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Systematic review to examine the methods used to adapt evidence-based psychological treatments for adults diagnosed with a mental illness
  1. Allison G. Harvey,
  2. Hannah S. Lammers,
  3. Michael R. Dolsen,
  4. Alice C. Mullin,
  5. Heather E. Hilmoe,
  6. Melanie Tran,
  7. Vera Portnova,
  8. Alison B. Tuck,
  9. Ajitha Mallidi,
  10. Anya Fang,
  11. Caitlin Byrnes,
  12. Esther Kao,
  13. Colin Lee
  1. Psychology, University of California Berkeley, Berkeley, California, USA
  1. Correspondence to Dr Allison G. Harvey, Psychology, University of California Berkeley, Berkeley, CA 94720, USA; aharvey{at}


Question The context for the implementation of evidence-based psychological treatments (EBPTs) often differs from the context in which the treatment was developed, which necessitates adaptations. In this systematic review we build on, and add to, prior approaches by examining the method used to guide such adaptations. In particular, we sought to elucidate the extent to which an empirical process is used.

Study selection and analysis We focused on publications describing adaptations made to EBPTs for adults diagnosed with a mental illness. We searched PubMed, PsycINFO, Embase and Web of Science from database inception to July 2018. Two raters independently coded the articles for the method used to conduct the adaptation, the reason for and nature of the adaptation, and who made the adaptation.

Findings The search produced 20 194 citations, which yielded 152 articles after screening. The most commonly used methods for planned adaptations were literature review (57.7%), clinical intuition (47.0%) and theory (38.9%). The use of data from stakeholder interviews ranked fourth (21.5%) and the use of other types of data (eg, pilot study, experiment, survey, interview) ranked last at fifth (12.1%). Few publications reporting ad hoc adaptations were identified (n=3).

Conclusions This review highlights a need to (a) educate providers and researchers to carefully consider the methods used for the treatment adaptation process, and to use empirical methods where possible and where appropriate, (b) improve the quality of reporting of stakeholder interviews and (c) develop reporting standards that articulate optimal methods for conducting treatment adaptations.

  • adult psychiatry

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. The data that support the findings of this study are available from the corresponding author, AH, upon reasonable request.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. The data that support the findings of this study are available from the corresponding author, AH, upon reasonable request.

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  • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

  • Contributors The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Author names: HL, MD, AM, HH, MT, VP, AT, AM, AF, CB, EK and CL.

    AGH conceived the study and wrote the first draft of the manuscript. AGH and HSL conceived of the search terms and conducted the searches. AGH, HSL and MRD devised the processes to extract the data and summarize it. AGH, HSL, MRD, ACM, HEH and VP wrote the results section and developed the tables and figures. All authors participated in all stages of the review process and approved the final version of the manuscript.

  • Funding This study was funded by the National Institute of Mental Health (R01MH120147).

  • Competing interests AH has received research support from the National Institutes of Health and book royalties from American Psychological Association, Guilford Press and Oxford University Press.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.