Current Treatment Options in Psychiatry

, Volume 6, Issue 3, pp 198–209 | Cite as

Adapting Evidence-Based Psychotherapies While Maintaining Fidelity

  • Heidi La BashEmail author
  • Tara Galovski
  • Shannon Wiltsey Stirman
PTSD (S Creech and L Sippel, Section Editors)
Part of the following topical collections:
  1. Topical Collection on PTSD


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.


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.


Modification Adaptation Cultural adaptation Implementation Treatment fidelity Cognitive Processing Therapy 



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 information

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

Compliance with ethical standards

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.

Human and animal rights and informed consent

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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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  • Heidi La Bash
    • 1
    Email author
  • Tara Galovski
    • 2
  • Shannon Wiltsey Stirman
    • 1
    • 3
  1. 1.National Center for PTSDVA Palo Alto Healthcare SystemMenlo ParkUSA
  2. 2.National Center for PTSDVA Boston Healthcare SystemBostonUSA
  3. 3.Stanford UniversityStanfordUSA

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