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Adapting Evidence-Based Psychotherapies While Maintaining Fidelity

  • PTSD (S Creech and L Sippel, Section Editors)
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Current Treatment Options in Psychiatry Aims and scope Submit manuscript

Abstract

Purpose of review

Extensive resources have been devoted to implementing evidence-based psychotherapies (EBPs) to facilitate the best available treatments to clients. Yet, when treatment settings or client characteristics do not align with the contexts in which an EBP was developed and tested, adaptations may be indicated. The purpose of this article is to provide a summary of the adaptation literature and highlight key issues, using Cognitive Processing Therapy as an example throughout the paper.

Recent findings

Informed by the literature to date, we use Stirman and colleagues’ Framework for Reporting Adaptations and Modifications (FRAME) to organize current thinking and provide a guide for conceptualizing different types of adaptations. Broadly, we discuss (1) why adapt, (2) goals of the adaptation, (3) who is involved in the adaptation process, (4) when to adapt, (5) forms of adaptation, and (6) measurement and evaluation.

Summary

As effective interventions for PTSD are developed and identified, implementation in routine care settings will increase access for underserved populations, who may not have been well-represented in the research that originally established efficacy or effectiveness of the EBP. However, a careful process of EBP adaptation, informed by theory, research, and program-level evaluation, can result in successful implementation. Stakeholder-informed, carefully-evaluated adaptation can allow more individuals to benefit from treatment.

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Acknowledgements

This work was completed with support from the Veterans Health Administration. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the United States government, Stanford University, or other affiliates.

Funding

This project was supported by a grant from the National Institutes of Health (R01 MH106506).

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Authors and Affiliations

  1. National Center for PTSD, VA Palo Alto Healthcare System, 795 Willow Road (NC-PTSD 334), Menlo Park, CA, 94025, USA

    Heidi La Bash PhD & Shannon Wiltsey Stirman PhD

  2. National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA

    Tara Galovski PhD

  3. Stanford University, Stanford, CA, USA

    Shannon Wiltsey Stirman PhD

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  1. Heidi La Bash PhD
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  2. Tara Galovski PhD
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  3. Shannon Wiltsey Stirman PhD
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Correspondence to Heidi La Bash PhD.

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Conflict of interest

Drs. La Bash and Galovski have nothing to disclose. Dr. Wiltsey Stirman received grant funding from the National Institutes of Health (R01 MH106506), which partially supported this manuscript. Dr. Wiltsey Stirman has nothing else to disclose.

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All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines). Informed consent was obtained from all individual participants included in the studies conducted by the study authors.

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La Bash, H., Galovski, T. & Stirman, S.W. Adapting Evidence-Based Psychotherapies While Maintaining Fidelity. Curr Treat Options Psych 6, 198–209 (2019). https://doi.org/10.1007/s40501-019-00177-9

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