title: How do components of evidence-based psychological treatment cluster in practice? A survey and cluster analysis.
abstract: Evidence-based psychological treatments (EBPTs) are clusters of interventions, but it is unclear how providers actually implement these clusters in practice. A disaggregated measure of EBPTs was developed to characterize clinicians' component-level evidence-based practices and to examine relationships among these practices. Survey items captured components of evidence-based treatments based on treatment integrity measures. The Web-based survey was conducted with 75 U.S. Department of Veterans Affairs (VA) substance use disorder (SUD) practitioners and 149 non-VA community-based SUD practitioners. Clinician's self-designated treatment orientations were positively related to their endorsement of those EBPT components; however, clinicians used components from a variety of EBPTs. Hierarchical cluster analysis indicated that clinicians combined and organized interventions from cognitive-behavioral therapy, the community reinforcement approach, motivational interviewing, structured family and couples therapy, 12-step facilitation, and contingency management into clusters including empathy and support, treatment engagement and activation, abstinence initiation, and recovery maintenance. Understanding how clinicians use EBPT components may lead to improved evidence-based practice dissemination and implementation.
authors.affiliation: Center for Health Care Evaluation, VA Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, CA 94025, USA. elizabeth.gifford@va.gov
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Gifford
authors.forename: Sara
authors.initials: S
authors.lastname: Tavakoli
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Weingardt
authors.forename: John W
authors.initials: JW
authors.lastname: Finney
authors.forename: Heather M
authors.initials: HM
authors.lastname: Pierson
authors.forename: Craig S
authors.initials: CS
authors.lastname: Rosen
authors.forename: Hildi J
authors.initials: HJ
authors.lastname: Hagedorn
authors.forename: Joan M
authors.initials: JM
authors.lastname: Cook
authors.forename: Geoff M
authors.initials: GM
authors.lastname: Curran
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D015928:Cognitive Behavioral Therapy / Q000379:methods; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D007406:Interview, Psychological / Q000379:methods; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011613:Psychotherapy / Q000379:methods*; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D014481:United States; D014493:United States Department of Veterans Affairs