Department of Psychology, Boston University, 648 Beacon Street, 6th Floor, Boston, MA 02215, USA.
Behav Res Ther. 2009 Nov;47(11):946-53. doi: 10.1016/j.brat.2009.07.005. Epub 2009 Jul 29.
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.
评估治疗的忠实度是治疗结果研究中的一个核心方法学考虑因素；它既影响了可以归因于干预的变化程度，也影响了复制和传播干预的能力。增加获得基于证据的心理治疗的机会的努力正受到前所未有的支持；但是，存在将治疗方法适应当地服务环境的压力，这有可能损害忠实度。然而，几乎没有证据可以为干预措施向服务提供环境的转移提供必要条件，并且在传播和实施计划中评估或强调忠实度的程度也有很大差异。此外，适应与传播工作的几个好处相关联，并且可能解决采用的相关障碍。最大化忠实度和适应度两者的好处的一个特别有希望的策略是使用跨诊断干预措施。这种治疗方法允许在治疗的节奏和内容上有更大的灵活性，同时仍然提供结构以促进测试和复制。初步证据支持这一策略的有效性，这可能特别有利于将其传播到服务提供环境中。此时，需要进一步研究来评估忠实度、适应度和结果之间的关系，并确定跨诊断治疗方法促进传播的潜力。
