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When does modifying the protocol go too far? Considerations for implementing evidence-based treatment in practice.
Abstract
The majority of evidence-based psychological treatments (EBTs) are packaged as manuals that provide guidance regarding when and how to deliver specific interventions (e.g., cognitive restructuring, exposure). However, clinical practice regularly necessitates flexibility in the timing and delivery of treatment strategies. Indeed, research on the dissemination and implementation of EBTs has highlighted the need to adapt these treatments to fit the needs of specific settings or patient populations. Adapting a treatment also means changing it from its original, evidence-based format, raising questions about how much or in which ways a treatment can be altered before it is no longer reflective of the original EBT. The purpose of this article is to discuss factors that contribute to the challenge of adapting EBTs, highlight considerations for clinicians with regard to modifying EBTs, and propose directions for future research that can provide guidelines for adapting EBTs in the future. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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The need for adaptable and modifiable treatments in clinical settings forms a challenge when implementing evidence-based treatment protocols in clinical practice.
“The need for adaptable and modifiable treatments in clinical settings forms a challenge when implementing evidence-based treatment protocols in clinical practice. 14”
From Acceptance and Commitment Therapy is feasible for people with acquired brain injury: A process evaluation of the BrainACT treatment. (2024) · cites this paper as [14]
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Lentz, T. A., Coffman, C. J., Cope, T. L., Stearns, Z. R., Simon, C. B., Choate, A., Gladney, M. N., France, C., Hastings, S. N., & George, S. Z. (2023) · Physical Therapy · doi:10.1093/ptj/pzad127 · Cited by 14
“46 By highlighting the variability inherent in delivering hybrid care, our data indicate what may be considered acceptable by providers and veterans in the VHA, with an average of approximately 3 completed calls for the physical activity and PiP content each.”
Harvey, A. G., Agnew, E. R., Hache, R. E., Spencer, J. M., Diaz, M., Patino, E. O., Milner, A., Dong, L., Kilbourne, A. M., Buysse, D. J., et al. (2025) · Implementation Science · doi:10.1186/s13012-025-01440-9 · Cited by 11
“The answer most certainly involves theory, data, and end-user input [15, 32, 33].”
Prevalence of Different Approaches to Clinical Hypnosis: Bridging Research and Practice
McCann, B. S. (2023) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207144.2023.2194934 · Cited by 9
“Half the response options include the term hypnotherapy, which does not represent what I do in practice. psychotherapy (Cassiello-Robbins et al., 2022).”
BackgroundKaplan, A., Garner, J., & Whitney, S. D. (2025) · Journal of School Psychology · doi:10.1016/j.jsp.2025.101470 · Cited by 9
Rauwenhoff, J. C., Bol, Y., Peeters, F., & van Heugten, C. M. (2024) · Clinical Rehabilitation · doi:10.1177/02692155231218813 · Cited by 2
“14 Following the intervention, most participants reported to continue using the therapy skills.”
BackgroundCassiello-Robbins, C. F., Ritschel, L. A., Mochrie, K. D., Edwards‐Powell, B., & Byars, K. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.3051 · Cited by 2
Self-citationDarnell, B. C., Benfer, N., & Litz, B. T. (2025) · Clinical Psychology Review · doi:10.1016/j.cpr.2025.102671 · Cited by 2
Motamedi, M., Lau, A. S., Byeon, Y. V., Yu, S. H., & Brookman-Frazee, L. I. (2023) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-023-09844-5 · Cited by 1
Clinically representative treatment for generalised anxiety disorder
Kjølsrød, E., Westgaard, M., Brattmyr, M., Lundqvist, J., Lindberg, M. S., Hjemdal, O., Havnen, A., & Solem, S. (2024) · Counselling and Psychotherapy Research · doi:10.1002/capr.12818
“…general outpatient clinics (Johnson et al., 2016; Solem et al., 2010), and future research should investigate how EBT can be adapted for clinics (Cassiello-Robbins et al., 2022; Youn et al., 2020) and address barriers towards implementing EBT both on a system and therapist level (Asnaani et…”
Metadata
- Authors
- Cassiello-Robbins, C., Dietch, J. R., Mochrie, K. D., Elbogen, E., & Rosenthal, M. Z.
- Affiliations
- Durham VA Health Care System (US)
- Venue
- American Psychologist
- Published
- 2022-10
- Volume
- 77
- Issue
- 7
- Pages
- 853-867
- ISSN
- 0003-066X (ISSN-L)
- 1935-990X
- OpenAlex
- W4221123168
- Cited by
- 9
- References
- 0
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 4
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Psychologist (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- evidence-based psychotherapy, treatment adaptation, protocol modification, dissemination and implementation, treatment manual, clinical practice
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