David H. Barlow

Boston University, Boston, Massachusetts, United States

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Publications (370)1287.49 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Accommodation consists of changes in family members’ behavior to prevent or reduce patients’ obsessive-compulsive disorder (OCD) rituals or distress. High levels of family accommodation are associated with more severe symptoms and functional impairment on the part of patients, and may also interfere with exposure-based treatment. The purpose of this study was to develop and test a brief, adjunctive intervention to reduce accommodation in the family members of adult OCD patients. Patients (N = 18, mean age = 35.44, 33% male, 94% Caucasian) received a course of standard individual exposure and ritual prevention (ERP) for OCD. Family members (N = 18, mean age = 41.72, 56% male, 94% Caucasian) were randomized to either receive or not receive the adjunctive intervention, consisting of two sessions of psychoeducation and skills training in reducing accommodation. Results revealed that the intervention successfully reduced scores on the clinician-rated the Family Accommodation Scale (Week 8 d = 1.05). Patients whose family members received the intervention showed greater reductions in Y-BOCS scores across treatment than patients whose family members had not (Week 8 d = 1.27), and hierarchical regression analyses revealed that change in family accommodation from baseline accounted for a significant amount of variance in later OCD symptoms (β = .45, p = .02). Results from this preliminary study suggest that this adjunctive intervention produces more rapid treatment response compared to traditional ERP alone. Accommodation is a potentially important target for improving treatment in OCD and other diagnostic groups where accommodation is likely to occur.
    Behavior Therapy 11/2014; · 2.43 Impact Factor
  • David H. Barlow
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    ABSTRACT: The series of articles in this issue of Behavior Research and Therapy presages a new field of translational research that could be called "the neuroscience of psychological treatments". After a brief retrospective on the origins and promise of this focus of study several cautions are adumbrated. As in any new field of scientific endeavor, close collaboration among stakeholders with interest in this field and the integration of a healthy scientific skepticism will best ensure the continued development of ever more powerful psychological treatments. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Behaviour Research and Therapy 11/2014; · 3.85 Impact Factor
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    ABSTRACT: Objective To conduct a preliminary examination of long-term outcomes on a broad range of affective disorder symptoms treated with a newly developed intervention: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). Method Maintenance of treatment gains at long-term follow-up (LTFU) were explored in patients (n = 15, mean age = 32.27; 60% female) who completed a clinical trial of the UP. Results Treatment gains observed at 6-month follow-up (6MFU) on measures of clinical severity, general symptoms of depression and anxiety, and a measure of symptom interference in daily functioning were largely maintained 12 months later (at an average of 18 months posttreatment), and any significant changes from 6MFU to LTFU reflected small increases in symptoms that remained, on average, in the subclinical range. Conclusions These findings provide the first initial support for the durability of broad treatment gains following transdiagnostic treatment.
    Comprehensive Psychiatry 11/2014; · 2.26 Impact Factor
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    ABSTRACT: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) has demonstrated promising results among patients with heterogeneous anxiety and comorbid depressive disorders when delivered on an individual basis, but greater efficiencies may be achieved with group-based applications. The aim of the present study was to provide a preliminary exploration of the UP when delivered in a group format. Among diagnostically diverse patients (N = 11), the UP group treatment resulted in moderate to strong effects on anxiety and depressive symptoms, functional impairment, quality of life, and emotion regulation skills, as well as good acceptability and overall satisfaction ratings from patients. Three clinical cases are presented in detail to illustrate the group-based UP delivery, followed by a critical discussion of associated challenges and proposed guidelines for group administration, as well as directions for future research.
    Behavior Modification 10/2014; · 1.70 Impact Factor
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    ABSTRACT: The need to capture severity and impairment of depressive symptomatology is widespread. Existing depression scales are lengthy and largely focus on individual symptoms rather than resulting impairment. The Overall Depression Severity and Impairment Scale (ODSIS) is a 5-item, continuous measure designed for use across heterogeneous mood disorders and with subthreshold depressive symptoms. This study examined the psychometric properties of the ODSIS in outpatients in a clinic for emotional disorders (N = 100), undergraduate students (N = 566), and community-based adults (N = 189). Internal consistency, latent structure, item response theory, classification accuracy, convergent and discriminant validity, and differential item functioning analyses were conducted. ODSIS scores exhibited excellent internal consistency, and confirmatory factor analyses supported a unidimensional structure. Item response theory results demonstrated that the ODSIS provides more information about individuals with high levels of depression than those with low levels of depression. Responses on the ODSIS discriminated well between individuals with and without a mood disorder and depression-related severity across clinical and subclinical levels. A cut score of 8 correctly classified 82% of outpatients as with or without a mood disorder; it evidenced a favorable balance of sensitivity and specificity and of positive and negative predictive values. The ODSIS demonstrated good convergent and discriminant validity, and results indicate that items function similarly across clinical and nonclinical samples. Overall, findings suggest that the ODSIS is a valid tool for measuring depression-related severity and impairment. The brevity and ease of use of the ODSIS support its utility for screening and monitoring treatment response across a variety of settings. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychological Assessment 09/2014; 26(3):815-830. · 2.99 Impact Factor
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    Stefan G Hofmann, David H Barlow
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    ABSTRACT: Laska, Gurman, and Wampold (2013) argue that common factors (CFs) have largely been ignored by clinical researchers developing research-based interventions but that CFs are primarily responsible for therapeutic change. On the contrary, many clinical researchers developing empirically supported treatments have been studying the contribution of these factors for decades. What has been demonstrated is that these factors are contributory, but are not sufficient to produce maximum effects and their impact differs greatly from disorder to disorder. But we also take note of a change of tone and perhaps substance from these authors on the contribution of CFs to evidence-based psychological interventions, and reflect on recent changes in our own views both of which may reduce differences in our respective positions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychotherapy Theory Research Practice Training 08/2014; · 0.84 Impact Factor
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    ABSTRACT: Previous research has shown that two dimensions of temperament referred to as neuroticism/behavioral inhibition (N/BI) and extraversion/behavioral activation (E/BA) are key risk factors in the development and maintenance of anxiety and mood disorders (Brown & Barlow, 2009). Given such findings, these temperamental dimensions may represent promising treatment targets for individuals with emotional disorders; however, to date, few studies have investigated the effects of psychological treatments on temperamental constructs generally assumed to be "stable, inflexible, and pervasive" (American Psychiatric Association, 2000). The present study addresses this gap in the literature by examining the effects of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; Barlow et al., 2011), a cognitive-behavioral therapy designed to target core processes of N/BI and E/BA temperaments, in a sample of adults with principal anxiety disorders and a range of comorbid conditions. Results revealed small effects of the UP on N/BI and E/BA compared with a waitlist control group at post-treatment. Additionally, decreases in N/BI and increases in E/BA during treatment were associated with improvements in symptoms, functioning, and quality of life. Findings provide preliminary support for the notion that the UP treatment facilitates beneficial changes in dimensions of temperament.
    Comprehensive Psychiatry 08/2014; 55(6):1426-1434. · 2.26 Impact Factor
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    ABSTRACT: Anxiety and depressive disorders commonly co-occur during adolescence, share multiple vulnerability factors, and respond to similar psychosocial and pharmacological interventions. However, anxiety and depression may also be considered distinct constructs and differ on some underlying properties. Prior research efforts on evidence-based treatments for youth have been unable to examine concurrent trajectories of primary anxiety and depressive concerns across course of treatment. The advent of transdiagnostic approaches for these emotional disorders in youth allows for such examination The present study examined separate trajectories of adolescent anxiety and depressive symptoms over course of a transdiagnostic intervention, Unified Protocol for Treatment of Emotional Disorders in Adolescence (UP-A; 2008), as well as up to six months following treatment. The sample included 59 adolescents ages 12–17 years old (M = 15.42, SD = 1.71) who completed at least eight sessions of UP-A as part of an open trial or randomized, controlled trial across two treatment sites. Piecewise latent growth curve analyses found adolescent self-rated anxiety and depressive symptoms showed similar rates of improvement during treatment, but while anxiety symptoms continued to improve during follow-up, depressive symptoms showed non-significant improvement after treatment. Parent-rated symptoms also showed similar rates of improvement for anxiety and depression during UP-A to those observed for adolescent self-report, but little improvement after treatment across either anxiety or depressive symptoms. To a certain degree, results mirror those observed among other evidence-based treatments for youth with anxiety and depression, though results hold implications for future iterations of transdiagnostic treatments regarding optimization of outcomes for adolescents with depressive symptoms.
    Journal of Anxiety Disorders 08/2014; · 2.96 Impact Factor
  • James F Boswell, Lisa M Anderson, David H Barlow
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    ABSTRACT: Idiographic research methods can provide rich information regarding the process of change in specific treatments. Objective: Adopting an idiographic, exploratory approach, this study examined (a) temporal patterns of 3 transdiagnostic change constructs (mindfulness, cognitive reappraisal, and emotion avoidance), (b) the relationships between these constructs and depression and anxiety symptom severity over time, and (c) changes in these constructs in relation to the introduction of specific transdiagnostic intervention strategies in a single case. Method: The case was a 64-year-old, White, female patient with principal major depressive disorder and secondary generalized anxiety disorder being treated with the Unified Protocol (UP). Univariate and multivariate time series analyses were applied to symptom and change construct data. Results: (a) Clinically significant decreases in depression and anxiety from baseline to posttreatment were observed, as well as clinically significant increases in mindfulness and reappraisal; (b) changes in mindfulness were associated with changes in depression and anxiety, and changes in mindfulness temporally preceded changes in depression and anxiety; (c) changes in reappraisal were associated with changes in depression, and changes in reappraisal temporally preceded changes in depression; (d) the UP module designed to increase present-focused emotion awareness exerted the strongest influence on mindfulness ratings, although other modules had an impact; (e) reappraisal ratings were most strongly influenced by the emotion monitoring and functional analysis module, although subsequent modules continued to have a measureable impact. Conclusions: Although specific to this case, these results begin to elucidate important processes of change in transdiagnostic cognitive-behavioral therapy for principal depression with comorbid anxiety. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Journal of Consulting and Clinical Psychology 07/2014; · 4.85 Impact Factor
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    ABSTRACT: Individuals with anxiety and depressive symptoms exhibit disturbances in positive emotion regulation, which may hinder full recovery. By comparison, individuals with strong beliefs regarding their capacity to “savor” or maintain positive emotions (i.e., savoring beliefs) display more adaptive positive emotion regulation. The present daily diary study explores three momentary processes involved in positive emotion regulation, namely positive emotion reactivity, regulatory goals, and regulatory effectiveness, and examines the comparative effects of baseline anxiety and depressive symptoms versus savoring beliefs on such processes in real-life contexts. A sample of 164 nonclinical undergraduates provided baseline measures of anxiety and depressive symptom severity and savoring beliefs prior to completing 14 daily assessments of positive emotions and emotion regulatory responses to daily positive events. Results indicated that higher baseline anxiety and depressive symptom severity were associated with decreased positive emotion reactivity and increased down-regulation of positive emotions; higher baseline savoring beliefs were associated with increased positive emotion reactivity, decreased down-regulation and increased up-regulation of positive emotions. Potential clinical implications are discussed.
    Journal of Psychopathology and Behavioral Assessment 06/2014; 36(2). · 1.55 Impact Factor
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    ABSTRACT: The credibility of a treatment rationale consists of “how believable, convincing, and logical the treatment is” (Kazdin, 1979, p. 82), while outcome expectancy consists of patients’ beliefs about how likely they are to benefit from a treatment. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) presents some challenges in this regard since the treatment rationale is not directly tailored to a specific disorder. We sought to examine the treatment credibility of the UP, as well as patients’ outcome expectancies regarding this transdiagnostic treatment, and how each of these “common factors” related to outcomes. Results suggest that outcome expectancies were more closely related to outcomes than were ratings of credibility, in line with research on these constructs in other treatments. Ratings of credibility and outcome expectancies for the UP were comparable to previously reported levels of these constructs in other cognitive-behavioral treatments.
    Journal of Experimental Psychopathology. 04/2014; 5(1):72-82.
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    ABSTRACT: Objective: Recently, innovative statistical tools have been used to model patterns of change in psychological treatments. These tools can detect patterns of change in patient progress early in treatment and allow for the prediction of treatment outcomes and treatment length. Method: We used growth mixture modeling to identify different latent classes of early change in patients with panic disorder (N = 326) who underwent a manualized cognitive-behavioral treatment. Results: Four latent subgroups were identified, showing clusters of change trajectories over the first 5 sessions. One of the subgroups consisted of patients whose symptoms rapidly decreased and also showed the best outcomes. This information improved treatment prediction by 16.1% over patient intake characteristics. Early change patterns also significantly predicted patients' early treatment termination. Patient intake characteristics that significantly predicted class membership included functional impairment and separation anxiety. Conclusions: These findings suggest that early treatment changes are uniquely predictive of treatment outcome. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Journal of Consulting and Clinical Psychology 01/2014; · 4.85 Impact Factor
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    ABSTRACT: Although the alliance-outcome correlation is well established, no published studies to date have separated between therapists' and patients' contributions while controlling for early symptom change. In this study, we examined therapist effects in two trials of CBT for panic disorder with agoraphobia (PDA) and the impact of therapists' and patients' contribution to the alliance on outcome and attrition in one trial. Alliance ratings were obtained from patients and therapists early and late in treatment (n = 133). Data were analyzed using multi-level modeling controlling for early symptom change. No therapist effects were found. The patients' contribution to the alliance predicted outcome (in both panic severity and anxiety sensitivity) and attrition. The therapists' contribution to the alliance predicted attrition but not outcome. Results suggest that the patient's contribution to the alliance plays an important role in CBT for PDA and that including common factors into research on CBT may help elucidate treatment processes.
    Behaviour Research and Therapy 11/2013; 52C:26-34. · 3.85 Impact Factor
  • Clinical Psychological Science. 10/2013;
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    ABSTRACT: The present study examined temporal dependencies of change of panic symptoms and two promising mechanisms of change (self-efficacy and anxiety sensitivity) during an 11-session course of cognitive-behavior therapy (CBT) for Panic Disorder (PD). 361 individuals with a principal diagnosis of PD completed measures of self-efficacy, anxiety sensitivity, and PD symptoms at each session during treatment. Effect size analyses indicated that the greatest changes in anxiety sensitivity occurred early in treatment, whereas the greatest changes in self-efficacy occurred later in treatment. Results of parallel process latent growth curve models indicated that changes in self-efficacy and anxiety sensitivity across treatment uniquely predicted changes in PD symptoms. Bivariate and multivariate latent difference score models indicated, as expected, that changes in anxiety sensitivity and self-efficacy temporally preceded changes in panic symptoms, and that intraindividual changes in anxiety sensitivity and self-efficacy independently predicted subsequent intraindividual changes in panic symptoms. These results provide strong evidence that changes in self-efficacy and anxiety sensitivity during CBT influence subsequent changes in panic symptoms, and that self-efficacy and anxiety sensitivity may therefore be two distinct mechanisms of change of CBT for PD that have their greatest impact at different stages of treatment.
    Behaviour Research and Therapy 09/2013; 51(11):767-777. · 3.85 Impact Factor
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    ABSTRACT: Recent findings support the relevance of anxiety sensitivity (AS) and interoceptive exposure (IE) across emotional disorders. This study (a) evaluated levels of AS across different anxiety disorders, (b) examined change in AS over the course of transdiagnostic psychological intervention, and its relationship with outcome, and (c) described the implementation of IE to address AS with patients with different anxiety disorders. Participants (N=54) were patients who received treatment with the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) in two consecutive treatment trials. Participants completed a measure of AS at pre- and posttreatment, and multiple occasions during treatment. Symptom severity was assessed at pre- and posttreatment, and clinical information related to physical symptoms and IE were collected as part of routine clinical practice. Elevated AS was observed at pretreatment across diagnoses and decreases in AS were observed from pre- to posttreatment. Similar changes occurred across the diagnostic categories, notably coinciding with the introduction of IE. Change in AS was correlated with reduced symptom levels at posttreatment and 6-month follow-up. Patients with different anxiety disorders endorsed similar physical symptoms and practiced similar IE exercises with similar effects. Results provide preliminary support for the usefulness of IE as a treatment strategy across the spectrum of anxiety disorders, and additional support for the transdiagnostic relevance of AS.
    Behavior therapy 09/2013; 44(3):417-31. · 2.85 Impact Factor
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    ABSTRACT: The effects of the antidepressant venlafaxine (VEN-225 mg daily) and transdiagnostic cognitive behavioral treatment (CBT) alone and in combination on alcohol intake in subjects with co-morbid alcohol use disorders (AUDs) and anxiety disorders were compared. Drinking outcomes and anxiety were assessed for 81 subjects treated for 11 weeks with one of 4 conditions: 1) VEN-CBT, 2) VEN-Progressive Muscle Relaxation therapy (PMR), 3) Placebo (PLC)-CBT and 4) a comparison group of PLC-PMR. For subjects who reported taking at least one dose of study medication, the Time × Group interaction was significant for percent days of heavy drinking and drinks consumed per day. For the measure of percent days heavy drinking, the paired comparison of PLC-CBT versus PLC-PMR group indicated that the PLC-CBT group had greater drinking reductions, whereas other groups were not superior to the comparison group. In Week 11, the proportion of subjects in the PLC-CBT group that had a 50% reduction from baseline in percent days heavy drinking was significantly greater than those in the comparison group. Of the 3 "active treatment" groups only the PLC-CBT group had significantly decreased heavy drinking when contrasted to the comparison group. This finding suggests that the transdiagnostic CBT approach of Barlow and colleagues may have value in the management of heavy drinking in individuals with co-morbid alcoholism and anxiety.
    Behaviour Research and Therapy 08/2013; 51(11):729-735. · 3.85 Impact Factor
  • Jonathan S Comer, David H Barlow
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    ABSTRACT: Mental illness imposes a staggering public health burden in the United States. Although the past 40 years have witnessed tremendous advances in the identification of evidence-based practices (EBPs) in psychological treatments, gaps persist between treatment in experimental settings and services available in the community. In response, considerable attention and large financial commitments have focused in recent years on broad dissemination and implementation efforts designed to improve the quality of psychological services delivered by a variety of generalist practitioners across practice settings. Increasingly, under the influence of the Patient Protection and Affordable Care Act, it is envisioned that these generalists will practice in integrated primary care settings. These advances hold enormous potential, and yet, given the tremendous diversity of mental health problems and human suffering, broad dissemination and implementation efforts to generalists alone may not be sufficient to adequately address the burden of mental illness. Some EBPs may prove too complex for universal dissemination, and the time and expense required for quality dissemination and implementation preclude large-scale training in the treatment of low base rate disorders. As dissemination and implementation efforts work to ensure a quality generalist mental health care workforce, herein we highlight the vital need for available specialty care in the delivery of psychological treatments. Given traditional barriers that interfere with the accessibility of specialty care, we propose the transformative potential of a specialty behavioral telehealth care workforce, transacting with the generalist practitioner workforce to collectively ensure the highest quality and timely delivery of needed treatments to affected individuals. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    American Psychologist 08/2013; · 6.87 Impact Factor
  • David H Barlow, Jonathan S Comer
    American Journal of Psychiatry 05/2013; · 14.72 Impact Factor
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    ABSTRACT: This study evaluated the implementation of computerized cognitive-behavioral therapy (cCBT) for depression and anxiety in a university health center. Students reporting symptoms of depression and/or anxiety were offered cCBT and randomized to a session email reminder or no-reminder condition. Participants reported significant symptom and functional improvement after receiving treatment, comparable to outcomes achieved in controlled efficacy trials. However, rates of session completion were low, and reminders did not enhance retention. Results suggest that cCBT is a promising intervention in this population, with little attenuation of gains relative to efficacy trials but low levels of treatment completion.
    Administration and Policy in Mental Health and Mental Health Services Research 04/2013; · 3.44 Impact Factor

Publication Stats

13k Citations
1,287.49 Total Impact Points


  • 1996–2014
    • Boston University
      • • Department of Psychology
      • • Center for Anxiety and Related Disorders
      Boston, Massachusetts, United States
    • University of Nebraska at Lincoln
      • Department of Psychology
      Lincoln, NE, United States
    • University of Oregon
      • Department of Psychology
      Eugene, OR, United States
  • 2013
    • Hebrew University of Jerusalem
      • Department of Psychology
      Yerushalayim, Jerusalem District, Israel
  • 1996–2012
    • Center for Autism and Related Disorders
      Burbank, California, United States
  • 2006–2010
    • University of Missouri - St. Louis
      • Department of Psychology
      Saint Louis, MI, United States
    • Yale University
      • Department of Psychiatry
      New Haven, Connecticut, United States
    • Rutgers New Jersey Medical School
      • Department of Psychiatry (RWJ Medical School)
      Newark, NJ, United States
  • 1998–2010
    • University of Massachusetts Boston
      • Department of Psychology
      Boston, Massachusetts, United States
    • Start Clinic for Mood and Anxiety Disorders
      Toronto, Ontario, Canada
    • University of Hawaiʻi at Mānoa
      • Department of Psychology
      Honolulu, HI, United States
    • Honolulu University
      Honolulu, Hawaii, United States
    • Smith College
      • Psychology
      Northampton, Massachusetts, United States
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States
  • 1990–2009
    • University of California, Los Angeles
      • • Department of Pediatrics
      • • Department of Psychology
      Los Angeles, California, United States
    • Albert Einstein College of Medicine
      New York City, New York, United States
  • 2008
    • Brown University
      Providence, Rhode Island, United States
  • 2003–2008
    • Mount Sinai School of Medicine
      • Department of Psychiatry
      Manhattan, NY, United States
  • 1977–2008
    • Harvard University
      • Department of Psychology
      Cambridge, MA, United States
  • 2007
    • University of New South Wales
      Kensington, New South Wales, Australia
  • 2004–2006
    • Massachusetts General Hospital
      • Department of Psychiatry
      Boston, MA, United States
  • 1990–2006
    • Albany State University
      • Division of Psychology
      Albany, GA, United States
  • 1989–2006
    • State University of New York
      New York City, New York, United States
    • CUNY Graduate Center
      New York City, New York, United States
  • 1982–2006
    • University at Albany, The State University of New York
      • Department of Psychology
      New York City, New York, United States
  • 2005
    • University of Minnesota Twin Cities
      • Department of Psychology
      Minneapolis, MN, United States
  • 1969–2005
    • University of Vermont
      • Department of Psychology
      Burlington, VT, United States
  • 1993–2004
    • Hospital of the University of Pennsylvania
      • Department of Psychiatry
      Philadelphia, Pennsylvania, United States
  • 1997
    • University of Nevada, Las Vegas
      • Department of Psychology
      Las Vegas, NV, United States
  • 1995–1996
    • Macquarie University
      Sydney, New South Wales, Australia
  • 1994
    • State University of New York College at Oneonta
      Oneonta, New York, United States
  • 1991–1992
    • University of Queensland 
      • School of Psychology
      Brisbane, Queensland, Australia
  • 1981–1991
    • Columbia University
      New York City, New York, United States
  • 1986
    • University of Houston
      • Department of Psychology
      Houston, Texas, United States
  • 1984
    • SUNY Ulster
      Kingston, New York, United States
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 1977–1984
    • University of North Carolina at Greensboro
      • Department of Psychology
      Greensboro, NC, United States
  • 1970–1975
    • University of Mississippi Medical Center
      Jackson, Mississippi, United States