À la Carte or Prix Fixe? Differing Approaches to Addressing the Gap in Dissemination of Evidence-Based Care in Mental Health

We comment on the use of a common elements treatment approach (CETA) to address mental health symptoms in a trauma-exposed population in Iraq and Thailand, with the aims of highlighting several of the strengths of this approach and how this approach may inform treatment, both within and outside of the United States. In particular, we compare the use of CETA as compared to a more focal treatment approach, consider the potential of using paraprofessionals as treatment providers, and highlight some of the challenges in cultural adaptions of psychotherapy protocols. We also identify remaining research questions, including whether a CETA approach is more efficient than focal interventions, whether CETA’s effects are due to one or two very strong elements, and whether it is more difficult to learn CETA than a robust non-CETA intervention. This use of CETA, along with our other adaptation work, also raises broader issues about how our field develops and disseminates psychotherapy protocols. We discuss several of them, including the need to develop treatments for providers with lower levels of formal education and mental health training and to develop treatment materials that are less expensive, use simplified language and terms, and that can be adapted for use with clients with lower levels of formal education and/or literacy.