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Dissemination or dialogue?

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This commentary discusses challenges in implementing evidence-based psychotherapies within the Veterans Affairs health system. It highlights issues with defining evidence and suggests collaborative therapist-researcher dialogue over top-down dissemination for better clinical adoption.

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Area of Science:

  • Psychology
  • Health Services Research
  • Clinical Psychology

Background:

  • The article by Karlin and Cross addresses the national dissemination and implementation of evidence-based psychotherapies in the U.S. Department of Veterans Affairs (VA) healthcare system.
  • This commentary offers a critical perspective on the lessons learned presented in their work.

Purpose of the Study:

  • To identify and discuss critical issues omitted from the original article's lessons learned regarding evidence-based psychotherapy implementation.
  • To propose alternative approaches for addressing clinician resistance to adopting new therapeutic treatments.

Main Methods:

  • Critical commentary and analysis of existing literature and dissemination models.
  • Review of the limitations of randomized controlled trial (RCT) methodology in social sciences.
  • Exploration of therapist-researcher dialogue as a dissemination strategy.

Main Results:

  • Identified controversy surrounding the definition of "evidence" and limitations of RCT methodology in social science research.
  • Proposed that therapist-researcher dialogue may be more effective than unidirectional, top-down dissemination in overcoming clinician resistance.
  • Highlighted clinician "resistances, reluctances, and refusals" as key barriers to implementing laboratory-based treatments.

Conclusions:

  • The current approach to disseminating evidence-based psychotherapies in the VA system may be hindered by definitional disputes and methodological critiques.
  • Collaborative dialogue between therapists and researchers is suggested as a more effective strategy for successful implementation and adoption of new treatments by clinicians.