Stop trying to carve Nature at its joints! The importance of a process-based developmental science for understanding neurodiversity.

Nature is dynamic and interdependent. Yet we typically study and understand it as a hierarchy of independent static things (objects, factors, capacities, traits, attributes) with well-defined boundaries. Hence, since Plato, the dominant research practice has been to 'carve Nature at its joints' (Phaedrus 265e), rooted in the view that the world comes to us pre-divided - into static forms or essences - and that the goal of science is to simply discover (identify and classify) them. This things-based approach dominates developmental science, and especially the study of neurodevelopmental conditions. The goal of this paper is to amplify the marginalised process-based approach: that Nature has no joints. It is a hierarchy of interacting processes from which emerging functions (with fuzzy boundaries) softly assemble, become actively maintained, and dissipate over various timescales. We further argue (with a specific focus on children with Down syndrome) that the prevailing focus on identifying, isolating, and analysing things rather than understanding dynamic interdependent processes is obstructing progress in developmental science and particularly our understanding of neurodiversity. We explain how re-examining the very foundation of traditional Western thought is necessary to progress our research on neurodiversity, and we provide specific recommendations on how to steer developmental science towards the process-based approach.

Comment on Lundh (2023).

In this commentary of Lundh's (2023) article, we point to an individualized process-based approach for the future of psychotherapy. The traditional nomothetic research paradigm is limiting our understanding of processes of change, oversimplifying psychological phenomena, and neglecting individual dynamics. In contrast, a process-based approach calls for ideographic methodologies, departing from the latent-disease paradigm toward process-based interventions. Process-based research promises avenues for enhancing intervention science and a deeper comprehension about psychopathology and therapeutic mechanisms, in a comprehensive, personalized, and holistic manner.

A process-based approach to cognitive behavioral therapy: A theory-based case illustration.

Despite the significant contribution of cognitive-behavioral therapy to effective treatment options for specific syndromes, treatment progress has been stagnating, with response rates plateauing over the past several years. This stagnation has led clinical researchers to call for an approach that instead focuses on processes of change and the individual in their particular context. Process-based therapy (PBT) is a general approach representing a model of models, grounded in evolution science, with an emphasis on idiographic methods, network models of case conceptualization, and enhancing wellbeing. In this paper, we describe the theory underlying PBT and present a case study for how to apply PBT tools and principles to deliver process-informed and person-centered evidence-based treatment. In addition, we discuss lessons learned from our case and provide suggestions for future considerations when implementing PBT in clinical settings.

Negative Affect and Problematic Binge-Watching: The Mediating Role of Unconstructive Ruminative Thinking Style.

The practice of binge-watching (i.e., watching multiple episodes of TV series in one session) has become increasingly prevalent, but comprehending its nature and potential underlying factors has been challenging. In particular, problematic binge-watching remains ill-defined and conceptualized, being regarded either as an addictive behaviour or a maladaptive emotion regulation strategy. Following a process-based approach, in the current study we explored the latter conceptualization, by investigating the potential mediating role of an unconstructive ruminative thinking style between negative affect and problematic binge-watching. To this end, TV series viewers completed an online survey assessing socio-demographic variables, TV series viewing habits, binge-watching motives and engagement, ruminative thinking styles and affect. Based on their answers, participants were allocated to one of the following three groups: non-binge-watchers (n = 59), trouble-free binge-watchers (n = 85), or problematic binge-watchers (n = 162). Group comparisons and mediation analyses were conducted to explore the underlying role of unconstructive rumination in problematic binge-watching. Results showed that, apart from the pattern of TV series watching, trouble-free binge-watchers shared little to no similarity with problematic binge-watchers, therefore supporting the need to differentiate these two behaviours. Moreover, mediation analyses revealed that an unconstructive ruminative thinking style partially mediated the relationship between negative affect and coping/escapism and that it fully accounted for the relationship between negative affect and binge-watching derived positive emotions in problematic binge-watchers. These findings thus add to the notion that problematic binge-watching might serve as a way to bolster a maladaptive emotion regulation strategy, implying that unconstructive rumination acts as a mediating process in this context.

On the pitfalls of conceptualizing excessive physical exercise as an addictive disorder: Commentary on Dinardi et al. (2021).

This commentary challenges some of the proposals made in the opinion paper entitled "The expanded interactional model of exercise addiction" by Dinardi, Egorov, and Szabo (2021). We first question the usefulness of the (expanded) interactional model of exercise addiction to determine the psychological processes underlying distress and functional impairment in excessive physical exercise. We then consider the authors' use of the Self-Determination Theory to model exercise addiction, which risks the misclassification of strenuous, but adaptive, patterns of physical exercise as exercise addiction. We finally address broader concerns regarding the idea that maladaptive exercising could be conceptualized as an addictive disorder.

"Third-wave" cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry.

For decades, cognitive and behavioral therapies (CBTs) have been tested in randomized controlled trials for specific psychiatric syndromes that were assumed to represent expressions of latent diseases. Although these protocols were more effective as compared to psychological control conditions, placebo treatments, and even active pharmacotherapies, further advancement in efficacy and dissemination has been inhibited by a failure to focus on processes of change. This picture appears now to be evolving, due both to a collapse of the idea that mental disorders can be classified into distinct, discrete categories, and to the more central attention given to processes of change in newer, so-called "third-wave" CBTs. Here we review the context for this historic progress and evaluate the impact of these newer methods and models, not as protocols for treating syndromes, but as ways of targeting an expanded range of processes of change. Five key features of "third-wave" therapies are underlined: a focus on context and function; the view that new models and methods should build on other strands of CBT; a focus on broad and flexible repertoires vs. an approach to signs and symptoms; applying processes to the clinician, not just the client; and expanding into more complex issues historically more characteristic of humanistic, existential, analytic, or system-oriented approaches. We argue that these newer methods can be considered in the context of an idiographic approach to process-based functional analysis. Psychological processes of change can be organized into six dimensions: cognition, affect, attention, self, motivation and overt behavior. Several important processes of change combine two or more of these dimensions. Tailoring intervention strategies to target the appropriate processes in a given individual would be a major advance in psychiatry and an important step toward precision mental health care.

Features and psychometric properties of the Montreal Cognitive Assessment: Review and proposal of a process-based approach version (MoCA-PA).

The current study presents a rapid review of the psychometric features of the standard Montreal Cognitive Assessment (MoCA), and the proposal for a modified version of the test, informed by the methodology of the Boston Process Approach to neuropsychological assessment. In order to aid the process of identification of the primary underlying neurocognitive mechanism responsible for defective test performance, the MoCA-Process-Based Approach (MoCA-PA) adds complementary or satellite test conditions in some of its subtests, includes "new" qualitative indices to capture the cognitive processes involved in each cognitive task, and incorporates new qualitative classifications of error subtypes. It provides concurrent assessment of multiple cognitive processes within each task, without significantly increasing administration time or placing significant additional burden upon the respondent. We present preliminary results obtained from an initial sample of 45 community-dwelling older adults attending a University program for seniors. Results suggest the usefulness of additional indices in providing additional information on cognitive deterioration that may be overlooked with the only consideration of quantitative scores. Future research will aim to collect normative data for different clinical populations using the newly developed indices in order to determine the validity and clinical utility of the relatively novel qualitative process-based methods used in the MoCA-PA.

Marrying Past and Present Neuropsychology: Is the Future of the Process-Based Approach Technology-Based?

A cognitive assessment strategy that is not limited to examining a set of summary test scores may be more helpful for early detection of emergent illness such as Alzheimer's disease (AD) and may permit a better understanding of cognitive functions and dysfunctions in those with AD and other dementia disorders. A revisit of the work already undertaken by Kaplan and colleagues using the Boston Process-Approach provides a solid basis for identifying new opportunities to capture data on neurocognitive processes, test-taking strategies and response styles. Thus, this critical review will combine traditional process-based assessment strategies with support provided or offered by newer technologies that have the potential to add value to data collection and interpretation. There is now considerable interest in neuropsychological test administration using computer/digital technology, both in research and in clinical settings. To add value, any computerized version of an existing cognitive test should respect the administration procedure for which normative data were obtained, should be time-saving in terms of scoring and interpretation, and should, we argue, facilitate gathering information about the processes and strategies followed in test completion. This article will offer an overview of the steps needed when implementing computerization of neuropsychological tests using a Process-Based Approach (PBA) to these technology-based adaptations and will discuss further developments in this area by linking it to future technological developments that may be possible in the area of neuropsychological assessment. Additionally, an overview of neuropsychological tests that may benefit from computerization will be presented, together with suggestions on the specific processes, strategies and features that may be captured with the aid of such computerization. Finally, hypotheses on how virtual reality could be an asset for the future of the PBA to neuropsychological assessment will also be discussed.

Methodological framework for evaluating clinical processes: A cognitive informatics perspective.

We propose a methodological framework for evaluating clinical cognitive activities in complex real-world environments that provides a guiding framework for characterizing the patterns of activities. This approach, which we refer to as a process-based approach, is particularly relevant to cognitive informatics (CI) research-an interdisciplinary domain utilizing cognitive approaches in the study of computing systems and applications-as it provides new ways for understanding human information processing, interactions, and behaviors. Using this approach involves the identification of a process of interest (e.g., a clinical workflow), and the contributing sequences of activities in that process (e.g., medication ordering). A variety of analytical approaches can then be used to characterize the inherent dependencies and relations within the contributing activities within the considered process. Using examples drawn from our own research and the extant research literature, we describe the theoretical foundations of the process-based approach, relevant practical and pragmatic considerations for using such an approach, and a generic framework for applying this approach for evaluation studies in clinical settings. We also discuss the potential for this approach in future evaluations of interactive clinical systems, given the need for new approaches for evaluation, and significant opportunities for automated, unobtrusive data collection.