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Since the first neuroscience-informed cognitive-behavior therapy (nCBT) article was published in the Journal of Mental Health Counseling in 2015, the model has evolved to reflect developments in the scientific literature. In this article, we describe a more integrated and consilient framework that reflects the harmonious, synergistic, and complementary relationship among nervous systems and brain structures in which no single system or structure has dominance or primacy over another. We review literature on nonhierarchical and multidirectional understandings of the dual process model and oscillatory transitions between the two processing systems. We also discuss current thinking regarding brain development and unsupported theories. We propose an updated nCBT model to support new information regarding brain processing. A case study is woven throughout, to provide an example of how these concepts might be applied in clinical practice.
The neuroscience-informed cognitive-behavior therapy (nCBT) research team published the first conceptual article on nCBT in a 2015 issue of the Journal of Mental Health Counseling (Field et ah, 2015). Since then, the research team has published a series of early studies examining counselor and client perceptions of credibility and outcome expectancy (Field et ah, 2016, 2017), treatment fidelity (Field et ah, 2019), and training outcomes (Miller et ah, 2019). During this time, basic and translational neuroscience have evolved, and similar models have expanded to capture the dynamic interactions of top-down and bottom-up processes in assessment and intervention (e.g., Barfield et ah, 2012; Tabibnia & Radecki, 2018). These advancements have informed our conceptual updating of nCBT. In this article, we describe updates and modifications to nCBT, organized by the following four approaches: (1) moving from an emphasis on hierarchical top-down processing to a focus on oscillatory transitions, (2) updating conceptualizations of brain development and evolution, (3) reconsidering assumptions of consciousness, and (4) discussing delivery considerations such as the counseling relationship as a preconscious intervention. We thread a case study of a fictional client named Ashley throughout the manuscript, to demonstrate how these concepts might manifest in clinical practice. Table 1 depicts the changes between the initial nCBT model and subsequent adjustments to the model, to assist the reader with following the organizational flow of the manuscript.
CHALLENGES TO THE PREVAILING HIERARCHICAL PROCESSING MODEL
Since our initial conceptual article in 2015 (Field et...