BulimiaNervosaDSM-IVCriteria-Associationfor：暴食症nervosadsmIV标准协会.pptVIP

Generalizability of Research Findings Clinical trials can be representative of the usual clinical population Mounting evidence that the results of RCTs can, and do, generalize to routine clinical practice in different settings Research on generalizability remains a priority Dissemination and Implementation Dissemination Clear evidence that patients are not receiving empirically-supported treatments in routine clinical care Even when patients do receive these treatments there is evidence that they are often not well-delivered Barriers to Dissemination and Implementation Clinicians are increasingly eager to learn – we have failed them to date Need to identify and assess competency levels required for therapists to implement empirically-supported treatments effectively Need to improve training methods and supervision Does CBT Pose Particular Problems for Dissemination? Yes Technical expertise required Complex treatment strategies/packages Need to combine technical expertise with relationship skills blending focus (structure of manual) with flexibility Can Less be More? Less complex treatments may be more easily disseminated Reduced training requirements for less complex treatment BA for depression (Dimidjian et al., 2006) PE for PTSD (Foa et al., 2005) CBTgsh for Binge Eating Disorder (Wilson et al., 2010) Barriers to Dissemination Problem: “Too many multi-component manuals designed to treat ever-expanding array of topographically defined syndromes” “such a ‘brute force’ empirical approach makes it increasingly difficult to teach what is known or to focus on what is essential” Hayes et al. (BRAT, 2006) Transdiagnostic CBT Transdiagnostic treatments may maximize the benefits of both fidelity and adaptation by treating similar disorders using interventions that may target underlying processes they offer greater flexibility in the pacing and content of treatment while still providing structure (Craske et al., 2009; Fairburn, 2008; McHugh et al.,