Changing the Game in Psychology: The Journey of PBBT
Blog post written by Dr. Yvonne Barnes-Holmes and Dr. Ciara McEnteggart
It might surprise you to know that PBBT really started as a research journey. Mental Health Professionals are naturally keen to embed their clinical work in a scientific basis, but in practice this rarely happens. As clinicians, we wanted that too, but as researchers, we could also see the other side and just how hard it is to advance psychological science to that place. We knew well the difficulties in getting psychological science to translate to application, so we weren’t naive on either front.
As our research gave us clear-cut answers on how best to define and understand complex human behaviour, we began to see the first green shoots of how this might speak to application. Developments came in parts, sometimes small parts, but new ideas on what to do with Clients flourished. And slowly, but not by design, our clinical work was changing. We were changing what we said to Clients and what we did with Clients. But what was changing most, is that we were beginning to understand why Clients experience what they do, why they do what they do with those experiences, and what we needed to do for that to change. And after some time, what we were doing with Clients looked nothing like any therapy we had ever learned.
Those were the early days of PBBT, long before there even was a thing called PBBT. But those changes were there, we were on that journey, and PBBT is where that journey of scientific discovery and clinical ambition ended up. It ended up organically at a full one-size-fits-all treatment package called PBBT. And that’s exactly what it is, it is a type of behaviour therapy that is totally based on scientifically-identified processes. What else would we have called it? A therapy with core concepts built directly and entirely from empirical innovation is the first of its kind in the field of psychology. And, the process-based nature of the therapy is undoubtedly what drives its positive outcomes.
How is PBBT really different from other therapies?
In truth, there are so many ways in which PBBT is different from any other form of psychological therapy and once inside PBBT everyone can see that. Exploring some of the key differences really helps to understand what PBBT is about.
Let’s start with the most obvious. PBBT doesn’t just say that it is totally grounded in basic science, it is totally grounded in basic science. When psychological therapy isn’t grounded in basic science, it’s usually because the basic science isn’t at a place where it can offer that. Our research had a major breakthrough when we could for the first time identify the fundamental units of human behaviour, where no such units existed before in our field (for those who want to geek out on the development of these scientific units – visit https://balc-i.net/publications/). These units offered a unique, precise definition of complex psychological experiences and behaviour, in whatever ways those experiences and behaviour manifest. In short, our research convinced us that all psychological problems involve the same core behavioural units.
The next difference is, for us, a really critical one and follows on from the previous one. A truly innovative attribute of PBBT as a psychotherapy is its ability to treat all forms and degrees of psychological suffering. Typically, psychotherapy regimes (such as CBT) have tailored themselves to diagnostic categories, especially depression and anxiety, because these problems are essentially all seen as different. In contrast, because PBBT is based on core psychological units, it can skillfully manipulate and change these units, however they have emerged or whatever they look like. In short, PBBT offers a one-size-fits-all treatment package, essentially because all psychological problems reflect the same core units at work. However, the scientific precision underneath PBBT enables it at the same time to mould itself around the unique nature of how these units have formed for an individual.
The final difference between PBBT and other forms of therapy is the pivotal role it attributes to the Clinical Practitioner. PBBT is a highly-specialised skillset aimed at detecting and manipulating the core units of behaviour as each Client presents with them. Where other treatment regimes use protocols to direct what Practitioners say and do with Clients, this limits the Practitioner’s ability to truly understand and define how the core units are working in a Client’s life, because the protocol dictates what you will do anyway. This also minimises the extent to which the Practitioner learns the skills of manipulating these units based on a precise analysis of what they see in an individual case. PBBT is a combination of analytic and clinical skills, where the Practitioner learns to do the analysis and then deciphers what this analysis directs them to say and do with Clients, so that the basic units change.
How PBBT can Address the Challenges within the Mental Health Industry
We have never lacked vision for PBBT, but we know what it requires to become a reality. The basic global facts will astound you. In reality, 970 million people worldwide are grappling with some form of mental health or substance use challenge. And, 50% of Clients who attend treatment will not recover fully. These poor therapeutic outcomes significantly affect both professionals and their Clients. Burnout among mental health professionals has an estimated prevalence of 60%, and many see no other option but to leave the profession. And the impact of this; increasing the pressure further on the mental health system as a whole. It’s a daunting spiral that seems to have no end.
We have spent many years training and talking to mental health professionals, from all disciplines and backgrounds. And one pattern we find over and over is that almost universally they seek out training in new therapy models to improve their clinical outcomes, because poor Client outcomes are simply too painful to live with as a helping professional. And the reason why they are on this relentless path of professional change is simple: psychology as a field has not provided a holistic treatment package that caters to Clients’ needs whilst allowing the professional to work from a coherent treatment perspective. That is, Clinicians draw from multiple conflicting models (often up to 10) to try to meet their Clients’ needs, because no single model is sufficient. Many clinicians describe themselves as a “Jack of all trades and a master of none” and it is a source of huge pain and shame for them, and thus their search continues.
Our vision that all Clients get access to effective psychological therapy cannot work if the therapy itself lacks efficacy or if Mental Health Professionals don’t get good training to have the right skills. The global challenge of psychological suffering is vast and escalating, and can simply feel overwhelming for the individual Clinician. It’s just a fact that no one Clinician can impact that tide, no matter how hard they work. The fragmented and disjointed nature of the field of psychology has been hugely detrimental to Clients, professionals and the mental healthcare system globally. We have to build a community with precise knowledge, and this has to be a unified community, working with a unified voice, in a unified way around this unified cause. This will take a village, so we are building a village.
Our vision for PBBT is for it to become the gold standard in psychotherapy so that we can improve the burden of mental healthcare across the globe. We want The PBBT Institute to become a globally recognised centre for learning that provides professionals with effective deliverable psychotherapy in a professional community where each and every one can feel valued and supported.
If you’re interested in learning more about PBBT, join us for an informational webinar on 22nd January 2025 at 4pm where we will speak more about PBBT, the PBBT Institute, and our new Professional Diploma in PBBT. Applications for the Diploma will be opening on 1st November 2024.
