Abstract
Similar to depression, anxiety is a significant public health problem with some estimates of prevalence as high as 28 % of the population. Cognitive behavioral therapy (CBT) has demonstrated both efficacy and effectiveness for the treatment of anxiety disorders, and is considered a frontline treatment. However, many consumers do not receive care at all or do not receive a sufficient dose of care. The authors provide a detailed analysis of systemic and individual barriers to receiving adequate treatment for anxiety and specify a number of simple, practical strategies to target the problem of under-engagement.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Ahmed, M., & Westra, H. A. (2009). Impact of a treatment rationale on expectancy and engagement in cognitive behavioral therapy for social anxiety. Cognitive Therapy and Research, 33(3), 314–322. doi:10.1007/s10608-008-9182-1.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Antony, M. M., Orsillo, S. M., & Roemer, L. (Eds.). (2001). Practitioner’s guide to empirically based measures of anxiety. New York: Springer.
Anxiety Disorders Association of Canada. (2003). Mental health and mental illness: Invited submission to the Standing Senate Committee on Social Affairs, Science, and Technology. Anxiety Disorders Association of Canada.
Aviram, A., & Westra, H. A. (2011). The impact of motivational interviewing on resistance in cognitive behavioural therapy for generalized anxiety disorder. Psychotherapy Research, 21(6), 698–708. doi:10.1080/10503307.2011.610832.
Bados, A., Balaguer, G., & Saldaña, C. (2007). The efficacy of cognitive–behavioral therapy and the problem of drop-out. Journal of Clinical Psychology, 63(6), 585–592. doi:10.1002/jclp.20368.
Bakker, A., Van Balkom, A. J., & Spinhoven, P. (2002). SSRIs vs. TCAs in the treatment of panic disorder: A meta-analysis. Acta Psychiatrica Scandinavica, 106(3), 163–167. doi:10.1034/j.1600-0447.2002.02255.x.
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
Becker, C. B., Zayfert, C., & Anderson, E. (2004). A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behaviour Research and Therapy, 42(3), 277–292. doi:10.1016/S0005-7967(03)00138-4.
Bennett-Levy, J. (2003). Mechanisms of change in cognitive therapy: The case of automatic thought records and behavioural experiments. Behavioural and Cognitive Psychotherapy, 31(3), 261–277. doi:10.1017/S1352465803003035.
Bennett-Levy, J., Butler, G., Fennell, M., Hackmann, A., Mueller, M., & Westbrook, D. (2004). Devising effective behavioural experiments. In K. Rouf, M. Fennell, D. Westbrook, M. Cooper, & J. Bennett-Levy (Eds.), Oxford guide to behavioural experiments in cognitive therapy (pp. 21–58). Oxford, UK: Oxford University Press.
Bieling, P., & Kuyken, W. (2003). Is cognitive case formulation science or science fiction. Clinical Psychology: Science and Practice, 10, 52–69.
Bordin, E. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice, 16, 252–260.
Brown, T. A., & Barlow, D. H. (2014). Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5)—Adult and lifetime version, clinican manual. Oxford, UK: Oxford University Press.
Butler, A., Chapman, J., Forman, E., & Beck, A. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17–31. doi:10.1016/j.cpr.2005.07.003.
Carroll, K. M. (1997). Enhancing retention in clinical trials of psychosocial treatments: Practical strategies. In L. S. Onken, J. D. Blaine, & J. J. Boren (Eds.), Beyond the therapeutic alliance: Keeping the drug-dependent individual in treamtent. Rockville, MD: NIDA Research monograph 165 (pp. 4–24).
Casey, L. M., Oei, T. P. S., & Newcombe, P. A. (2005). Looking beyond the negatives: A time period analysis of positive cognitions, negative cognitions, and working alliance in cognitive-behavior therapy for panic disorder. Psychotherapy Research, 15(1–2), 55–68. doi:10.1080/10503300512331327038.
Chadwick, P., Williams, C., & Mackenzie, J. (2003). Impact of case formulation in cognitive behaviour therapy for psychosis. Behaviour Research and Therapy, 41(6), 671–680. doi:10.1016/S0005-7967(02)00033-5.
Christon, L. M., McLeod, B. D., & Jensen-Doss, A. (2015). Evidence-based assessment meets evidence-based treatment: An approach to science-informed case conceptualization. Cognitive and Behavioral Practice, 22, 36–48. doi:10.1016/j.cbpra.2013.12.004.
Clark, D. A. (2013). Collaborative empiricism: A cognitive response to exposure reluctance and low distress tolerance. Cognitive and Behavioral Practice, 20(4), 445–454. doi:10.1016/j.cbpra.2012.06.001.
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., … Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, null(01), 11–27. doi:10.1017/S0033291714000129.
Craske, M. G., Roy-Byrne, P., Stein, M. B., Sullivan, G., Hazlett-Stevens, H., Bystritsky, A., & Sherbourne, C. (2006). CBT intensity and outcome for panic disorder in a primary care setting. Behavior Therapy, 37(2), 112–119. doi:10.1016/j.beth.2005.05.003.
Crits-Christoph, P., Connolly Gibbons, M. B., Crits-Christoph, K., Narducci, J., Schamburger, M., & Gallop, R. (2006). Can therapists be trained to improve their alliances? A preliminary study of alliance fostering psychotherapy. Psychotherapy Research, 16(3), 268–281. doi:10.1080/10503300500268557.
Crits-Christoph, P., Connolly Gibbons, M. B., Hamilton, J., Ring-Kurtz, S., & Gallop, R. (2011). The dependability of alliance assessments: The alliance–outcome correlation is larger than you might think. Journal of Consulting and Clinical Psychology, 79(3), 267–278. doi:10.1037/a0023668.
Deacon, B. J., Farrell, N. R., Kemp, J. J., Dixon, L. J., Sy, J. T., Zhang, A. R., & McGrath, P. B. (2013). Assessing therapist reservations about exposure therapy for anxiety disorders: The Therapist Beliefs about Exposure Scale. Journal of Anxiety Disorders, 27(8), 772–780. doi:10.1016/j.janxdis.2013.04.006.
Deacon, B. J., Lickel, J. J., Farrell, N. R., Kemp, J. J., & Hipol, L. J. (2013). Therapist perceptions and delivery of interoceptive exposure for panic disorder. Journal of Anxiety Disorders, 27(2), 259–264. doi:10.1016/j.janxdis.2013.02.004.
Deacon, B. J., Sy, J. T., Lickel, J. J., & Nelson, E. A. (2010). Does the judicious use of safety behaviors improve the efficacy and acceptability of exposure therapy for claustrophobic fear? Journal of Behavior Therapy and Experimental Psychiatry, 41(1), 71–80. doi:10.1016/j.jbtep.2009.10.004.
Delsignore, A., Carraro, G., Mathier, F., Znoj, H., & Schnyder, U. (2008). Perceived responsibility for change as an outcome predictor in cognitive-behavioural group therapy. British Journal of Clinical Psychology, 47(3), 281–293. doi:10.1348/014466508X279486.
Dozois, D. J. A., Westra, H. A., Collins, K. A., Fung, T. S., & Garry, J. K. F. (2004). Stages of change in anxiety: Psychometric properties of the University of Rhode Island Change Assessment (URICA) scale. Behaviour Research and Therapy, 42(6), 711–729. doi:10.1016/S0005-7967(03)00193-1.
DuPont, R. L., Rice, D. P., Miller, L. S., Shiraki, S. S., Rowland, C. R., & Harwood, H. J. (1996). Economic costs of anxiety disorders. Anxiety, 2(4), 167–172. doi:10.1002/(SICI)1522-7154(1996)2:4<167::AID-ANXI2>3.0.CO;2-L.
Farrell, N. R., Deacon, B. J., Dixon, L. J., & Lickel, J. J. (2013). Theory-based training strategies for modifying practitioner concerns about exposure therapy. Journal of Anxiety Disorders, 27(8), 781–787. doi:10.1016/j.janxdis.2013.09.003.
Farrell, N. R., Deacon, B. J., Kemp, J. J., Dixon, L. J., & Sy, J. T. (2013). Do negative beliefs about exposure therapy cause its suboptimal delivery? An experimental investigation. Journal of Anxiety Disorders, 27(8), 763–771. doi:10.1016/j.janxdis.2013.03.007.
Federoff, I. C., & Taylor, S. (2001). Psychological and pharmacological treatments of social phobia: A meta-analysis. Journal of Clinical Psychopharmacology, 21(3), 311–324.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (2002). Structured Clinical Interview for DSM-IV Axis I Disorders, research version, patient edition (SCID I/P). New York: Biometrics Research, New york State Psychiatric Interview.
Fluckiger, C., Del Re, A. C., Wampold, B. E., Symonds, D., & Horvath, A. O. (2012). How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis? Journal of Counselling Psychology, 59(1), 10–17.
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., … Tu, X. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, Clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162(1), 151–161.
Fontenelle, L., & Santana. (2011). A review of studies concerning treatment adherence of patients with anxiety disorders. Patient Preference and Adherence, 5, 427. doi:10.2147/PPA.S23439.
First, M. B., Wiliams, J. B. W., Karg, R. S., & Spitzer, R.L. (2015). User’s guide for the Structured Clinical Interview for DSM-5 Disorders (SCID-5). Arlington, VA: American Psychiatric Association.
Gearing, R. E., Townsend, L., Elkins, J., El-Bassel, N., & Osterberg, L. (2014). Strategies to predict, measure, and improve psychosocial treatment adherence. Harvard Review of Psychiatry, 22(1), 31–45. doi:10.1097/HRP.10.1097/HRP.0000000000000005.
Greenberg, P. E., Sisitsky, T., Kessler, R. C., Finkelstein, S. N., Berndt, E. R., Davidson, J. R., … Fyer, A. J. (1999). The economic burden of anxiety disorders in the 1990s. Journal of Clinical Psychiatry, 60(7), 427–435. doi:10.4088/JCP.v60n0702.
Grilo, C. M., Money, R., Barlow, D. H., Goddard, A. W., Gorman, J. M., Hofmann, S. G., … Woods, S. W. (1998). Pretreatment patient factors predicting attrition from a multicenter randomized controlled treatment study for panic disorder. Comprehensive Psychiatry, 39(6), 323–332. doi:10.1016/S0010-440X(98)90043-8.
Gulliver, A., Griffiths, K. M., Christensen, H., & Brewer, J. L. (2012). A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC Psychiatry, 12(1), 81.
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry, 10(1), 113.
Harned, M. S., Dimeff, L. A., Woodcock, E. A., & Contreras, I. (2013). Predicting adoption of exposure therapy in a randomized controlled dissemination trial. Journal of Anxiety Disorders, 27(8), 754–762. doi:10.1016/j.janxdis.2013.02.006.
Haug, T., Nordgreen, T., Öst, L. G., & Havik, O. E. (2012). Self-help treatment of anxiety disorders: A meta-analysis and meta-regression of effects and potential moderators. Clinical Psychology Review, 32(5), 425–445. doi:10.1016/j.cpr.2012.04.002.
Heimberg, R. G., & Becker, R. E. (2002). Cognitive-behavioral group therapy for social phobia: Basic mechanisms and clinical strategies. New York: Guilford Press.
Helbig-Lang, S., & Petermann, F. (2010). Tolerate or eliminate? A systematic review on the effects of safety behavior across anxiety disorders. Clinical Psychology: Science and Practice, 17(3), 218–233.
Hembree, E. A., Foa, E. B., Dorfan, N. M., Street, G. P., Kowalski, J., & Tu, X. (2003). Do patients dropout prematurely from exposure therapy for PTSD? Journal of Traumatic Stress, 16(6), 555–562.
Hood, H. K., Antony, M. M., Koerner, N., & Monson, C. M. (2010). Effects of safety behaviors on fear reduction during exposure. Behaviour Research and Therapy, 48(12), 1161–1169. doi:10.1016/j.brat.2010.08.006.
Hunsley, J., Elliott, K., & Therrien, Z. (2013). The efficacy and effectiveness of psychological treatments. Ottawa, ON: Canadian Psychological Association.
Huppert, J. D., Kivity, Y., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2014). Therapist effects and the outcome–alliance correlation in cognitive behavioral therapy for panic disorder with agoraphobia. Behaviour Research and Therapy, 52, 26–34. doi:10.1016/j.brat.2013.11.001.
Institute of Medicine. (2014). Treatment fo Posttraumatic Stress Disorder in military and veteran populations: Final assessment. Washington, DC: The National Academies Press.
Issakidis, C., & Andrews, G. (2004). Pretreatment attrition and dropout in an outpatient clinic for anxiety disorders. Acta Psychiatrica Scandinavica, 109(6), 426–433. doi:10.1111/j.1600-0047.2004.00264.x.
Katerelos, M., Hawley, L. L., Antony, M. M., & McCabe, R. E. (2008). The exposure hierarchy as a measure of progress and efficacy in the treatment of social anxiety disorder. Behavior Modification, 32(4), 504–518. doi:10.1177/0145445507309302.
Keijsers, G. P. J., Kampman, M., & Hoogduin, C. A. L. (2001). Dropout prediction in cognitive behavior therapy for panic disorder. Behavior Therapy, 32(4), 739–749. doi:10.1016/S0005-7894(01)80018-6.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 593–602. doi:10.1001/archpsyc.62.6.593.
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617–627. doi:10.1001/archpsyc.62.6.617.
Kim, E. J. (2005). The effect of decreased safety behaviours on anxiety and negative thoughts in social phobics. Anxiety Disorders, 19, 69–86.
Kobak, K. A., Greist, J. H., Jefferson, J. W., Katzelnick, D. J., & Henk, H. J. (1998). Behavioral versus pharmacological treatments of obsessive compulsive disorder: A meta-analysis. Psychopharmacology, 136(3), 205–216. doi:10.1007/s002130050558.
Kohn, R., Saxena, S., Levav, I., & Saraceno, B. (2004). The treatment gap in mental health care. Bulletin of the World Health Organization, 82(11), 858–866. doi:10.1590/S0042-96862004001100011.
Kuyken, W., Padesky, C. A., & Dudley, R. (2008). The science and practice of case conceptualization. Behavioural and Cognitive Psychotherapy, 36(Special Issue 06), 757–768. doi:10.1017/S1352465808004815.
Kuyken, W., Padesky, C., & Dudley, R. (2009). Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. New York: Guilford Press.
Lecrubier, Y. (2001). Prescribing patterns for depression and anxiety worldwide. Journal of Clinical Psychiatry, 62(Suppl. 13), 31–36.
Lepine, J. P. (2002). The epidemiology of anxiety disorders: Prevalence and societal costs. The Journal of Clinical Psychiatry, 63(Suppl. 14), 4–8.
Levy, H. C., & Radomsky, A. S. (2014). Safety behaviour enhances the acceptability of exposure. Cognitive Behaviour Therapy, 43(1), 83–92.
Longmore, R. J., & Worrell, M. (2007). Do we need to challenge thoughts in cognitive behavior therapy? Clinical Psychology Review, 27(2), 173–187. doi:10.1016/j.cpr.2006.08.001.
Lutz, W., Hofmann, S. G., Rubel, J., Boswell, J. F., Shear, M. K., Gorman, J. M., … Barlow, D. H. (2014). Patterns of early change and their relationship to outcome and early treatment termination in patients with panic disorder. Journal of Consulting and Clinical Psychology, 82(2), 287–297. doi:10.1037/a0035535.
Maltby, N., & Tolin, D. F. (2005). A brief motivational intervention for treatment‐refusing OCD patients. Cognitive Behaviour Therapy, 34(3), 176–184. doi:10.1080/16506070510043741.
McDonagh, A., Friedman, M., McHugo, G., Ford, J., Sengupta, A., Mueser, K., … Descamps, M. (2005). Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73(3), 515–524. doi:10.1037/0022-006X.73.3.515.
McLean, C. P., & Foa, E. B. (2013). Dissemination and implementation of prolonged exposure therapy for posttraumatic stress disorder. Journal of Anxiety Disorders, 27(8), 788–792. doi:10.1016/j.janxdis.2013.03.004.
McManus, F., Van Doorn, K., & Yiend, J. (2012). Examining the effects of thought records and behavioral experiments in instigating belief change. Journal of Behavior Therapy and Experimental Psychiatry, 43(1), 540–547. doi:10.1016/j.jbtep.2011.07.003.
McMillan, D., & Lee, R. (2010). A systematic review of behavioral experiments vs. exposure alone in the treatment of anxiety disorders. A case of exposure while wearing the emperor’s new clothes? Clinical Psychology Review, 30(5), 467–478. doi:10.1016/j.cpr.2010.01.003.
Meyer, J. M., Farrell, N. R., Kemp, J. J., Blakey, S. M., & Deacon, B. J. (2014). Why do clinicians exclude anxious clients from exposure therapy? Behaviour Research and Therapy, 54, 49–53. doi:10.1016/j.brat.2014.01.004.
Miller, W. R., & Rollnick, S. (2009). Ten things that motivational interviewing is not. Behavioural and Cognitive Psychotherapy, 37(02), 129–140. doi:10.1017/S1352465809005128.
Milosevic, I., & Radomsky, A. S. (2013). Incorporating the judicious use of safety behavior into exposure-based treatments for anxiety disorders: a study of treatment acceptability. Journal of Cognitive Psychotherapy, 27(2), 155–174. doi:10.1891/0889-8391.27.2.155.
Mörtberg, E. (2014). Working alliance in individual and group cognitive therapy for social anxiety disorder. Psychiatry Research, 220(1–2), 716–718. doi:10.1016/j.psychres.2014.07.004.
Moscovitch, D. A. (2009). What is the core fear in social phobia? A new model to facilitate individualized case conceptualization and treatment. Cognitive and Behavioral Practice, 16(2), 123–134. doi:10.1016/j.cbpra.2008.04.002.
Mumma, G. H., & Smith, J. L. (2001). Cognitive–behavioral-interpersonal scenarios: Interformulator reliability and convergent validity. Journal of Psychopathology and Behavioral Assessment, 23(4), 203–221. doi:10.1023/A:1012738802126.
National Institute of Health and Clinical Excellence. (2011, January). Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: Management in primary, secondary and community care. NICE.
Norton, P. J., Klenck, S. C., & Barrera, T. L. (2010). Sudden gains during cognitive–behavioral group therapy for anxiety disorders. Journal of Anxiety Disorders, 24(8), 887–892. doi:10.1016/j.janxdis.2010.06.012.
Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics of North America, 33(3), 557–577.
Otto, M. W., Reilly-Harrington, N. A., Kogan, J. N., & Winett, C. A. (2003). Treatment contracting in cognitive-behavior therapy. Cognitive and Behavioral Practice, 10(3), 199–203.
Ougrin, D. (2011). Efficacy of exposure versus cognitive therapy in anxiety disorders: Systematic review and meta-analysis. BMC Psychiatry, 11(1), 200.
Parrish, C., Radomsky, A., & Dugas, M. (2008). Anxiety-control strategies: Is there room for neutralization in successful exposure treatment? Clinical Psychology Review, 28(8), 1400–1412. doi:10.1016/j.cpr.2008.07.007.
Persons, J. B., Beckner, V. L., & Tompkins, M. A. (2013). Testing case formulation hypotheses in psychotherapy: Two case examples. Cognitive and Behavioral Practice, 20(4), 399–409. doi:10.1016/j.cbpra.2013.03.004.
Price, M., & Anderson, P. L. (2012). Outcome expectancy as a predictor of treatment response in cognitive behavioral therapy for public speaking fears within social anxiety disorder. Psychotherapy, 49(2), 173–179. doi:10.1037/a0024734.
Rachman, S., Radomsky, A. S., & Shafran, R. (2008). Safety behaviour: A reconsideration. Behaviour Research and Therapy, 46(2), 163–173. doi:10.1016/j.brat.2007.11.008.
Radomsky, A. S., Shafran, R., Coughtrey, A. E., & Rachman, S. (2010). Cognitive-behavior therapy for compulsive checking in OCD. Cognitive and Behavioral Practice, 17(2), 119–131. doi:10.1016/j.cbpra.2009.10.002.
Ramnero, J., & Öst, L. G. (2007). Therapists’ and clients’ perception of each other and working alliance in the behavioral treatment of panic disorder and agoraphobia. Psychotherapy Research, 17(3), 320–328. doi:10.1080/10503300600650852.
Rowa, K., Gifford, S., McCabe, R., Milosevic, I., Antony, M. M., & Purdon, C. (2014). Treatment fears in anxiety disorders: Development and validation of the treatment ambivalence questionnaire: treatment fears in anxiety disorders. Journal of Clinical Psychology, 70(10), 979–993. doi:10.1002/jclp.22096.
Ruzek, J. I., & Rosen, R. C. (2009). Disseminating evidence-based treatments for PTSD in organizational settings: A high priority focus area. Behaviour Research and Therapy, 47(11), 980–989. doi:10.1016/j.brat.2009.07.008.
Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 19, 6–10.
Salkovskis, P. M., Hackmann, A., Wells, A., Gelder, M. G., & Clark, D. M. (2007). Belief disconfirmation versus habituation approaches to situational exposure in panic disorder with agoraphobia: A pilot study. Behaviour Research and Therapy, 45(5), 877–885. doi:10.1016/j.brat.2006.02.008.
Schnurr, P. P., Friedman, M. J., Engel, C. C., Foa, E. B., Shea, M. T., Chow, B. K., … Bernardy, N. (2007). Cognitive behavioral therapy for posttraumatic stress disorder in women: A randomized controlled trial. JAMA, 297(8), 820–830.
Spitzer, R. L., Kroenke, K., Williams, J. W., & and the Patient Health Questionnaire Primary Care Study Group. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. JAMA, 282(18), 1737–1744. doi:10.1001/jama.282.18.1737.
Spitzer, R. L., Williams, J. B., Kroenke, K., Linzer, M., Verloin deGruy, F., Hahn, S. R., … Johnson, J. G. (1994). Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 study. Journal of the American Medical Association, 272(22), 1749–1756.
Stangier, U., Heidenreich, T., Peitz, M., Lauterbach, W., & Clark, D. M. (2003). Cognitive therapy for social phobia: Individual versus group treatment. Behaviour Research and Therapy, 41(9), 991–1007. doi:10.1016/S0005-7967(02)00176-6.
Stark, M., Campbell, B., & Brinkerhoff, C. (1990). “Hello, may we help you?” A study of attrition prevention at the time of the first phone contact with substance-abusing clients. American Journal of Drug and Alcohol Abuse, 16(2), 67–76. doi:10.3109/00952999009001573.
Stecker, T., Fortney, J. C., & Sherbourne, C. D. (2011). An intervention to increase mental health treatment engagement among oif veterans: A pilot trial. Military Medicine, 176(6), 613–619.
Sy, J. T., Dixon, L. J., Lickel, J. J., Nelson, E. A., & Deacon, B. J. (2011). Failure to replicate the deleterious effects of safety behaviors in exposure therapy. Behaviour Research and Therapy, 49(5), 305–314. doi:10.1016/j.brat.2011.02.005.
Teasdale, J. D. (1999). Emotional processing, three modes of mind and the prevention of relapse in depression. Behaviour Research and Therapy, 37, S53–S77.
Tolin, D. F. (2010). Is cognitive–behavioral therapy more effective than other therapies? A meta-analytic review. Clinical Psychology Review, 30(6), 710–720. doi:10.1016/j.cpr.2010.05.003.
Tolin, D. F., Diefenbach, G. J., Maltby, N., & Hannan, S. (2005). Stepped care for obsessive-compulsive disorder: A pilot study. Cognitive and Behavioral Practice, 12(4), 403–414. doi:10.1016/S1077-7229(05)80068-9.
Tryon, G. S., & Winograd, G. (2011). Goal consensus and collaboration. Psychotherapy: Theory, Research, and Practice, 48(1), 50–57. doi:10.1037/a0022061.
Twomey, C., O’Reilly, G., Byrne, M., Bury, M., White, A., Kissane, S., … Clancy, N. (2014). A randomized controlled trial of the computerized CBT programme, MoodGYM, for public mental health service users waiting for interventions. British Journal of Clinical Psychology, 53(4), 433–450. doi:10.1111/bjc.12055.
Van Apeldoorn, F. J., Stant, A. D., van Hout, W. J. P. J., Mersch, P. P. A., & den Boer, J. A. (2014). Cost-effectiveness of CBT, SSRI, and CBT+SSRI in the treatment for panic disorder. Acta Psychiatrica Scandinavica, 129(4), 286–295. doi:10.1111/acps.12169.
Van Minnen, A., Hendriks, L., & Olff, M. (2010). When do trauma experts choose exposure therapy for PTSD patients? A controlled study of therapist and patient factors. Behaviour Research and Therapy, 48(4), 312–320. doi:10.1016/j.brat.2009.12.003.
Wang, P. S., Berglund, P., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 603–613.
Weiss, M., Kivity, Y., & Huppert, J. D. (2014). How does the therapeutic alliance develop throughout cognitive behavioral therapy for panic disorder? Sawtooth patterns, sudden gains, and stabilization. Psychotherapy Research, 24(3), 407–418. doi:10.1080/10503307.2013.868947.
Westra, H. A. (2012). Motivational interviewing in the treatment of anxiety. New York: Guilford Press.
Whittal, M. L., Robichaud, M., Thordarson, D. S., & McLean, P. D. (2008). Group and individual treatment of obsessive-compulsive disorder using cognitive therapy and exposure plus response prevention: A 2-year follow-up of two randomized trials. Journal of Consulting and Clinical Psychology, 76(6), 1003–1014. doi:10.1037/a0013076.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Ouimet, A.J., Ashbaugh, A.R. (2017). Anxiety. In: O'Donohue, W., James, L., Snipes, C. (eds) Practical Strategies and Tools to Promote Treatment Engagement. Springer, Cham. https://doi.org/10.1007/978-3-319-49206-3_15
Download citation
DOI: https://doi.org/10.1007/978-3-319-49206-3_15
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-49204-9
Online ISBN: 978-3-319-49206-3
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)