Although an evidence-based treatments have been developed for most types of mental illness, there is substantial room for improvement. The effect sizes of most available treatments are small to moderate, gains may not persist, and there are too many patients who derive little or no benefit. Even under optimal conditions, treatment failure is alarmingly common.

Traditionally the development of psychological treatments has involved consensus between groups of skilled clinician researchers and many medication treatments have been discovered by serendipity. Consequently, there have been calls for ‘increased attention to science’ in the treatment development process (Insel, 2009; Salkovskis, 2002).

Our approach to treatment development is to use a multi-systems and mechanisms-focused framework in which (a) cognitive, affective, biological, behavioral and developmental contributors are emphasized as the source for deriving novel interventions and (b) intervention research is used to develop hypotheses about and/or confirm mechanisms.

A central theme that runs across all our research is a deep interest in the Science of Behavior Change: https://commonfund.nih.gov/behaviorchange

Examples of our treatment development work can be found within the tabs on this webpage. Other examples include …

Treatment development teams often need to take on the challenging task of retooling in the rapidly expanding science of dissemination and implementation (D&I) to ensure the investments made in developing new treatments can be accessed by the people who most need them. Over the past decade we have been developing expertise in D&I within a partnership with community mental health centers (CMHCs) across California. This research was funded via two R01s awarded by NIMH (MH105513, MH120147). Dr. Harvey was also fortunate to participate in the Training Institute for Dissemination and Implementation Research in Health (TIDIRH) in 2017 conducted by the National Cancer Institute.

Examples of our implementation science research includes:

As we have conducted research across a range of mental disorders, we noticed striking similarities in the processes that maintain them. This observation drove our interest in a transdiagnostic approach. The term ‘transdiagnostic processes’ refers to processes that are in common across more than one mental disorder. The potential advantages of studying, and intervening on, transdiagnostic processes are at least threefold. First, if a transdiagnostic process contributes to the maintenance of symptoms across multiple disorders, then one powerful approach is to focus treatment on that process rather than on the large number of discrete disorders currently listed in the DSM. Second, comorbidity among mental disorders is the norm. Hence, a significant clinical dilemma is which disorder/s to prioritize for treatment. Targeting treatment at a transdiagnostic process provides one path forward. Third, a transdiagnostic approach may reduce the heavy burden on clinicians, who must learn multiple disorder-focused protocols, with common theoretical underpinnings and interventions (Harvey et al., 2004). Indeed, this approach may help solve the ‘too many empirically supported treatments problem’ (p. 68) that impedes the dissemination and uptake of treatments (Weisz, Ng, & Bearman, 2014).

We have highlighted sleep and circadian problems as biologically and theoretically plausible transdiagnostic contributors to mental and physical health difficulties. Our ‘treatment experiments’ involved carefully devising a set of procedures to improve sleep and circadian functioning and observing if these procedures improve mental and physical outcomes. Over an iterative process spanning more than 15 years, this process of ‘devising a set of procedures’ has resulted in the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TSC).

Examples of our TSC research includes::

This line of research arises from a long-term interest in memory and cognitive science. The specific idea was triggered by the clinical observation that patient memory for treatment can be poor. We were concerned that poor memory for treatment may contribute to poorer outcome. Consistent with these observations, we empirically established that memory for treatment is poor and that better recall for treatment is associated with better outcome. We also developed an intervention designed to improve memory for treatment. Distilled from the cognitive science and education literatures and based on carefully honed criteria, the Memory Support Intervention includes eight powerful memory promoting strategies. Although this new intervention—the Memory Support Intervention—has potential to be added to a broad range of treatment types, such as psychosocial treatments and physician visits for medication management (‘pantreatment’) for a broad range of mental and physical disorders (‘transdiagnostic’), we have focused on major depressive disorder (MDD) and cognitive therapy (CT) to create a ‘platform’ for the next step in investigating this approach.

Examples of our memory support research includes::

Zieve, G. G., Dong, L., Weaver, C., Ong, S. L., & Harvey, A. G. (2019). Patient constructive learning behavior in cognitive therapy: A pathway for improving patient memory for treatment?. Behaviour research and therapy, 116, 80–89. https://doi.org/10.1016/j.brat.2019.02.006

Sarfan, L. D., Zieve, G. G., Mujir, F., Gumport, N. B., Xiong, M., & Harvey, A. G. (2023). Serial Mediators of Memory Support Strategies Used With Cognitive Therapy for Depression: Improving Outcomes Through Patient Adherence and Treatment Skills. Behavior therapy, 54(1), 141–155. https://doi.org/10.1016/j.beth.2022.07.012

Dong, L., Lee, J. Y., & Harvey, A. G. (2017). Memory support strategies and bundles: A pathway to improving cognitive therapy for depression?. Journal of consulting and clinical psychology, 85(3), 187–199. https://doi.org/10.1037/ccp0000167

Harvey, A. G., Lee, J., Smith, R. L., Gumport, N. B., Hollon, S. D., Rabe-Hesketh, S., Hein, K., Dolsen, E. A., Haman, K. L., Kanady, J. C., Thompson, M. A., & Abrons, D. (2016). Improving outcome for mental disorders by enhancing memory for treatment. Behaviour research and therapy, 81, 35–46. https://doi.org/10.1016/j.brat.2016.03.007