Stefan Hofmann

Clinical translational research

Hofmann's research focuses on translating discoveries from emotion research and neuroscience into clinical applications, particularly in the treatment of anxiety disorders. He has published numerous studies on the mechanisms of mindfulness-based interventions and cognitive behavioral therapy, including large-scale meta-analyses of CBT efficacy across psychological disorders.^[17]

Pharmacological augmentation of psychotherapy

Exposure therapy for anxiety disorders operates partly through extinction learning. Hofmann has studied the use of d-cycloserine, a partial agonist of the glutamate receptor, as an adjunct to exposure therapy. Initial studies suggested that d-cycloserine could enhance extinction learning, but subsequent research and meta-analyses have produced mixed results.^[23] Evidence suggests that d-cycloserine may improve outcomes when exposure sessions are well conducted but can worsen outcomes when exposure is poorly administered, though subsequent meta-analyses have produced mixed results: a Cochrane review found no evidence of benefit over placebo,^[24] a large individual participant data meta-analysis reported only a small augmentation effect,^[25] and later meta-analyses have questioned the usefulness of d-cycloserine augmentation altogether.^[26] The clinical significance of these effects remains debated.^[27] Hofmann has drawn an analogy to Schrödinger's cat, noting that d-cycloserine augmentation is "both dead and alive"—its effect uncertain until the quality of the exposure session determines whether it helps or harms.^[28]

Social anxiety disorder

A substantial portion of Hofmann's research has addressed social anxiety disorder, including its maintaining mechanisms and treatment. In a 2007 theoretical paper, he proposed a comprehensive cognitive model of social anxiety identifying self-focused attention, post-event rumination, and perceived social cost as key maintenance factors, and outlined treatment implications of this model.^[29] Drawing on this model, Hofmann has studied social mishap exposures (also termed social cost exposures), in which patients with social anxiety deliberately commit minor social violations during structured exposure exercises—for example, asking a stranger an overly personal question or intentionally making a minor mistake during a public task. The rationale, grounded in the cognitive model, is that such exercises directly test patients' beliefs about the catastrophic consequences of social errors; by observing that feared outcomes typically do not occur or are tolerable, patients may revise inflated estimates of social cost and reduce reliance on safety behavior.^[29] Hofmann has continued to investigate this approach, including a 2024 commentary on targeting perfectionism in social anxiety through social mishap exposures.^[30] His work on social anxiety has received media attention, including coverage in The Atlantic^[7] and The New York Times.^[8]

Emotion research

Hofmann has contributed to research on mindfulness-based interventions and the role of emotion in therapy. In collaboration with colleagues, he conducted a meta-analysis on the effects of mindfulness-based therapy on anxiety and depression.^[31] He has also proposed an interpersonal emotion regulation model of mood and anxiety disorders.^[32] Hofmann's work on interpersonal emotion regulation argues that emotions are often regulated through relationships, and understanding these social regulatory processes is essential for understanding psychopathology and therapeutic change. He has developed the Interpersonal Emotion Regulation Questionnaire (IERQ).^[33] Among his other contributions to emotion research, Hofmann has investigated the role of intranasal oxytocin in psychiatric symptoms; a 2015 meta-analysis on this topic was retracted and replaced in 2016 after coding errors were identified, and the corrected analysis found no evidence of efficacy over placebo.^[34]

Process-based therapy

In collaboration with Steven C. Hayes, Hofmann has been developing process-based therapy (PBT), an idiographic treatment approach based on cognitive behavioral therapy that integrates insights from evolution theory and complex network theory to target the processes underlying effective psychological treatments.^[35][36] Together with David Sloan Wilson, they have also argued that clinical psychology should be grounded in an evolutionary framework.^[37] PBT conceptualizes psychopathology as maladaptation to a given context, rather than as an expression of a latent disease entity. PBT views the person as a dynamic system of biopsychosocial processes that requires healthy flexibility to adapt to an ever-changing context. These processes interact to form a complex network. The structural and dynamic features of this network are the foundations for developing a personalized, process-focused approach to psychotherapy. Effective treatment targets the underlying core processes driving psychopathology rather than relying on diagnostic categories. Although PBT is rooted in CBT and other evidence-based treatments, it rejects the contemporary therapy protocol-for-syndrome approach and advocates for a functional-analytic and idiographic approach to therapy.

PBT has attracted some criticism. Paul M. G. Emmelkamp questioned whether a process-based approach is necessary, arguing that existing evidence-based treatments already incorporate process considerations and that the empirical support for PBT remains limited.^[38]

Books

• Hofmann, S. G. (2011). An introduction to modern CBT: Psychological solutions to mental health problems. Wiley-Blackwell. ISBN 978-0470971765.
• Hofmann, S. G. (2016). Emotion in therapy: From science to practice. Guilford Press. ISBN 978-1462524488.
• Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2022). Psychopathology: An integrative approach to mental disorders (9th ed.). Cengage Learning. ISBN 978-0357657843.
• Hayes, S. C. & Hofmann, S. G. (Eds.) (2018). Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. New Harbinger. ISBN 978-1626255968.
• Hofmann, S. G. & Doan, S. N. (2018). The social foundations of emotion: Developmental, cultural, and clinical dimensions. American Psychological Association. ISBN 978-1433829277.
• Hayes, S. C. & Hofmann, S. G. (Eds.) (2020). Beyond the DSM: Toward a process-based alternative for diagnosis and mental health treatment. Context Press. ISBN 978-1684036615.
• Hofmann, S. G. (2020). The anxiety skills workbook: Simple CBT and mindfulness strategies for overcoming anxiety, fear, and worry. New Harbinger. ISBN 1684034523.
• Hofmann, S. G., Hayes, S. C., & Lorscheid, D. (2021). Learning process-based therapy: A skills training manual. New Harbinger. ISBN 1684037557.
• Hofmann, S. G. (2023). CBT for social anxiety. New Harbinger. ISBN 1648481205.

Selected articles

• Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cognitive Behaviour Therapy, 36, 195–209. doi:10.1080/16506070701421313
• Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183. doi:10.1037/a0018555
• Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. doi:10.1007/s10608-012-9476-1
• Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety, 29(5), 409–416. doi:10.1002/da.21888
• Hofmann, S. G. (2014). Interpersonal Emotion Regulation Model of Mood and Anxiety Disorders. Cognitive Therapy and Research, 38(5), 483–492. doi:10.1007/s10608-014-9620-1
• Whitfield-Gabrieli, S., Ghosh, S. S., Nieto-Castanon, A., Saygin, Z., Doehrmann, O., Chai, X. J., Reynold, G. O., Hofmann, S. G., Pollack, M. H., & Gabrieli, J. D. E. (2016). Brain connectomics predict response to treatment in social anxiety disorder. Molecular Psychiatry, 21(5), 680–685. doi:10.1038/mp.2015.109
• Hofmann, S. G. (2016). Schrödinger's cat and d-cycloserine to augment exposure therapy – both are dead and alive. JAMA Psychiatry, 73(8), 771–772. doi:10.1001/jamapsychiatry.2016.1132
• Hayes, S. C. & Hofmann, S. G. (2017). The third wave of CBT and the rise of process-based care. World Psychiatry, 16(2), 245–246. doi:10.1002/wps.20442
• Hofmann, S. G. & Hayes, S. C. (2019). The future of intervention science: Process-based therapy. Clinical Psychological Science, 7(1), 37–50. doi:10.1177/2167702618772296
• Phelps, E. A. & Hofmann, S. G. (2019). Memory editing from science fiction to clinical practice. Nature, 572, 43–50. doi:10.1038/s41586-019-1433-7
• Hofmann, S. G. (2020). The age of depression and its treatment. JAMA Psychiatry, 77(7), 667–668. doi:10.1001/jamapsychiatry.2020.0158
• Hayes, S. C. & Hofmann, S. G. (2021). "Third-wave" cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry. World Psychiatry, 20(3), 363–375. doi:10.1002/wps.20884
• Hofmann, S. G. (2024). Targeting perfectionism in social anxiety with social mishap exposures. Clinical Psychology: Science and Practice, 31, 344–347. doi:10.1037/cps0000222

Fellowships and academy memberships

• Fellow, Association for Psychological Science (2011)^[20][17]
• Fellow, American Psychological Association (2014)^[2][20]
• Member, Academia Europaea (2018)^[20]
• Fellow, American Association for the Advancement of Science (2020)^[40]