David H. Barlow

Boston University, Boston, Massachusetts, United States

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Publications (410)1509.16 Total impact

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    ABSTRACT: Previous research suggests that patients with panic disorder exhibit higher levels of aggression than patients with other anxiety disorders. This aggression is associated with more severe symptomatology and interpersonal problems. However, few studies have examined whether higher levels of aggression are associated with a worse treatment response in this population. The present study sought to examine the association of aggression with panic disorder symptom severity in a sample of 379 patients who participated in a trial examining long-term strategies for the treatment of panic disorder. We found that aggression was significantly associated with higher baseline levels of panic disorder symptoms, anxiety, depression, and functional impairment. Further, we found that patients higher in aggression did not achieve the same level of improvement in general anxiety symptoms during treatment compared to patients lower in aggression, even when controlling for baseline anxiety symptom severity. These results suggest that more research is needed concerning patients with anxiety disorders with higher aggression, as they may be a group in need of additional treatment considerations. Copyright © 2015. Published by Elsevier Inc.
    Comprehensive psychiatry 05/2015; DOI:10.1016/j.comppsych.2015.04.012 · 2.26 Impact Factor
  • PLoS ONE 04/2015; 10(4):e0122969. DOI:10.1371/journal.pone.0122969 · 3.53 Impact Factor
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    American Journal of Psychiatry 04/2015; 172(4):393. DOI:10.1176/appi.ajp.2015.14101347 · 13.56 Impact Factor
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    ABSTRACT: Existing research supports a relationship between nonsuicidal self-injury (NSSI) and the emotional disorders (i.e., anxiety, mood, and related disorders). The aim of this investigation was to conduct a meta-analysis of the associations between NSSI and the emotional disorders, and evaluate the quality of evidence supporting this relationship. A literature search was conducted from database inception through June 2014, and two reviewers independently determined the eligibility and quality of studies. A total of 56 articles providing data on engagement in NSSI among individuals with and without emotional disorders met eligibility criteria. Compared to those without an emotional disorder, individuals with an emotional disorder were more likely to report engagement in NSSI (OR=1.75, 95% CI: 1.49, 2.06). This increase of risk of NSSI was shown for each disorder subgroup, with the exceptions of bipolar disorder and social anxiety disorder. The largest associations were observed for panic and post-traumatic stress disorder; however, the risk of NSSI did not differ significantly across disorders. The quality of evidence was variable due to inconsistent methodological factors (e.g., adjustment for confounding variables, NSSI assessment). Overall, these findings provide evidence for a relationship between NSSI and the emotional disorders, and support conceptualizations of NSSI as transdiagnostic. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Clinical Psychology Review 02/2015; 37. DOI:10.1016/j.cpr.2015.02.006 · 7.18 Impact Factor
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    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; DOI:10.1016/j.beth.2014.11.001 · 2.43 Impact Factor
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    ABSTRACT: Over the past several decades, the diagnosis of mental disorders has been characterized by classifying psychopathology into as many discrete diagnoses as can be reliability identified (e.g., APA, 2013). There is increasing evidence, however, that this approach to diagnosis may come at the expense of validity as trivial symptom-level differences are emphasized with little regard for common core mechanisms. Traditionally, cognitive-behavioral (CBT) approaches to treating psychopathology have followed a diagnosis-specific approach such that unique protocols have been developed for most disorders. Recent advances in CBT have suggested that targeting transdiagnostic mechanisms responsible for the development and maintenance of a wider range of psychopathology may be a more efficient approach to treatment than addressing disorder symptoms themselves. In order to create a more personalized treatment package, we propose establishing a profile for each patient that quantifies dysfunction in terms of empirically-supported underlying mechanisms; we further suggest that data from this profile be used to select CBT modules specific to the core mechanisms maintaining an individual patient's symptoms.
    Depression and Anxiety 11/2014; 31(11). DOI:10.1002/da.22301 · 4.29 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; 62. DOI:10.1016/j.brat.2014.09.003 · 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; 55(8). DOI:10.1016/j.comppsych.2014.07.016 · 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; 39(2). DOI:10.1177/0145445514553094 · 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. DOI:10.1037/a0036216 · 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; DOI:10.1037/a0037045 · 3.01 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. DOI:10.1016/j.comppsych.2014.04.015 · 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; DOI:10.1016/j.janxdis.2014.05.007 · 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; DOI:10.1037/a0037403 · 4.85 Impact Factor
  • Shannon Sauer‐Zavala, David H. Barlow
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    ABSTRACT: The goal of this article is to advance understanding of borderline personality disorder (BPD) as an emotional disorder and to use this information as a heuristic for reconceptualizing targeted treatment approaches. The first section reviews evidence that BPD is characterized by the hallmark of emotional disorders, frequent intense negative emotions, and adverse reactions to them. Next, overlap between BPD and other emotional disorders is described, followed by a section delineating how these similarities can be largely accounted for by a shared underlying vulnerability, namely, high levels of neuroticism. Finally, we discuss the treatment implications of this conception of BPD in the context of recent transdiagnostic approaches to emotional disorders.
    Clinical Psychology Science and Practice 06/2014; 21(2). DOI:10.1111/cpsp.12063 · 2.92 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). DOI:10.1007/s10862-013-9387-9 · 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.
    04/2014; 5(1):72-82. DOI:10.5127/jep.033712
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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; 82(2). DOI:10.1037/a0035535 · 4.85 Impact Factor
  • Kate Bentley, Matthew K. Nock, David H. Barlow
    01/2014; 2(5):638– 656. DOI:10.1177/2167702613514563
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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. DOI:10.1016/j.brat.2013.11.001 · 3.85 Impact Factor

Publication Stats

19k Citations
1,509.16 Total Impact Points


  • 1996–2015
    • Boston University
      • • Center for Anxiety and Related Disorders
      • • Department of Psychology
      Boston, Massachusetts, United States
    • University of Oregon
      • Department of Psychology
      Eugene, OR, United States
  • 1998–2014
    • University of Massachusetts Boston
      • Department of Psychology
      Boston, Massachusetts, United States
    • University of Hawaiʻi at Mānoa
      • Department of Psychology
      Honolulu, HI, United States
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States
  • 2010
    • University of Missouri - St. Louis
      • Department of Psychology
      Saint Louis, MI, United States
  • 2005–2010
    • Center for Autism and Related Disorders
      Burbank, California, United States
    • Beth Israel Deaconess Medical Center
      Boston, Massachusetts, United States
    • Complutense University of Madrid
      Madrid, Madrid, Spain
  • 2008
    • Mount Sinai School of Medicine
      • Department of Psychiatry
      Manhattan, NY, United States
  • 1980–2008
    • Brown University
      Providence, Rhode Island, United States
    • University of Pittsburgh
      • Psychology
      Pittsburgh, Pennsylvania, United States
  • 1990–2006
    • Albany State University
      • Division of Psychology
      Albany, GA, United States
    • Albert Einstein College of Medicine
      New York City, New York, United States
  • 1977–2005
    • Harvard University
      • Department of Psychology
      Cambridge, Massachusetts, United States
  • 1969–2005
    • University of Vermont
      • Department of Psychology
      Burlington, VT, United States
  • 2003
    • Rhode Island Hospital
      Providence, Rhode Island, United States
  • 1984–1996
    • State University of New York
      New York, New York, United States
    • Children's National Medical Center
      Washington, Washington, D.C., United States
  • 1980–1996
    • University at Albany, The State University of New York
      • Department of Psychology
      New York City, New York, United States
  • 1995
    • University of Iowa
      • Department of Psychology
      Iowa City, Iowa, United States
    • Uniformed Services University of the Health Sciences
      • Department of Medical & Clinical Psychology
      베서스다, Maryland, United States
  • 1990–1994
    • University of California, Los Angeles
      • Department of Psychology
      Los Ángeles, California, United States
  • 1990–1992
    • University of Queensland 
      • School of Psychology
      Brisbane, Queensland, Australia
  • 1989
    • CUNY Graduate Center
      New York City, New York, United States
  • 1987
    • Indiana State University
      HUF, Indiana, United States
  • 1986
    • University of Houston
      • Department of Psychology
      Houston, Texas, United States
  • 1979
    • University of North Carolina at Greensboro
      • Department of Psychology
      Greensboro, North Carolina, United States
  • 1976–1978
    • Butler Hospital
      Providence, Rhode Island, United States
  • 1970–1975
    • University of Mississippi Medical Center
      Jackson, Mississippi, United States