagnostic paradigm suggest that research exclusively focused on refining the DSM-defined syndromes may never succeed in uncovering their underlying etiologies. For that to happen, an as-yet unknown paradigm shift may need to occur” (Kupfer, First, & Regier, 2002, p. xix).
The Research Domain Criteria (RDoC) approach of the National Institute of Mental Health (NIMH) broke away from the hegemony of syndromal class