Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions
Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions
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DOI：
10.1016/j.brat.2009.07.005
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发表时间：
2009-11-01
影响因子：
4.1
通讯作者：
Barlow, David H.
中科院分区：
文献类型：
--
作者：
McHugh, R. Kathryn;Murray, Heather W.;Barlow, David H.
评估治疗保真度是治疗结果研究中的核心方法学考虑因素;它影响到干预措施的变化程度以及复制和传播干预措施的能力。努力增加获得循证心理治疗的机会正在得到前所未有的支持;但存在使治疗适应服务环境的压力，这可能会损害忠诚度。然而，很少有证据可以告知运输的干预措施，以提供服务的设置的必要条件，在何种程度上的忠诚度，甚至评估或强调在传播和实施方案的差异显着。此外，适应与传播努力的若干好处有关，并可能解决采用的相关障碍。一个特别有前途的战略，最大限度地提高保真度和适应的好处是使用transdiagnosis干预。这样的治疗允许更大的灵活性的节奏和内容的治疗，同时仍然提供结构，以促进测试和复制。初步证据支持这一战略的效力，这可能特别有利于向提供服务的环境中传播。在这个时候，需要进一步的研究来评估保真度，适应和结果之间的关系，并确定跨诊断治疗的潜力，以促进传播。(C)2009爱思唯尔有限公司保留所有权利。
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. (C) 2009 Elsevier Ltd. All rights reserved.