Dissemination of cognitive-behavioral treatments for anxiety disorders: overcoming barriers and improving patient access

Gunter, Raymond W.; Whittal, Maureen L.

doi:10.1016/j.cpr.2009.11.001

Cited by 224Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsMental Health Treatment and Access

Dissemination of cognitive-behavioral treatments for anxiety disorders: overcoming barriers and improving patient access

Gunter, Raymond W., Whittal, Maureen L.·2010·Clinical Psychology Review

DOI 10.1016/j.cpr.2009.11.001

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Abstract

Cognitive-behavioral therapies for anxiety disorders are highly efficacious (e.g., Butler, Chapman, Forman, & Beck, 2006; Deacon & Abramowitz, 2004). These treatments nevertheless remain underutilized and difficult to access for many of the patients who suffer from these conditions (e.g., Norton & Hope, 2005). We identify various barriers to the wide-scale dissemination of these treatments, including those that are applicable to empirically supported treatments more generally (e.g., lack of training opportunities, failure to address practitioner concerns) as well as those that may be relatively specific to CBT for anxiety disorders (e.g., practitioner concerns around using exposure interventions). We offer suggestions for overcoming these barriers, including specific guidance about continued accumulation of a supportive research base, making the appeals that are necessary to obtain required funding and organizational support, and the training of practitioners to deliver these treatments. Advocates of CBT for anxiety disorders will need to demonstrate that these treatments are cost effective, if wide-scale dissemination is to occur. In the United States, advocacy with third party payers will also be necessary. Although providing such steps may prove to be a difficult endeavour, the patients who stand to benefit from this work deserve nothing less.

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There are several access barriers to conventional face-to-face CBT, such as limited accessibility, high cost, and perceived stigma.
“However, there are several access barriers to conventional, face-to-face CBT, such as limited accessibility, high cost, and perceived stigma (Gunter and Whittal, 2010; Mohr et al., 2010).”
From The effect of internet-delivered cognitive behavioral therapy for depression and anxiety on quality of life: A meta-analysis of randomized controlled trials (2023) · cites this paper as Gunter and Whittal, 2010

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Vincent, C., Eberts, M., Naik, T. U., Gulick, V., & O’Hayer, C. V. (2021) · PLoS ONE · doi:10.1371/journal.pone.0259364 · Cited by 50 · see citing works
“Additionally, other studies found some clinicians were hesitant to adopt VR due to fear surrounding detrimental effects on their therapeutic relationships with clients/patients [25, 33, 36].”
Background
Treating Social Anxiety in an Era of Social Distancing: Adapting Exposure Therapy for Youth During COVID-19
Khan, A. N., Bilek, E. L., Tomlinson, R. C., & Becker‐Haimes, E. M. (2021) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2020.12.002 · Cited by 49 · see citing works
Manualized cognitive therapy versus cognitive-behavioral treatment-as-usual for social anxiety disorder in routine practice: A cluster-randomized controlled trial
Hoyer, J., Čolić, J., Pittig, A., Crawcour, S. C., Moeser, M., Ginzburg, D. M., Lin, J., Wiltink, J., Leibing, E., & Stangier, U. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.05.012 · Cited by 47 · see citing works
“In addition, there is evidence that clinicians apply and slightly modify techniques l arned in their initial psychotherapeutic training, while feeling reluctant to adopt new evidence-based techniques (Barlow, 1981; Gunter & Whittal, 2010; Weisz et al., 2014).”
Background
Overlapping and non-overlapping practices in usual and evidence-based care for youth anxiety
Higa-McMillan, C., Kotte, A., Jackson, D., & Daleiden, E. L. (2017) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-016-9502-2 · Cited by 43 · see citing works
Feasibility and efficacy of a digital CBT intervention for symptoms of generalized anxiety disorder: a randomized multiple-baseline study
Miller, C. B., Gu, J., Henry, A. L., Davis, M. L., Espie, C. A., Stott, R., Heinz, A. J., Bentley, K. H., Goodwin, G. M., Gorman, B. S., et al. (2021) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2020.101609 · Cited by 40 · see citing works
Exercise Intervention in Treatment of Neuropsychological Diseases: A Review
Chen, Z., Lan, W., Yang, G., Li, Y., Xiang, J., Chen, L., Zhou, Y. N., & Li, S. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.569206 · Cited by 48 · see citing works
Referral to a new psychological therapy service is associated with reduced utilisation of healthcare and sickness absence by people with common mental health problems: a before and after comparison
de Lusignan, S., Chan, T., Parry, G., Kim, D.-B., & Kendrick, T. (2011) · Journal of Epidemiology and Community Health · doi:10.1136/jech.2011.139873 · Cited by 39 · see citing works
Randomized-controlled trial on a novel (meta-)cognitive self-help approach for obsessive-compulsive disorder (“myMCT”)
Hauschildt, M., Schröder, J., & Moritz, S. (2016) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2016.04.010 · Cited by 37 · see citing works
Implementation outcomes of military provider training in cognitive processing therapy and prolonged exposure therapy for post-traumatic stress disorder.
Borah, E. V., Wright, E. C., Donahue, D., Cedillos, E. M., Riggs, D. S., Isler, W., & Peterson, A. L. (2013) · Military Medicine · doi:10.7205/milmed-d-13-00072 · Cited by 37 · see citing works
Kava for the treatment of generalised anxiety disorder (K-GAD): study protocol for a randomised controlled trial
Savage, K. M., Stough, C. K. K., Byrne, G. J., Scholey, A. B., Bousman, C., Murphy, J., MacDonald, P., Suo, C., Hughes, M. E., Thomas, S. D. M., et al. (2015) · Trials · doi:10.1186/s13063-015-0986-5 · Cited by 43 · see citing works
I mproving A ccess to P sychological T herapies ( IAPT ) and treatment outcomes: Epistemological Assumptions and Controversies
Williams, C. (2015) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12181 · Cited by 29 · see citing works
Childhood trauma and attachment style predict the four-year course of obsessive compulsive disorder: Findings from the Netherlands obsessive compulsive disorder study
Tibi, L., van Oppen, P., van Balkom, A. J. L. M., Eikelenboom, M., Hendriks, G., & Anholt, G. E. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.12.028 · Cited by 42 · see citing works
Retaining Critical Therapeutic Elements of Behavioral Interventions Translated For Delivery via the Internet: Recommendations and an Example Using Pain Coping Skills Training
Rini, C. K., Porter, L. S., Somers, T. J., McKee, D. C., & Keefe, F. J. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3374 · Cited by 35 · see citing works
“…health care providers about their efficacy or ideal use), the lack of available therapists in some geographic regions, the substantial time and resources needed to deliver them, the shortage of qualified therapists, and the need for people to travel to in-person sessions held at a set time [16,17].”
Efficacy and acceptability of cannabinoids for anxiety disorders in adults: A systematic review & meta-analysis
Bahji, A., Meyyappan, A. C., & Hawken, E. R. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.07.030 · Cited by 36 · see citing works
IAPT and the internet: the current and future role of therapist-guided internet interventions within routine care settings
Thew, G. R. (2020) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x20000033 · Cited by 36 · see citing works
“…developed in research contexts may not bridge the gap into routine practice, and a number of potential barriers to this have been identified, including lack of training opportunities, professionals ’ reservations, and demonstrating cost-effectiveness (Gunter and Whittal, 2010; Weisz et al ., 2014).”
Group transdiagnostic cognitive-behavior therapy for anxiety disorders: a pragmatic randomized clinical trial
Roberge, P., Provencher, M. D., Gaboury, I., Gosselin, P., Vasiliadis, H., Benoît, A., Carrier, N., Antony, M. M., Chaillet, N., Houle, J., et al. (2020) · Psychological Medicine · doi:10.1017/s0033291720004316 · Cited by 43 · see citing works
“…at transdiagnostic approaches to CBT (tCBT) that can be applied to diagnostically heterogeneous groups of patients with anxiety disorders could be more conducive to widespread dissemination and implementation (Barlow et al., 2017; Craske, 2012; Gunter & Whittal, 2010; Norton & Roberge, 2017).”
Background
Bridging the Gaps Between Basic Science and Cognitive-Behavioral Treatments for Anxiety Disorders in Routine Care
Richter, J., Pittig, A., Hollandt, M., & Lueken, U. (2017) · Zeitschrift für Psychologie · doi:10.1027/2151-2604/a000309 · Cited by 33 · see citing works
“This set of barriers concerns economic and organizational differences between controlled research studies and routine care (Gunter & Whittal, 2010).”
Smartphone-Based Interventions and Internalizing Disorders in Youth: Systematic Review and Meta-analysis
Buttazzoni, A. N., Brar, K., & Minaker, L. M. (2020) · Journal of Medical Internet Research · doi:10.2196/16490 · Cited by 32 · see citing works
Preliminary Evidence for the Enhancement of Self-Conducted Exposures for OCD Using Cognitive Bias Modification
Amir, N., Kuckertz, J. M., Najmi, S., & Conley, S. L. (2015) · Cognitive Therapy and Research · doi:10.1007/s10608-015-9675-7 · Cited by 30 · see citing works
“One reason for this under-utilization of ERP may be that most graduate programs do not provide specialized training in CBT for OCD (Crits-Christoph et al. 1995; Davidson 1998; Gunter and Whittal 2010), and other resources for training in CBT for OCD (e.g., workshops) are limited and costly.”
Background
Characteristics of attrition among children receiving trauma-focused treatment.
Wamser‐Nanney, R. A., & Steinzor, C. E. (2016) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000143 · Cited by 51 · see citing works
Psychological therapy using virtual reality for treatment of driving phobia: a systematic review
Elphinston, R. A., Vaezipour, A., Fowler, J. A., Russell, T. G., & Sterling, M. (2023) · Disability and Rehabilitation · doi:10.1080/09638288.2022.2069293 · Cited by 27 · see citing works
Therapists’ characteristics associated with the (non-)use of exposure in the treatment of anxiety disorders in youth: A survey among Dutch-speaking mental health practitioners
de Jong, R., Lommen, M. J. J., van Hout, W. J. P. J., de Jong, P. J., & Nauta, M. H. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102230 · Cited by 25 · see citing works
Virtual Reality (VR) Treatments for Anxiety Disorders Are Unambiguously Successful, so Why Are so Few Therapists Using It? Barriers to Adoption and Potential Solutions
Wray, T. B., Kemp, J. J., & Larsen, M. A. (2023) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2023.2229017 · Cited by 25 · see citing works
“…nearly all of the most effective approaches to psychotherapy across anxiety disorders involve some degree of exposure (Chorpita & Daleiden, 2009; Gunter & Whittal, 2010), and these exposures are likely responsible for much of the clinical benefit conferred by these treatments (Gould et al.,…”
Background
Cognitive Behavioral Digital Interventions are Effective in Reducing Anxiety in Children and Adolescents: A Systematic Review and Meta-analysis
Csirmaz, L., Nagy, T., Vikor, F., & Kasos, K. (2023) · Journal of Prevention · doi:10.1007/s10935-023-00760-0 · Cited by 22 · see citing works
“Multiple barriers, such as location, time, cost (Gunter & Whittal, 2010), and stigmatization (Kaushik, 2016), can hinder access to psychotherapy for children and their families.”
Background
First‐line therapy for post‐traumatic stress disorder: A systematic review of cognitive behavioural therapy and psychodynamic approaches
Paintain, E., & Cassidy, S. (2018) · Counselling and Psychotherapy Research · doi:10.1002/capr.12174 · Cited by 25 · see citing works
“…exposure may involve actively testing the individual’s faulty cognitions through the use of behavioural experiments, repeated exposure to attempt to reduce the intensity of fear responses and eliminate avoidance responses, and improve skills for handling feared situations (Gunter & Whittal, 2010).”
Background
Delivering exposure and ritual prevention for obsessive–compulsive disorder via videoconference: Clinical considerations and recommendations
Goetter, E. M., Herbert, J. D., Forman, E. M., Yuen, E. K., Gershkovich, M., Glassman, L. H., Rabin, S. J., & Goldstein, S. P. (2013) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2013.01.003 · Cited by 27 · see citing works
“…Brody, & Karp, 1995), therapist underutilization of and adverse reactions to the approach (Olatunji, Deacon, & Abramowitz, 2009), inadequate dissemination efforts (Gunter & Whittal, 2010), and a maldistribution of specialist providers that places individuals in rural areas at a disadvantage.”
Background
Gulf War and Health: Treatment for Chronic Multisymptom Illness.
War, G. (2017) · Military Medicine · doi:10.7205/milmed-d-16-00325 · Cited by 25
New Developments in Emotion-Focused Therapy for Social Anxiety Disorder
Shahar, B. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9092918 · Cited by 31 · see citing works
“Having just one evidence-based treatment option for such a prevalent, chronic, and disabling condition, especially given that most people with anxiety disorders do not end up getting evidence-based treatment [23], is problematic.”
Background
Effectiveness of using mental health mobile apps as digital antidepressants for reducing anxiety and depression: protocol for a multiple baseline across-individuals design
Marshall, J. M., Dunstan, D. A., & Bartik, W. (2020) · JMIR Research Protocols · doi:10.2196/17159 · Cited by 24 · see citing works
“Although effective treatments for anxiety and depression exist, many people do not access these for various reasons [6].”
How was cognitive behavioural therapy for mood disorder implemented in Japan? A retrospective observational study using the nationwide claims database from FY2010 to FY2015
Hayashi, Y., Yoshinaga, N., Sasaki, Y., Tanoue, H., Yoshimura, K., Kadowaki, Y., Arimura, Y., Yanagita, T., & Ishida, Y. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-033365 · Cited by 26 · see citing works
A randomized Control Trial Examining the Initial Efficacy of an Intolerance of Uncertainty Focused Psychoeducation Intervention.
Shapiro, M. O., Allan, N. P., Raines, A. M., & Schmidt, N. B. (2023) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-022-10002-y · Cited by 21 · see citing works
“…training in CBT. Treatment burden (i.e., amount of time required) and access to care due to a lack of trained therapists are among the most cited barriers to treatment for anxietyand depression-related conditions (Gunter & Whittal, 2010; Heckman et al., 2015; Wolitzky-Taylor et al., 2019).”
Background
The effect of internet-delivered cognitive behavioral therapy for depression and anxiety on quality of life: A meta-analysis of randomized controlled trials
Maj, A., Michalak, N., Graczykowska, A., & Andersson, G. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100654 · Cited by 22 · see citing works
Therapist factors associated with intent to use exposure therapy: a systematic review and meta-analysis
Langthorne, D., Beard, J., & Waller, G. (2023) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2023.2191824 · Cited by 23 · see citing works
“However, despite the effectiveness of exposure therapy, it is underused by very many clinicians (Becker et al., 2004; Gunter & Whittal, 2010; Hipol & Deacon, 2013; Rosen et al., 2004).”
BackgroundMethod
Exposure and Response Prevention Helps Adults With Obsessive-Compulsive Disorder Who Do Not Respond to Pharmacological Augmentation Strategies
McLean, C. P., Zandberg, L. J., Meter, P. E. V., Carpenter, J. K., Simpson, H. B., & Foa, E. B. (2015) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.14m09513 · Cited by 21 · see citing works
Change Processes in Cognitive Therapy for Social Anxiety Disorder Delivered in Routine Clinical Practice
Thew, G. R., Ehlers, A., Grey, N., Wild, J., Warnock-Parkes, E., Dawson, R. L., & Clark, D. (2020) · Clinical Psychology in Europe · doi:10.32872/cpe.v2i2.2947 · Cited by 21 · see citing works
“…clinical settings complement efficacy studies, in that they can test whether findings from controlled research settings apply in routine practice (Gunter & Whittal, 2010; Kettlewell, 2004; Weisz, Ng, & Bearman, 2014), it can be argued that for a predictor to be considered reliable, it should…”
Background
Anxiety and its treatment: Promoting science-based practice
Lohr, J. M., Lilienfeld, S. O., & Rosen, G. M. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.06.007 · Cited by 22 · see citing works
Preferences for evidence‐based practice dissemination in addiction agencies serving women: a discrete‐choice conjoint experiment
Cunningham, C. E., Henderson, J. L., Niccols, A., Dobbins, M., Sword, W. A., Chen, Y., Mielko, S., Milligan, K., Lipman, E. L., Thabane, L., et al. (2012) · Addiction · doi:10.1111/j.1360-0443.2012.03832.x · Cited by 19 · see citing works
Anxious youth in research and service clinics
Aalberg, M., Cummings, C. M., Gere, M. K., Torgersen, S. O., & Kendall, P. C. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.09.003 · Cited by 16 · see citing works
Nothing to Fear but Fear Itself: A Mechanistic Test of Unconscious Exposure
Siegel, P., Cohen, B., & Warren, R. (2022) · Biological Psychiatry · doi:10.1016/j.biopsych.2021.08.022 · Cited by 18 · see citing works
Internet‐based cognitive behavioral therapy for anxiety in an outpatient specialized care setting: A qualitative study of the patients’ experience of the therapy
Pedersen, M. K., Mohammadi, R., Mathiasen, K., & Elmose, M. (2020) · Scandinavian Journal of Psychology · doi:10.1111/sjop.12665 · Cited by 22 · see citing works
Dissemination of exposure in the treatment of anxiety disorders and post‐traumatic stress disorder among German cognitive behavioural therapists
Schumacher, S., Weiss, D., & Knaevelsrud, C. (2018) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2320 · Cited by 19 · see citing works
A Cognitive-Neuropsychological Account of Treatment Action in Anxiety: Can We Augment Clinical Efficacy?
Reinecke, A., & Harmer, C. J. (2015) · Psychopathology Review · doi:10.5127/pr.035113 · Cited by 13 · see citing works
“CBT courses as an alternative intervention approach, on the other hand, similarly fail to successfully treat a subgroup of patients (Hans & Hiller, 2013) and are often long, cost-intensive, and difficult to access (Gunter & Whittal, 2010; Otto, Pollack, & Maki, 2000; Wang et al., 2006).”
Background
Strategies to improve access to cognitive behavioral therapies for anxiety disorders: A scoping review
Carrier, J., Gallagher, F., Vanasse, A., & Roberge, P. (2022) · PLoS ONE · doi:10.1371/journal.pone.0264368 · Cited by 20 · see citing works
Providers' Use of Evidence-Based Treatments for Posttraumatic Stress Disorder: The Influence of Training, Attitudes, and Barriers in Military and Private Treatment Settings
Borah, E. V., Holder, N., & Chen, K. (2017) · Best practices in mental health · doi:10.70256/997168psfxuw · Cited by 18 · see citing works
Antisocial behavioral syndromes and 3‐year quality‐of‐life outcomes in United States adults
Goldstein, R. B., Dawson, D. A., Smith, S. M., & Grant, B. F. (2012) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2012.01848.x · Cited by 16 · see citing works
“I Could Do It in My Own Time and When I Really Needed It”: Perceptions of Online Pain Coping Skills Training For People With Knee Osteoarthritis
Lawford, B. J., Hinman, R. S., Nelligan, R. K., Keefe, F. J., Rini, C. K., & Bennell, K. L. (2019) · Arthritis Care & Research · doi:10.1002/acr.24093 · Cited by 18 · see citing works
“Collectively, these findings suggest that the convenience and accessibility of online delivery has the potential to address barriers to cognitive behavioral interventions, such as lack of access to trained therapists, as well as the inconvenience of travelling to attend a clinic in-person at a set time (26,27).”
Background
Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists
Benito, K., Herren, J. A., Freeman, J. B., Garcia, A. M., Block, P., Cantor, E., Chorpita, B. F., Wellen, B. C. M., Stewart, E., Georgiadis, C., et al. (2020) · Behavior Therapy · doi:10.1016/j.beth.2020.10.003 · Cited by 17 · see citing works
App-Based Delivery of Clinical Emotional Freedom Techniques: Cross-Sectional Study of App User Self-Ratings
Church, D., Stapleton, P., & Sabot, D. (2020) · JMIR mhealth and uhealth · doi:10.2196/18545 · Cited by 20 · see citing works
“The mHealth platform offers the potential for a range of self-management strategies to assist psychological symptoms of anxiety and stress, particularly for individuals who require psychological support but have limited access to regular health care [24,28].”
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Cognitive‐Behavioral Therapy for Anxious Children: From Evidence to Practice
Sawyer, M. C., & Nunez, D. (2014) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12024 · Cited by 16 · see citing works
Virtual reality intervention for improving cognitive function in post-stroke patient: A systematic review and meta-analysis
Gunawan, H., Gunawan, I., Hambarsari, Y., Danuaji, R., Hamidi, B. L., & Benedictus, B. (2024) · Brain Disorders · doi:10.1016/j.dscb.2024.100152 · Cited by 14 · see citing works
Patient Perceptions of In Vivo Versus Virtual Reality Exposures for the Treatment of Anxiety Disorders: Cross-Sectional Survey Study
Lévy, A., Nittas, V., & Wray, T. B. (2023) · JMIR Formative Research · doi:10.2196/47443 · Cited by 18 · see citing works
“Almost all effective psychotherapy approaches for anxiety disorders incorporate some exposure techniques [7], and these exposure techniques likely have the strongest effects on patient outcomes [8,9].”
Background
Active Approach Does not Add to the Effects of in Vivo Exposure
van Uijen, S. L., van den Hout, M., & Engelhard, I. M. (2015) · Journal of Experimental Psychopathology · doi:10.5127/jep.042014 · Cited by 12 · see citing works
“Cognitive behavior therapy (CBT), in particular, Exposure and Response Prevention (ERP) is a highly effective treatment for anxiety disorders (Gunter & Whittal, 2010; Shafran et al., 2009).”
Collaborative Empiricism: A Cognitive Response to Exposure Reluctance and Low Distress Tolerance
Clark, D. A. (2013) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2012.06.001 · Cited by 14 · see citing works

Authors: Gunter, R. W., & Whittal, M. L.
Affiliations: Alberta Health Services (CA)
University of British Columbia (CA)
Corresponding author: Gunter, Raymond W.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2010-03
Volume: 30
Issue: 2
Pages: 194-202
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2009.11.001
OpenAlex: W2017929229
Cited by: 224
References: 0
Citations by year: 2026: 5 · 2025: 15 · 2024: 17 · 2023: 11 · 2022: 14 · 2021: 8 · 2020: 28 · 2019: 17 · 2018: 11 · 2017: 10 · 2016: 8 · 2015: 28 · 2014: 11 · 2013: 15 · 2012: 15
FWCI: 1.28
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords: cognitive behavioral therapy, anxiety disorders, dissemination of evidence-based treatment, barriers to treatment access, empirically supported treatments, exposure therapy, practitioner training, cost-effectiveness, third-party payers, organizational support
MeSH terms: Anxiety Disorders, Cost-Benefit Analysis, Humans, Models, Psychological, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Evidence-Based Medicine

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Dissemination of cognitive-behavioral treatments for anxiety disorders: overcoming barriers and improving patient access

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