Active inference: A new approach to understanding change in psychotherapy

Psychotherapy has long been seen as an effective way to address psychological difficulties and personal growth. However, researchers are still struggling to understand what actually leads to therapeutic change and how best to describe the process. One modern approach that has recently gained attention is the active inference framework (AIF), which also has the potential to unify research on psychopathology and psychotherapy. At the same time, it has long been known in psychotherapy that the process of change can be supported by various common factors, such as the therapeutic relationship or mindfulness techniques. A study by Petra Hubatka and Tomáš Řiháček from INPSY/Center for Psychotherapy Research focused on linking these factors to active inference and sought answers to how this framework can explain mechanisms of change in psychotherapy.

What is active inference?

AIF is a theoretical model with a mathematical formalization that treats the human brain as a "prediction machine" that constantly tries to balance expectations with reality and helps people understand the world around them and themselves. Simply put, if these predictions do not match reality, it may indicate that the perceptions a person has of themselves and the world around them may not be appropriate for their current life circumstances. AIF assumes that people are able to compensate for these deviations (e.g., by adjusting their beliefs to better match reality). However, if they fail to adjust this "internal model" of the world and themselves in the long term so that the predictions match reality better, they may experience psychological difficulties such as depression or anxiety. Psychotherapy according to this framework helps clients to adjust their expectations to better match their life situation and reality. Thus, AIF can help professionals better understand how change works in psychotherapy and how to better help clients overcome psychological difficulties.

Objectives of the current study

The authors of the study, Petra Hubatka and Tomáš Řiháček, decided to explore how AIF can be used to describe common factors of change in psychotherapy. The aim was to summarise existing research studies and to produce a mapping review that shows how individual change factors can be described within the theoretical framework of AIF. The authors identified a total of 22 studies that met the inclusion criteria.

How to help the client from the AIF perspective?

According to the results, in all the studies analysed, the individual authors agreed that clients come to therapy with sub-optimised prediction models. This means that these people may have overly accurate or, conversely, inaccurate assumptions about the world or their own worth. The goal of psychotherapy is to optimize these models so that clients can more effectively predict and respond to their life situations. Two main ways in which psychotherapy can optimize these models have been identified among studies:

• goal-oriented interventions, which aim to change the client's response in a predetermined way (e.g., through desensitization techniques, i.e., gradually reducing sensitivity to certain stimuli)
• exploration-based interventions aimed at broadening the client's perspective and increasing the accessibility of emotions, thoughts, memories and bodily sensations (e.g. through mindfulness)

The study summarized many common factors for change in psychotherapy, but one of the most frequently discussed common factors was the therapeutic relationship. The authors stated that this relationship could be explained by the alignment of the prediction models between therapist and client. This process involves mutual learning and adjustment, leading to a reduction in uncertainty and the creation of a shared perspective. Mindfulness was also identified as a key mechanism leading to a change in client expectations. The authors of the studies argued that mindfulness helps to increase awareness of what is currently being sensed, which may contribute to better processing of emotions and changing inappropriate responses.

The study authors concluded that active inference provides a promising explanatory framework for a deeper understanding of mechanisms of change in psychotherapy. One of the major advantages of AIF is the built-in mathematical apparatus on which the theory is based. Therefore, AIF could be useful in the future in conceptualizing individual cases and understanding the processes that maintain maladaptive behavior in a particular client. The study thus represents an important step towards unifying psychotherapeutic research and practice.

Recommended citation:

Hubatka, P., & Řiháček, T. (2024). Common factors viewed through the lens of the active inference framework: A mapping review. Journal of Psychotherapy Integration. https://doi.org/10.1037/int0000350