Which of the following is true about the therapy approach described in the Geld et al. 2013 protocol?

• A. It used a fixed manual.
• B. It used a flexible manual.
• C. It had no protocol.
• D. It used group therapy as the primary approach.

Answer: (B)

The key idea here is how a therapy protocol is delivered through manualization. A flexible manual means there is a guiding framework with core components, but therapists can adapt pacing, emphasis, and examples to fit each client’s needs while still sticking to the essential elements of the treatment. In the Geld et al. 2013 protocol, this approach allows clinicians to tailor sessions to individuals and contexts without abandoning the structured structure that keeps the treatment identifiable across participants.

This balance—standard structure plus clinical adaptability—helps maintain treatment fidelity to the protocol’s goals while enhancing relevance and engagement for diverse clients. A fixed manual, by contrast, would lock in exact content and sequencing for every client, limiting responsiveness. Saying there’s no protocol would eliminate the standardized framework that the study is built on, and focusing on group therapy would describe the setting rather than how the treatment content is delivered.