Applied Pragmatic Functional Contextualism: A New Epistemological and Theoretical Framework for Applied Mental Health Research

Eli Cwinn ^1,* , Kayla Hamel ²

1. Western University, CA, USA

2. Centre for Addictions and Mental Health, CA, USA

* Correspondence: Eli Cwinn

Academic Editor: Marianna Mazza

Received: January 22, 2024 | Accepted: June 22, 2024 | Published: July 10, 2024

OBM Integrative and Complementary Medicine 2024, Volume 9, Issue 3, doi:10.21926/obm.icm.2403041

Recommended citation: Cwinn E, Hamel K. Applied Pragmatic Functional Contextualism: A New Epistemological and Theoretical Framework for Applied Mental Health Research. OBM Integrative and Complementary Medicine 2024; 9(3): 041; doi:10.21926/obm.icm.2403041.

© 2024 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.

1. Introduction

There is a need for a theoretical framework specifically designed for applied mental health research to help researchers learn what works, under what conditions does ‘it’ work, and for whom ‘it’ works for. Presently, many psychology publications require a strong theory underlying research findings, especially for qualitative research [1,2,3,4]. In practice, reviewers and editorial staff tend to treat theory in the Popperian sense: as a content-based phenomenological net that can be used to identify hypotheses through a deductive process (henceforth content-based theory). In other words, the theory or its postulates are treated as the truth criterion against which experimental findings are evaluated (see below for a further description). Some examples of such content-based theories are social learning theory [5], self-determination theory [6], ecological systems theory [7], schema theory [8], and the like. This tradition in the philosophy of science is useful for evaluating the degree to which a theory can predict observations. In this paper we argue that requiring content-based theory as an organizing framework for applied mental health research is problematic because many important questions for applied mental health research cannot be adequately asked or answered, and this has several deleterious implications for our ability to meet society’s mental health needs.

We do not propose a “Wild West” of atheoretical subjectivism (see [9] for a full discussion) or purely descriptive and uncategorized science. Rather, we argue that an alternative theoretical framework is required to augment the depth and utility of psychological knowledge. In this paper, we first provide a rationale for why theory (in general) matters and describe why and how theory is essential for useful and valid applied mental health research. Next, we argue that relying on content-based theory alone is both problematic and harmful, as well as insufficient for the goals of psychology as a discipline. While this issue is relevant to the discipline of science in general, we center this discussion in the field of applied mental health research where the problems and pitfalls of content-based theory are especially salient and particularly important to address given the weighty consequences for human suffering. Lastly, we provide a description of, and argument for, a different type of theoretical framework that addresses the function of theory-driven research while compensating for some of the weaknesses in content-based theory. This Applied Pragmatic and Functional Contextualism (APFC) framework takes a contextually-framed, mechanistic approach to understanding the phenomenology of human experience and applied mental health. We provide potential implications and next steps for using this type of framework.

2. Why Does Theory Matter?

In general, we seek knowledge to both (a) understand “life, the universe, and everything” [10] and (b) to use that knowledge to improve the quality of life for ourselves and the natural world in which we interact [11]. Western Science is one frame by which we can discover and articulate that knowledge, and most major psychology publications are framed within a Western Science perspective [12]. Western science tends to argue that knowledge can grow either through the discovery and acquisition of new truths about the world [13] or through a hermeneutic (i.e., inductive, iterative, and interpretive) process of increasing the richness and depth of understanding a phenomenon [14]. Both of these processes of knowing require a truth criterion that lies outside the frame of inquiry. For example, the statement “this apple is green” requires a criterion related to what constitutes and apple and a second criteria of what constitutes green. “This apple is green” cannot have any meaning in itself without referencing something outside the statement.

Theory is important because it establishes sets of truth criteria against which specific statements and observations can be verified. Scientific knowledge is developed through an iterative process of inductively creating “statements” that describe the world, using deduction to develop a hypothesis referencing a truth criterion, and then updating “theory” through induction in response to what was observed in the deductive phase [15]. For example, one may inductively make the statement that “the mass of an object determines the speed at which it falls, with ‘heavier objects’ falling more quickly than ‘lighter’ objects.” You can make a deduction that a brick will fall more quickly than a feather, test that prediction with experimentation, and update the theory according to findings. In this case, we know that differently weighted objects only travel at different speeds in very large scales (e.g. planetary bodies) and that aerodynamics rather than mass affects the speed of falling objects at smaller scales [16].

Theory also matters because it helps organize a social system where new knowledge can be added to a body of understanding. In as much as scientific inquiry is an epistemological stance and method of knowledge articulation, it is also a social activity completed by humans operating in a number of intersecting communities (i.e. community of thinkers, a broader academic community, social community, family, social location within society, the social location of that society in a global context). Theory affords the ability to (hopefully) communicate ideas and knowledge efficiently between different members in these various communities. When the purpose of knowledge articulation is practical or applied, theory is also important because it allows a community to build on the learnings and knowledge of previous generations of thinkers who have also attempted to solve a problem. In other words, theory allows for a system by which knowledge can be organized, which in turn, allows for increased depth or breadth of knowledge articulation over time. From a functional perspective, the requirement for research to be grounded in theory is important in order to promote (1) an a priori truth criterion that can be used as a referent for interpreting the observations and (2) an ongoing and organized system of relations between observed phenomena. For a theoretical framework to be useful then, it must serve the two functions of: (1) specifying a way of knowing what the information means and whether it is “true,” as well as (2) instructions on how to discuss the findings in a way that allows other community members to contribute to that body of understanding.

Many theories in psychology operate in a manner akin to a Popperian [15] view of knowledge generation: namely, that there is a cyclical process of inductive theory development, followed by deductive specification of what observations would be expected if the theory were true, and experimentation to determine if those observations come to bear. When there is consistent dis-corroboration, the theory is adjusted, and the deductive process begins again. By following this method, content-based theories are developed and refined in the hopes of identifying ontological truths about the foci of psychological science.

3. Problems and Pitfalls of Content-Based Theory for Applied Mental Health Research

While content-based theories do meet the required functions of theory in scientific knowledge articulation listed above, we argue that it is not the only way of meeting those functions. The strength of the traditional approach is that it facilitates discussions about ontological truth (i.e., universal truths about the world). Ironically, however, it is not well suited to applied mental health research because the goals of that research are not limited to discovering ontological truths about the world, but rather, are primarily focused on discovering practical truths to reduce suffering.

Many journals in the field of psychology expect that a content-based theory is used a priori for the design of research and interpretation of research data. This might be especially true when researchers provide qualitative findings and those that provide hermeneutic, phenomenological, or interpretive, data. There are several problems and pitfalls of psychology publications requiring content-based theory as a rationale for a set of findings. We have identified at least three reasons why these pitfalls may be especially relevant in the domain of applied health research targeting mental health prevention and promotion (henceforth applied mental health research).

First, requiring content-based theory establishes and promotes context where social inequities are likely to be perpetuated because it relies on a structure of knowledge creation that centers academia rather than the voices and experiences of the community. There is a robust history of racism and silencing of minority voices in psychology [17]. In large part, this was maintained by academically driven theory and an unwillingness to - or unawareness of – the value of the experiences of marginalized people and communities as valid. As a result, many leading psychological theories were developed on the basis of majority voices. Thus, when a content-based theory is required a priori, a common result is the omission of the voices and experiences of disempowered and marginalized individuals. For example, a qualitative study found that Indigenous elders believe that Western mental health practices could be effectively introduced into Indigenous communities but they have not been effective because Western mental health interventions have not honored Indigenous healing perspectives and frequently disparage and dismiss well established healing practices within the traditions of the community [18]. If researchers are required by funding agencies or by journal submission requirements to include an a priori theory when conducting this type of research, researchers have two options: the first, to force a pre-existing theory on the data collected from participants, one which was generally developed without their voices and experiences, or, the second, to find an appropriate theory after the fact that they can use to organize their findings [19,20]. With regard to the former, this contributes to a context where privileged and powerful individuals are encouraged to declare that their view is right and the view of others is wrong, carrying harmful implications for marginalized voices and movements that might also have important contributions to make [21], especially when those marginalized communities have different epistemologies and systems of knowing [22,23].

The latter strategy of finding a theory to fit the data after the fact is problematic because it circumvents the falsification process which is a foundational tenet that lends rigour to empirical research. Circumventing it can lead to erroneous corroboration of a content-based theory that might otherwise be dis-corroborated [15,24], and thus may lead to invalid conclusions about both theories and specific findings. In this way, this practice might be implicated in the replication crisis. This issue has been flagged as a likely common (though surreptitious) practice in the research field [19,20], and given the potential ramifications of this process outlined here, should be considered as one argument for the need to find an alternative to a priori content-based theories as a prerequisite to conducting and/or publishing research.

This relates to a second problem: requiring content-based theory establishes a blind spot where important findings may not be communicated to the community of research psychologists because they were discovered spuriously rather than intentionally. When publications require content-based theory a priori they set the stage where researchers will be more likely to examine phenomena within the scope of that theory. In the context of applied mental health research, this results in slower and less impactful knowledge development which has real consequences for the populations that the research seeks to serve. For example, in recent years, a small body of research has identified that requiring LGTB2Q+ youth to get parental consent to participate in research has deleterious effects. For example, in one study, it was found that the most at-risk youth do not participate in applied mental health research designed to support them and their communities when parental consent is required. Therefore, public health initiatives designed for that population are missing the target persons in their evaluations [25]. This important finding emerged from an intervention trial that utilized an evidence-based implementation-sensitive research framework to foster healthy relationship skills among LGBT2Q+ youth [26]. While the default practice of requiring consent is not inherently faulty, this example highlights an instance in which proceeding with this standard practice can lead to the omission of minoritized voices. Implementation sensitive research is definitionally atheoretical because the feature of being implementation sensitive means that the program must be agile and responsive to the implementation contingencies and contextual features of a specific setting (e.g. program facilitators, program recipients, physical infrastructure, organizational culture [27]). It was through an attempt at reducing implementation barriers that the authors observed the deleterious effects of parental consent processes on LGBT2Q+ youth, rather than as a result of a theory-driven attempt at creating new knowledge. Applied mental health research is replete with examples of important knowledge creation emerging from atheoretical research agendas, but because many psychology publications require content-based theory, those findings are often not communicated. Alternatively, scholars might be tempted to “hold theory lightly” and “play the game” of publication by discussing their results in light of a theory that explains the findings even if that theory was not intentionally chosen at the design phase [19,20].

A third problem with requiring content-based theory is that it creates a context that favors categorical and topographic ways of understanding the human experience as opposed to functional and mechanistic understandings. In the domain of applied mental health research, this slows and impairs the rapidity and impact of the knowledge articulation and mobilization. As a result, we now know that many applied mental health programs work, but we don’t know how they work, or for whom. The emphasis on content-based theories encourages researchers to study gross features that align with theories instead of functional or mechanistic components that might only be discovered through spurious findings or pragmatic atheoretical inquiry (see [11] for a related argument applied to implementation science). As one example, researchers used behaviorism to demonstrate that antecedent manipulation via individualized student greetings (i.e., teachers saying “hello” to students) leads to more on-task behavior [28]. This does not answer questions about how this intervention works or for whom. One could readily imagine that a student who is fearful of their teacher would react differently to personal attention compared to students who seek connection with their teacher.

To review, requiring content-based theory is problematic because it risks decentering the voices of marginalized communities, may contribute to the replication crisis by circumventing the falsification process, creates blind spots in research, and creates gaps in our ability to understand how and for whom applied mental health research findings are relevant. While these concerns may be relevant to scientific inquiry generally, they are highly relevant to applied mental health research and carry implications for human well-being; thus, are worthy and pressing matters to address. An alternative to requiring content-based theories is for psychology publications to encourage and adopt additional types of theoretical frameworks, for example, functional and mechanistic theoretical frameworks.

4. Applied Pragmatic Functional Contextualism is an Alternative Theoretical Framework for Knowing

The problems and pitfalls associated with content-based theory have been addressed in different ways within other process-based epistemic frameworks such as such as Interpretative Phenomenological Analysis [29], Grounded Theory [30], Mechanisms in Implementation Science [31], Structural Equation Modelling [32], Path Analysis, Mediation and Moderation [33] and others. Nonetheless, none of these frameworks sufficiently address the need for an organizing theoretical framework specifically designed for applied mental health research because they are either too resource-intensive to be practical or have different aims and foci that do not lend themselves well to the questions that applied mental health research aims to answer. For example, Grounded Theory seeks to develop theory and universal explanations for a phenomenon, Interpretative Phenomenological Analysis seeks to understand the meaning and nature of human experience, and other process-based epistemic models each have their own analytic goals that do not satisfice the need for a new model for applied mental health research.

To address this problem and fill the gap in the landscape of theoretical frameworks suited to applied mental health research, we propose an alternative framework which we call “Applied Pragmatic Functional Contextualism” (APFC).

At first glance, the term Applied Pragmatic Functional Contextualism may seem redundant because functional contextualism is a well-established theory rooted in pragmatism [34]. Nonetheless, functional contextualism was developed to provide an account of behaviour, emotional difficulties, human cognition, and language at the individual level [34] and therefore its scale and units of analysis are unrealistic to be used as a theoretical framework for applied mental health research. Indeed, functional contextualism as a theoretical framework requires a model to “(1) focus on the whole event, (2) [demonstrate a] sensitivity to the role of context in establishing the nature and function of an event, and (3) [reference] a firm grasp on a pragmatic truth criterion” [35] (p.6). There are too many complex ecological levels to make this depth of analysis practical for applied mental health research. To name but a few examples: policy and funding, culture of large institutions like health systems, culture of specific institutions, the physical attributes of specific instructions like their physical location and structure, facilitator characteristics, intervention characteristics, implementation fidelity of both specified and unspecified intervention characteristics, experience of the individual, historical context of these systems and models of care in relation to the individual’s social location and identity [36].

As such, APFC uses the same rationale as traditional functional contextualism but on a broader ecological scale. We suggest that for research to be consistent with APFC-based theory, it must:

1. Have a pragmatic truth criterion rooted in “successful working,” which specifies that an analysis is only true if the analysis meets its analytic goals devised by the researcher and increases one's ability to predict and influence the target of the applied mental health research in a specific context [37,38];
2. Describe potential mechanisms by which the findings were conferred with a sensitivity to the contexts in which those findings occurred;
3. Situate those findings and possible mechanisms in relation to a phenomenological network of other research findings; and 
4. Consider the relevant features of the wider system in which the applied research event occurs and the ways in which that influences the findings themselves. 

The APFC framework will influence all phases of the research process. For instance, at the design phase, researchers will strive to identify and capture information about various contexts that might influence key study variables (e.g., participant and facilitator characteristics and perspectives, experience of relevant persons within the institute where intervention is occurring, history of that institution as relating to relevant persons, etc.). Researchers will want to proactively consider how to measure the variables of interest in a valid way. While collecting data, researchers working in an APFC-consistent manner should set out to create open and trust-worthy connections with various involved parties, and should be open to adapting and changing their practices in response to learning throughout the research process. While conducting data analysis, researchers should consider how different sources of data influence one another rather than interpreting findings in isolation. Finally, when drawing research conclusions and writing up research findings, results should be situated within the wider phenomenological net and consider the social context in which the research occurred. Researchers also have to be attentive to the pragmatic truth criterion and describe findings with functional utility at a procedural or mechanistic level. For instance, it isn’t sufficient or APFC-consistent to conclude simply that a therapy works; instead, we want to be able to indicate under which conditions, and for whom it works.

In more concrete terms, a study can be seen as consistent with the APFC framework when it meets the analytic goals of the researcher in a way that increases the field’s ability to predict and influence the target of the applied mental health research, and does so in a way articulates specific mechanisms that plausibly account for the observations. Those mechanisms and findings should be meaningfully linked to previous research in the field of inquiry, and the findings should be situated within the wider context of the whole system in which the research occurs. The operational definition of these criteria and concrete examples considerations of who the definition might be applied are provided in the tables below. The second table provides readers with two examples of research that would be consistent with an APFC framework, and the third table provides an example of a similar research topic but conducted in a manner that is not APFC consistent. See Table 1 for operational definitions, Table 2 for an example of an APFC consistent research design, and Table 3 for an example of research that is naturalistic and descriptive but which is not APFC consistent.

Table 1 APFC criteria, operational definition, and checklist of examples of how to apply the criteria.

Table 2 Examples of research design, analysis, and interpretations that are consistent with APFC.

Table 3 Example of a research design, analysis and interpretation that is not consistent with APFC.

5. Summary: Applied Pragmatic Functional Contextualism

Rather than evaluating the degree to which a theory can predict observations, evidence-based implementation-sensitive applied mental health research aspires to understand which outcomes occur under which conditions and for whom. The requirement of situating research within a content-based theory is ill suited for applied mental health research for a number of reasons described above. Nonetheless, having a theoretical framework is still important for advancing science. The present paper articulates a theoretical framework that can be used in applied mental health research that maintains the benefits of theory-driven research, while overcoming the limitations imposed by requirements to rely on a content-based theoretical foundation. We argue that using this framework to guide applied mental health research will facilitate more expedient, nuanced, and potentially useful knowledge.

We acknowledge that no theory can truly be content-free and that all theories carry with them meta-theoretical assumptions. Indeed, the APFC framework still falls within a broadly positivistic framework. Nonetheless, APFC seeks to circumvent the requirement of a Popperian-like approach to “confirming” or (more accurately) disconfirming the content of a specific theory.

Using APFC as a theoretical framework has beneficial implications for individual researchers, applied mental health settings and the clients they serve, and the field generally. Regarding individual researchers, APFC provides a valid and theoretically meaningful framework for conducting applied mental health research without needing to either force findings into a theory a priori or apply a theory to fit the data ad hoc. APFC might help applied mental health settings and their clients because it creates a framework for better identifying what interventions work (or don’t work), for whom they work, and under what conditions do they work. It also provides a framework that encourages soliciting and centering the voices of intervention recipients and process data on possible mechanisms, mediators, or moderators. APFC also benefits the field generally by establishing a framework that allows for more applied mental health research to be published in psychology journals and by circumventing practices that might lead to non-replicable findings and misrepresenting the credibility or import of findings.

To aide in the uptake and usability of the APFC framework, we provide concrete examples of considerations for each of the four APFC criteria. We also provide examples of research designs and analyses that are APFC consistent and contrast one of those examples against an APFC inconsistent design and analysis.

In the words of Yogi Berra “in theory there is no difference between theory and practice. In practice there is” and “you can observe a lot just by watching.” We hope that the APFC framework addresses a gap in the field that is created by over-reliance on content-based theory and that use of APFC will advance a more nuanced, contextually-relevant, and mechanistic understanding of applied mental health inquiries.

Acknowledgments

We would like to thank Dr. Claire Crooks for her support in identifying the need for a new epistemological framework and for the logistical support to develop the idea and manuscript. We would like to further thank Dr. Crooks for her feedback and support in the organization and framing of the paper, and to the field of applied mental health research and implementation sensitive public health and mental health generally. She will be missed as a professional and as a mentor and friend.

We would like to thank Dr. Mike Pullman for his early feedback and encouragement in further developing the ideas in this manuscript.

Most importantly, we would like to thank all the clinicians, intervention scientists, and implementation scientists who are engaged in applied mental health research. We are similarly (or perhaps more) grateful to the many humans experiencing emotional and behavioral health difficulties who courageously share their experience with research teams in the hopes of advancing our collective ability to identify and heal these most painful domains of suffering.

Author Contributions

Eli Cwinn Ph.D., C.Psych. developed the APFC framework as an epistemological framework for applied mental health research. He developed a rough argument for the limitations of existing epistemologies and the rationale for why theory driven research is important. Kayla Hamel Ph.D., C.Psych. refined the general logic of the ideas and tied them to real world problems in psychological research. She also extended the logic of the paper to identify implications of APFC to a number of user groups. Dr. Hamel also identified the need to provide guidance on practical applications of APFC to different research areas. Drs. Cwinn and Hamel jointly developed the user checklist and equally contributed to the writing, editing, and reviewing of the manuscript.

Competing Interests

The authors have declared that no competing interests exist.