Treatment fidelity in eating disorders and psychological research: Current status and future directions

Abstract

Objective: The evaluation and use of treatment fidelity procedures are rare in the development and implementation of psychological interventions. This article aims to review the construct of treatment fidelity, highlight limitations to currently available measures, and introduce a conceptual framework for studying and adapting fidelity measures in clinical research and practice using eating disorders as an example.Method: As treatment fidelity assesses whether an intervention was delivered as intended, we operationalized this construct as: (a) treatment adherence, (b) therapist competence, and (c) treatment differentiation.Results: There is a significant gap in the literature assessing and documenting treatment fidelity. Available studies indicate that existing adherence measures can be time consuming, costly, and are not widely used in the field. Furthermore, therapist competence is a complex and context-dependent construct that is challenging to measure. Finally, treatment differentiation is often inferred by ensuring adherence.Discussion: The development of simplified formal tests of treatment fidelity would help draw conclusions about treatment efficacy and improve the dissemination and implementation of interventions to promote optimal clinical outcomes.

Development and initial pilot validation of a treatment fidelity instrument for family-based interoceptive exposure for adolescents with low-weight eating disorders

“…Finally, as with many measures of treatment fidelity, the described therapist adherence measure focuses on prescribed treatment components but not proscribed aspects. Adherence measures would benefit from including both prescribed and proscribed treatment elements to ensure delivery of distinct treatment interventions [ 5 ]. Future research in this area would be beneficial.…”

“…Therapist adherence is crucial for successful implementation and evaluation of an intervention and to ensure that the intervention can be replicated reliably [ 2 , 3 ]. It is particularly important in randomized controlled trials, not only to monitor the extent to which treatment is implemented consistently, but also to ensure differentiation in the delivery of distinct treatment interventions [ 4 , 5 ].…”