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Evidence-based psychological treatments for mental disorders: Modifiable barriers to access and possible solutions
Open accessAbstract
The prevalence of mental disorders is high and appears to be growing, yet the majority of individuals who meet diagnostic criteria for a mental disorder are not able to access an adequate treatment. While evidence-based psychological treatments (EBPTs) are effective single or adjunctive treatments for mental disorders, there is also evidence that access to these treatments is diminishing. We seek to highlight modifiable barriers to these problems at the patient, therapist, treatment, organization and government-levels of analysis. A range of solutions to each set of contributors is offered and domains for future research are highlighted. In particular, we focus on the need to continue to work toward innovation in treatment development while also solving the difficulties relating to the dissemination of EBPTs. Several relatively new concepts in the field will be discussed (implementation cliff, program drift, voltage drop and deployment treatment development) and we contrast America and England as examples of government-level processes that are in the process of major change with respect to EBPTs. We conclude that there is a need for people in our field to become more knowledgeable about, and get involved in, shaping public policy.
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“Overall, MAST-V helps to address patient-, therapist-, and treatment-level barriers to mental health care access (Harvey & Gumport, 2015).”
From Brief modular anxiety intervention for primary care: Hybrid I pilot randomized controlled trial of feasibility, acceptability, effectiveness, and implementation potential (2024) · cites this paper as Harvey & Gumport, 2015
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“Although effective psychological treatments for depression and anxiety exist, they are difficult to access for many individuals [5,6].”
From Blended care-cognitive behavioral therapy for depression and anxiety in real-world settings: Pragmatic retrospective study (2020) · cites this paper as [5]
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“This is caused both by under-treatment of mental disorders such as depression (Demyttenaere et al., 2004, Harvey and Gumport, 2015) and therapist drift from evidence-based treatment protocols (Waller, 2009).”
From Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care (2016) · cites this paper as Harvey and Gumport, 2015
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“Research suggests that only a limited amount of patients in routine practise actually receives evidence-based treatment (Gyani et al., 2014, Harvey and Gumport, 2015).”
From Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care (2016) · cites this paper as Harvey and Gumport, 2015
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Novianty, A., & Hadjam, M. N. R. (2017) · Jurnal Psikologi · doi:10.22146/jpsi.22988 · Cited by 73
“…kecil dari faktor-faktor lainnya, salah satunya hambatan eksternal yang sering terjadi di lapangan yaitu faktor geografis, akses transportasi, dan faktor ekonomi JURNAL PSIKOLOGI 59 (Harvey & Gumport, 2015), serta kemampuan identifikasi tenaga kesehatan terkait kesehatan mental (Marastuti, 2014).”
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“This issue, known as the implementation cliff (Harvey & Gumport, 2015), is in part, due to therapist-level factors, such as limited training and resources and inadequate psychotherapy process skills in treating multi-stressed, multi-problem families.”
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“Nonetheless, dropout rates (DR) in patients undergoing psychological treatment are generally high and thus many patients do not benefit from the proven efficacy of these interventions (Harvey& Gumport, 2015; Swift& Greenberg, 2012).”
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“Little is known about these patterns and predictors, as most mental health services research focuses on recent treatment of current episodes rather than initial treatment of incident cases (Harvey & Gumport, 2015; Olfson, Blanco, & Marcus, 2016).”
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“…utilized to provide evidence-based treatments for a broad spectrum of disorders (Gros et al., 2013) and have been shown to increase accessibility to providers and decrease associated costs with in-person treatment (e.g., transportation, missed work; Harvey & Gumport, 2015; Trott & Blignault, 1998).”
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“people receive psychological treatment and, in many cases, these interventions are not evidence-based [104, 105].”
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“Despite the existence of evidence-based treatments, few adolescents who seek professional help receive effective treatment [4].”
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“Although coping with stress is stressful by itself, psychotherapy, meditation, and other relaxing techniques are showed as helpful (31).”
BackgroundRojas, S. M., Gold, S. D., Bryan, C. J., Pruitt, L. D., Felker, B. L., & Reger, M. A. (2021) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2020.12.001 · Cited by 18
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Porter, C. M., Galloghly, E., & Burbach, F. (2022) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x22000216 · Cited by 19
“VCT can overcome potential barriers to therapy, including geographic location, time and convenience, and limited access to transport (Carpenter et al ., 2018; Harvey and Gumport, 2015; Murphy et al ., 2020).”
Jin, S., Kim, B., & Han, K. (2025) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3706598.3713732 · Cited by 24
“As a complement to traditional mental health services, digital device-based mental health support has gained attention as a potential solution to overcome these barriers [9, 11, 12, 62, 63, 78, 97, 98, 134, 135, 163, 207].”
Brinsley, J., Singh, B., & Maher, C. A. (2023) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2023.04.023 · Cited by 15
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“…(e.g. case-based training tools and structured oral examination), integration of sleep interventions on clinical placements, or ongoing professional consultation (e.g. group supervision/telephone consultation) appears crucial for bridging the CBT-I evidence-practice gap [60, 61, 72, 94, 118, 122].”
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“However, access to evidence-based psychotherapy in public health care settings is often overly difficult and the supply and demand of evidence-based methods do not align [5].”
Gumport, N. B., Yu, S. H., & Harvey, A. G. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113443 · Cited by 17
Self-citationJelinek, L., Peth, J., Runde, A., Arlt, S., Scheunemann, J., & Gallinat, J. (2020) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2529 · Cited by 17
Barakat, S., & Maguire, S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20010119 · Cited by 17
“Due to the scalable and cost-effective nature of self-help interventions (supported and pure self-help), researchers and policy makers have endorsed these treatments as being well suited to a stepped-care model of healthcare delivery [142].”
BackgroundMental health in the virtual world: Challenges and opportunities in the metaverse era
del Hoyo, Y. L., Elices, M., & García‐Campayo, J. (2024) · World Journal of Clinical Cases · doi:10.12998/wjcc.v12.i17.2939 · Cited by 14
Timko, C., Nash, A., Owens, M. D., Taylor, E. N., & Finlay, A. K. (2020) · Substance Abuse Research and Treatment · doi:10.1177/1178221819901281 · Cited by 13
Wilfley, D. E., Fitzsimmons‐Craft, E. E., Eichen, D. M., Buren, D. J. V., Welch, R. R., Robinson, A. H., Jo, B., Raghavan, R., Proctor, E. K., Wilson, G. T., et al. (2018) · Contemporary Clinical Trials · doi:10.1016/j.cct.2018.07.002 · Cited by 12
Photorealistic avatars to enhance the efficacy of Selfattachment psychotherapy
Ghaznavi, I., Gillies, D. F., Nicholls, D., & Edalat, A. (2020) · IEEE International Conference on Artificial Intelligence and Virtual Reality (AIVR) · doi:10.1109/aivr50618.2020.00022 · Cited by 13
“The traditional approach to CBT is collaborative, highly structured and needs to be administered by a trained clinician which makes it less costeffective, limits its accessibility and thus makes it less scalable [3].”
BackgroundKarlin, B. E., & Brenner, L. A. (2020) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12344 · Cited by 12
The novel rapid-acting neurosteroid-based antidepressant generation
Günay, A., & Pinna, G. (2022) · Current Opinion in Endocrine and Metabolic Research · doi:10.1016/j.coemr.2022.100340 · Cited by 12
Hobbs, T., de Lima, E. S., Bevington, D., Preece, C., Allen, K., Barna, P., Berry, V., Booker, T. L., Davies, K., Davis, G. D., et al. (2023) · Wellcome Open Research · doi:10.12688/wellcomeopenres.20095.1 · Cited by 12
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Kelcey, B., Xie, Y., Spybrook, J. K., & Dong, N. (2020) · Multivariate Behavioral Research · doi:10.1080/00273171.2020.1738910 · Cited by 12
“…along multiple levels including the patient-level (e.g., adherence, motivation, engagement), therapist-level (e.g., beliefs, preferences, cognitive biases, fidelity), the clinic-level (e.g., leader skepticism, lack of training time), and government-level (e.g., policies; Harvey & Gumport, 2015).”
BackgroundInfluentialWolf, M., Kraft, S., Tschauner, K., Bauer, S., Becker, T. M., & Puschner, B. (2016) · Mental Health & Prevention · doi:10.1016/j.mhp.2016.02.003 · Cited by 12
Lock, J., Grange, D. L., Accurso, E. C., Welch, H. A., Mondal, S., & Agras, W. S. (2020) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2020.03.002 · Cited by 13
Norwood, C., Sabin‐Farrell, R., Malins, S., & Moghaddam, N. G. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23112 · Cited by 12
“Although the relative paucity of evidence for a link between WA and outcome in remote psychotherapy, remote delivery of psychotherapy is growing in popularity and evidence base (Hollis et al., 2015).”
BackgroundBraun-Koch, K., & Rief, W. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.836227 · Cited by 11
Bailey‐Straebler, S., Glasofer, D. R., Ojeda, J., & Attia, E. (2024) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x24000023 · Cited by 15
“Guidance on improving the equity of access to evidence-based care for patients with EDs and low income is lacking for real-world therapists; it is therefore crucial to explore and develop solutions (Harvey and Gumport, 2015; Kazdin, 2017; Kazdin et al ., 2017).”
BackgroundDisordered Society: Women in Eating Disorder Recovery Advise Policymakers on Change
Saunders, J. F., Eaton, A. A., & Frazier, S. L. (2018) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-018-0903-9 · Cited by 11
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“…income and/or lack of supplementary health insurance, cannot afford consultation in the private sector (Gulliver, Griffiths, & Christensen, 2010; Harvey & Gumport, 2015; Mojtabai, 2005; Perreault et al., 2013; Walker, Cummings, Hockenberry, & Druss, 2015) face long wait times for access to…”
BackgroundOliver, J. A., & Lang, J. M. (2018) · Children and Youth Services Review · doi:10.1016/j.childyouth.2018.10.004 · Cited by 11
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“There is strong indication that evidence-based psychological treatment provided by mental health professionals (i.e., formal help-seeking) can greatly aid recovery from psychological illness [32 – 34].”
BackgroundDevelopment and preliminary validation of the treatment adherence rating scale
Gumport, N. B., Dong, L., Lee, J. Y., Zhao, X., & Harvey, A. G. (2022) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2022.101832 · Cited by 11
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“In addition, research also indicates that only one in four people with emotional disorders are estimated to receive psychotherapy and, in many cases, these interventions are not evidence-based (Harvey and Gumport, 2015).”
BackgroundCOVID-19 mitigation policies and psychological distress in young adults
Jackson, M., & Williams, J. L. (2021) · SSM - Mental Health · doi:10.1016/j.ssmmh.2021.100027 · Cited by 9
“Professional treatment of psychological distress is known to be effective in young people (National Research Council, 2015), but it is underutilized (Harvey & Gumport, 2015; National Academies of Sciences, Engineering, and Medicine, 2019), meaning that population-based initiatives are also required.”
Understanding Health-Promoting Behaviors and Influential Factors in Schizophrenia Patients
Yu, H.-J. (2024) · Nutrients · doi:10.3390/nu16101490 · Cited by 9
Awareness of and attitudes toward CBT, DBT, and ACT in an acute psychiatric sample
Kuckertz, J. M., Silverman, A. L., Bullis, J. R., Björgvinsson, Þ., & Beard, C. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22908 · Cited by 10
Kooistra, L. C., Wiersma, J., Ruwaard, J., Riper, H. M., Penninx, B. W. J. H., & van Oppen, P. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.07.072 · Cited by 8
Quiñonez-Freire, C., Vara, M. D., Herrero, R., Mira, A., García‐Palacios, A., Botella, C., & Baños, R. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100352 · Cited by 8
The Prospect of Focal Ultrasound in the Treatment of Mental Disorders
Trenado, C., Pedroarena‐Leal, N., & Ruge, D. (2023) · Psychiatry International · doi:10.3390/psychiatryint4030029 · Cited by 8
Metadata
- Authors
- Harvey, A. G., & Gumport, N. B.
- Affiliations
- University of California, Berkeley (US)
- Corresponding author
- Harvey, Allison G.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 68
- Pages
- 1-12
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC4395546
- OpenAlex
- W2075286177
- Cited by
- 221
- References
- 149
- Citations by year
- 2026: 21 · 2025: 27 · 2024: 24 · 2023: 31 · 2022: 29 · 2021: 10 · 2020: 24 · 2019: 20 · 2018: 19 · 2017: 9 · 2016: 5 · 2015: 2
- FWCI
- 21.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health (1 R01 MH105513-01)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- evidence-based psychotherapy, mental illness, access to mental health care, barriers to treatment access, voltage drop, mental health policy, public policy, mental health services
- MeSH terms
- Mental Disorders, England, Humans, Mental Health Services, Evidence-Based Medicine
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