Mindfulness-based and exposure-based psychotherapies use distinct therapeutic procedures, yet the psychological capacities potentially engaged across these procedures have not been clearly synthesized. This integrative review examines empirical and theoretical literature on mindfulness- and exposure-related processes to identify capacities relevant to therapeutic engagement, learning, and adaptive responding. Across the reviewed literature, five capacities were identified as recurring points of convergence: attentional stability and engagement, distress tolerance and willingness, meta-awareness, learning flexibility, and behavioral flexibility. The synthesis suggests that mindfulness-based procedures may provide opportunities to exercise capacities involved in sustained contact with internal experience, whereas exposure-based procedures provide structured conditions for approach, expectancy violation, and behavioral learning. The proposed capacity-cultivation framework organizes these potential areas of convergence while preserving the procedural differences between mindfulness and exposure. The framework is conceptual rather than causal or prescriptive and is intended to support process-oriented formulation and empirical investigation of how capacities develop and function across therapeutic contexts, rather than to determine treatment selection. This perspective complements symptom-focused models by examining therapeutic change in terms of capacities that may support flexible engagement with distress, uncertainty, and action.
Reflective Practice (RP) is widely regarded as a cornerstone of psychotherapy training, supervision, and continuing professional development. Yet, despite its prominence across psychotherapeutic traditions, it remains conceptually vague and empirically contested. Recent critiques from basic psychological science (e.g., Lilienfeld Basterfield, 2020) have argued that reflection may amplify cognitive bias and foster illusions of insight rather than improve clinical judgment. We argue that these criticisms carry weight precisely because the field has often failed to clearly define what RP is, how it functions, and under what conditions it becomes beneficial or harmful. Drawing on developmental models of therapist learning, we conceptualize RP as a multidimensional construct encompassing reflexivity as a capacity, reflective stance as an attitude, and reflection as activity. We propose that RP is most likely to support development when relationally scaffolded, informed by external feedback, and oriented toward testing and revising interpretations rather than confirming them. Reviewing developmental, quantitative, qualitative, and process-oriented evidence, we further argue that RP operates primarily as a probabilistic, context-dependent contributor to therapist development rather than as a discrete intervention with predictable outcomes. We conclude that RP is neither a panacea nor an illusion. Rather, when relationally scaffolded, theoretically informed, and oriented toward learning rather than certainty, it may provide a central mechanism through which therapists learn from clinical experience. Effective psychotherapy depends not only on therapeutic concepts and techniques but also on therapists’ ability to reflect on their clinical work, relationships, and decision-making. This paper conceptualizes Reflective Practice as a developmental process through which therapists may learn from experience, adapt to complex clinical situations, and develop their understanding and skills throughout their professional careers.
Concentrated treatment formats may improve dissemination of evidence-based psychotherapy for anxiety disorders. The Bergen 4-Day Treatment (B4DT) is an intention-focused, exposure-based intervention with promising results for panic disorder in Norway. This case series reports the first implementation of the B4DT for panic disorder outside Norway. Three adults with DSM-5 panic disorder with agoraphobia received B4DT in a German psychiatric day-clinic. The four-day intervention combined a 1:1 therapist-to-patient ratio, individually tailored exposures, group reflections, and intentional engagement with feared bodily sensations. Clinician-rated panic severity and self-reported outcomes were assessed at baseline and one-week post-treatment; self-report follow-up was collected after three months. All patients completed treatment and assessments. Panic severity decreased in all cases; two patients met response and remission criteria post treatment. Self-reported panic severity remained low at three months. Case analyses highlighted distinct patient trajectories and therapist learning regarding autonomy, experiential avoidance, reassurance, and psychoeducation. B4DT for panic disorder appeared feasible and acceptable and showed preliminary clinical benefit. Trial Registry Deutsches Register Klinischer Studien, DRKS00038563; December 2, 2025.
This paper distinguishes between two broad approaches to psychoanalysis: etiologically speculative and etiologically neutral. Etiologically speculative approaches advance causal claims about psychopathology, often through reconstructions of early experience, whereas etiologically neutral approaches treat such formulations as provisional hypotheses whose validity depends on evidence beyond their clinical plausibility. Drawing on the distinction between narrative and historical truth, the paper argues that compelling clinical narratives do not establish etiological validity. Etiological neutrality is presented not as a prohibition against causal theorizing, but as an epistemically modest stance that distinguishes hypotheses about particular symptoms, defenses, and relational patterns from claims about the causes of psychiatric conditions as a whole. The paper situates this stance within a medical model that permits treatment in the absence of definitive causal knowledge and concludes that psychoanalysis can retain scientific credibility by clearly distinguishing meaning, mechanism, and cause.
Adults with autism are at an increased risk of developing comorbid psychiatric disorders. Research has estimated that approximately 70
