Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions

Abstract

Assessing treatment fidelity is a core methodological consideration in the study of treatment outcome; it influences both the degree to which changes can be attributed to the intervention and the ability to replicate and disseminate the intervention. Efforts to increase access to evidence-based psychological treatments are receiving unprecedented support; but pressures exist to adapt treatments to service settings, running the risk of compromising fidelity. However, little evidence is available to inform the necessary conditions for the transportation of interventions to service provision settings, and the degree to which fidelity is even evaluated or emphasized in dissemination and implementation programs varies dramatically. Moreover, adaptation is associated with several benefits for dissemination efforts and may address relevant barriers to adoption. A particularly promising strategy for maximizing the benefits of both fidelity and adaptation is the use of transdiagnostic interventions. Such treatments allow for greater flexibility of the pacing and content of treatment, while still providing structure to facilitate testing and replication. Preliminary evidence supports the efficacy of this strategy, which may be particularly conducive to dissemination into service provision settings. At this time, further research is needed to evaluate the relationships among fidelity, adaptation, and outcome, and to determine the potential for transdiagnostic treatments to facilitate dissemination.

The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management

“…30 Hence, the potential scope of ACT and PF is broad. ACT is truly a "transdiagnostic" approach as is sometimes advocated, 61 meaning that it is meant to be applicable to different type of psychological problems, and, in a specifically pain-related context, that it ought to be applicable across a full range of different pain diagnosis. e.g.,60,70 ACT has generated a wide array of applications including the following treatment formats for chronic pain: three or four week residential group treatment delivered by an interdisciplinary team, 58 individual treatment, 90 self-administered workbooks with therapist support, 75 via the internet, 7 outpatient group treatment, 91 and one-day workshop-based treatment.…”

Psychodynamic psychotherapy: developing the evidence base

“…Trans diagnostic treatment protocols have been pioneered by researchers in the field of CBT (e.g. Barlow 2004;Norton 2008;McHugh 2009), but psychodynamic psychotherapy may be particularly suited to this approach as it is traditionally less tailored to single mental disorders, but focuses on the core underlying processes of mental conditions, including psychotic illnesses. Newer conceptualisations of schizophrenia and other psychoses, and their treatments, are based on attachment theory and mentalising (Lysaker 2013;Rosenbaum 2013) and although RCTs of psychodynamic psychotherapy in schizophrenia are lacking, promising research by groups such as the Danish National Schizophrenia Project (Rosenbaum 2012) strengthens the evidence for the effectiveness of psychodynamic treatment in psychosis.…”

The Cognitive Behavioural Processes Questionnaire: A Preliminary Analysis within Student, Mixed Clinical and Community Samples and the Identification of a Core Transdiagnostic Process

“…Consequently, several prominent groups of researchers and clinicians have provided a range of benefits for moving towards a transdiagnostic approach to cognitive behavioural therapy (CBT; Craske 2012; Harvey et al 2004;Hayes et al 2013;Mansell et al 2009;McHugh et al 2009;McManus et al 2010). Yet, the empirical, theoretical and clinical status of the transdiagnostic approach lags behind the ambitions of its supporters.…”