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World Psychiatry 20:3 October 2021 are more experiential and “may lead to positive outcomes for trainees and practitioners”, there is no robust evidence that they are more effective than classic behavior therapies or “second wave” CBTs. One important way to investigate mechanisms of change is mediation. Several potential mediators have been proposed in the literature in relation to depression. Cognitive theory states that depression is caused and maintained by dysfunctional cognitions and maladaptive information processing strategies, and depression severity can be reduced by altering the function, content and structure of cognitions associated with negative affect, as is done in CBT. Changing the content of thoughts is seen as an unnecessary step in ACT, as it is assumed that distancing oneself from thoughts is a sufficient and more productive way to diminish the influence of thoughts on behavior. Distancing is achieved through the process of defusion or decentering. In an RCT, manualized CBT was compared with ACT, and patients in both conditions reported significant and large reductions of depressive symptoms aa well as improvement in quality of life up to 12 months after treatment. Interestingly, dysfunctional cognitions did not only mediate treatment effects of depressive symptoms in CBT, but also in ACT. On the other hand, decentering mediated not only treatment effects in ACT, but also in CBT. Thus, both treatments seem to work through changes in dysfunctional cognitions and decentering, even though the treatments differ substantially. Another interesting issue for further research is the role of the therapeutic alliance in CBT and “third-wave” therapies. In an RCT, the alliance-outcome association in CBT vs. MBCT was evaluated in diabetic patients with depressive symptoms. Because both CBT and MBCT therapists aim to form a therapeutic bond by adopting an open, empathic, accepting, and nonjudging attitude towards patients, it was hypothesized that the therapeutic bond was going to predict the subsequent symptom change in both treatments. The results showed, however, that patients’ ratings of the therapeutic alliance predicted depressive symptom improvement in CBT, but not in MBCT. There is a clear need for further studies into the role of the therapeutic alliance in “third-wave” therapies. Although the empirically supported treatment approach is currently still followed by a majority of CBT researchers and practitioners, a growing minority argues for the need to put greater emphasis on individual case formulation based on empirically tested theories instead of treatment protocols. Hayes and Hofmann suggest to study processes of change in therapy using idiographic analysis for nomothetic purposes and to treat the individual patient “by understanding the process-based complexity of his/her problem and applying tailored intervention strategies”. But, what is the evidence that individualized treatment based on functional analysis and case formulation is more effective than standard protocolized treatment? Hayes and Hofmann cite two studies to support the notion that treatment modules to target person-specific maladaptive processes of change are more effective than global protocols. In one of these studies, an individualized approach was found to be more effective than standard treatment in children with behavioral problems. However, only about one half of children in the control condition actually engaged in behavioral health services. To test the study hypothesis, the individualized approach should be compared with an evidencebased treatment for behavioral problems. Actually, there is no robust evidence for a superior effectiveness of treatment based on functional analysis compared with manualized evidence-based treatments. Although there are clear advantages associated with an individualized approach, if proven effective, there are also disadvantages. First, the success of the therapy will largely depend upon the therapist’s creativity. Moreover, an individualized treatment approach is certainly much more difficult to learn and practice than a manual-based, standardized, evidence-based intervention.