Hannah E. Frank

Brown University · Department of Psychiatry and Human Behavior

Objective Accommodation, or the ways in which families modify their routines and expectations in response to a child’s anxiety, is common and interferes with anxiety treatment outcomes. However, little research has examined family accommodation among youth with autism spectrum disorder and anxiety. The current study aimed to (a) identify pre-treatm...

Background Current approaches to increasing the rates of clinician use of exposure therapy for anxiety disorders in community settings are limited. Research underscores the importance of addressing contextual variables to facilitate clinician use of evidence‐based practices; however, no studies have identified the innovation‐specific organizational...

A lack of effective therapist training is a major barrier to evidence‐based intervention (EBI) delivery in the community. Systematic reviews published nearly a decade ago suggested that traditional EBI training leads to higher knowledge but not more EBI use, indicating that more work is needed to optimize EBI training and implementation. This syste...

Background Implementation researchers have typically studied organizational culture and climate by testing whether individual dimensions are linked to the implementation of evidence-based practices (EBPs) rather than examining how the overarching social context influences implementation. This approach may limit implementation theory and strategy de...

Efficacious psychological treatments exist for a variety of mental health conditions, but many who could benefit from these treatments do not receive them. Increasing efforts have been made to disseminate effective protocols, and several approaches for implementing such treatments have been proposed, including the use of protocols, principles, prac...

This paper posits that a clinician's own anxious reaction to delivering specific evidence-based interventions (EBIs) should be better accounted for within implementation science frameworks. A key next step for implementation science is to delineate the causal processes most likely to influence successful implementation of evidence-based interventio...

Background Trauma narratives are a critical, exposure-based component of trauma-focused cognitive-behavioral therapy, yet community therapists rarely use them. Given evidence that intentions to deliver elements of cognitive behavioral therapy vary by component, and that intentions to deliver exposure are the weakest, this study focused specifically...

Findings have been mixed regarding the relationship between comorbid depression and anxiety and treatment outcomes for anxious youth. The current study compared a sample of anxious youth with a comorbid depressive disorder (n = 20) and those without comorbid depression (n = 137). All participants received 16 weekly sessions of Coping Cat and comple...

Most evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD) and anxiety disorders include exposure; however, in community settings, the implementation of exposure lags behind other EBT components. Clinician-level determinants have been consistently implicated as barriers to exposure implementation, but few organizational determin...

Mental health treatment in schools has the potential to improve youth treatment access. However, school-specific barriers can make implementing evidence-based interventions difficult. Task-shifting (i.e., training lay staff to implement interventions) and computer-assisted interventions may mitigate these barriers. This paper reports on a qualitati...

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors that have been associated with youth outcomes in prior clinical trials of exposure therapy. Sixteen therapists in practice settings treated 46 youth with an anxiety disorder or Obsessive-Compulsive Disorder (OCD). Therapists were randomly...

Background: Trauma narratives are a critical, exposure-based component of trauma-focused cognitive-behavioral therapy, yet community therapists do not always use them. Given evidence that intentions to deliver elements of cognitive behavioral therapy vary by component, and that intentions to deliver exposure are the weakest, this study focused spec...

Background : This study examined the transition to telehealth services during the COVID-19 pandemic in terms of attendance rates, the provision of evidence-based interventions, and clinical outcomes. Methods : The feasibility of in-person versus telehealth visits for integrated primary care sessions was compared using chart review data. Data on pa...

Although schools are one of the largest providers of behavioral health services for youth, many barriers exist to the implementation of evidence-based interventions in schools. This study used the Stages of Implementation Completion (SIC) to examine school-based implementation outcomes for a computer-assisted cognitive behavioral therapy interventi...

Mental health treatment in schools has the potential to improve youth treatment access. However, school-specific barriers can make implementing evidence-based interventions difficult. Task-shifting (i.e., training lay staff to implement interventions) and computer-assisted interventions may mitigate these barriers. This paper reports on a qualitati...

The current study explored whether patient characteristics predicted patterns of antidepressant use (i.e., never used, single episode of use, or two or more episodes) in a naturalistic follow-up. Participants in the child/adolescent multimodal (CAMS) extended long-term study. (n = 318) indicated medication use over the course of eight follow-up vis...

Cognitive behavioral therapy (CBT) is well established as an efficacious treatment for anxious youth, yet a number of youth remain symptomatic after the 10–16 sessions of treatment stipulated by most CBT treatment manuals. While a significant minority do not respond, no study has examined the frequency and impact of additional therapy sessions. Thi...

An amendment to this paper has been published and can be accessed via the original article.

Objective: This article examined associations between change in youth and family characteristics during youth anxiety treatment and long-term anxiety severity and overall functioning. Method: Participants (N = 488; age 7-17 years; 45% male; 82% white) were randomized to 12 weeks of cognitive behavioral therapy (Coping Cat), medication (sertralin...

Background Although exposure is a key evidence-based intervention for anxiety, it is infrequently used in clinical settings. This study employed a novel training strategy, experiential learning, to improve exposure implementation. This study aimed to assess the feasibility and acceptability of experiential training and preliminary training effectiv...

Latinxs are particularly underrepresented in anxiety and obsessive compulsive disorder (OCD) treatment studies ( Merikangas et al., 2011; Williams et al., 2010), despite epidemiological findings of equal or higher prevalence of anxiety/OCD amongst Latinxs (Goodman et al., 2008; Ruscio et al., 2010; Varela & Hensley Maloney, 2009). To better underst...

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e. indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a Community Mental Health Agency (CMHA) provided exposure therapy for eight youth with Obsessive Co...

Background: Trauma focused-cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experien...

Background: Trauma focused-cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experien...

This study measured therapist behaviors in relation to subsequent habituation within exposure tasks, and also tested their direct and indirect relationships (via habituation) with clinical outcomes of exposure therapy. We observed 459 videotaped exposure tasks with 111 participants in three clinical trials for pediatric obsessive–compulsive disorde...

Working memory (WM) develops rapidly during early childhood. In the present study, visual WM (VSM) was measured using the well‐established Spin the Pots task (Hughes & Ensor, 2005), a complex non‐verbal eight‐location object occlusion task. A self‐ordered hiding procedure was adopted to allow for an examination of children's strategy use during a V...

Accommodation refers to the ways in which parents or other family members modify routines or expectations to alleviate a child’s symptoms and emotional distress. In the context of youth obsessive-compulsive disorder (OCD) and anxiety, accommodation contributes to both the development and the maintenance of the disorder. We review the literature on...

Objective: This study measured a variety of within-exposure fear changes and tested the relationship of each with treatment outcomes in exposure therapy. Method: We coded 459 videotaped exposure tasks from 111 participants in 3 clinical trials for pediatric obsessive-compulsive disorder (OCD; POTS trials). Within exposures, fear level was observ...

Cognitive behavioral therapy (CBT) has been established as an empirically supported treatment for anxiety in youth. Recent efforts have been underway to elucidate the evidence- based process factors that are associated with successful outcomes. These factors have included both therapy content (homework; exposure tasks) and therapy process (therapeu...

Direct-to-consumer (DTC) marketing strategies represent an increasingly popular approach to promote patient awareness of psychological treatments (PTs). The Marketing Mix is a well-established framework used to inform marketing decisions consisting of four “P’s”: Product (or Service), Promotion, Place, and Price. We conducted the first DTC marketin...

Anxiety disorders are highly prevalent among youth, with comorbid diagnoses being the norm, not the exception. Few guidelines exist regarding the best approach to treating anxious youth with comorbid mental health conditions. The present paper presents a framework to guide clinicians treating anxious youth who present with comorbid (a) depressive d...

This chapter outlines recommendations for measures that can be used to screen for and diagnose obsessive-compulsive disorder (OCD), as well as to assess severity of symptoms in children. It discusses factors that might affect assessment, including developmental considerations and differential diagnoses. Children presenting with complaints of intrus...

The comprehensive behavioral (ComB) model focuses on the cycle of antecedents, behaviors, and consequences that maintain body-focused repetitive behaviors (BFRBs). It is postulated that BFRBs occur more frequently in the presence of antecedent triggers that cue the BRFB or urges to engage in the behavior. Overall, experimental studies examining the...

Accommodation refers to the ways in which family members act to alleviate a child's symptoms and distress. In the context of youth obsessive-compulsive disorder (OCD) and anxiety, accommodation may contribute to the development and maintenance of the disorder. We review the theory and research literature on accommodation, including measures of acco...

Studies have suggested that exposure is a key ingredient in the treatment of youth with anxiety disorders and obsessive–compulsive disorder (OCD), yet there are several barriers to the implementation of exposures. This may reflect the lack of detail in treatment protocols specifically outlining the delivery of exposure and the lack of consensus on...

Cognitive behavioral therapy (CBT) is an empirically supported and well-established treatment for youth anxiety disorders. CBT therapists often involve parents and school staff in treatment to promote the generalization of therapeutic gains across settings. To facilitate therapist communication with those who provide collateral support, we discuss...

Pediatric obsessive-compulsive disorder (OCD) is a chronic and impairing condition that often persists into adulthood. Barrett, Farrell, Pina, Peris, and Piacentini (2008), in this journal, provided a detailed review of evidence-based psychosocial treatments for youth with OCD. The current review provides an evidence-base update of the pediatric OC...

Previous research has shown that among the various subtypes of obsessive–compulsive disorder (OCD), adults (e.g. Frost, Krause, and Steketee (1996). Behavior Modification, 20(1), 116–132.) and older children and adolescents (Bloch et al. (2009). Pediatrics, 124(4), 1085–1093; Storch et al. (2007). Compr Psychiatry, 48(4), 313–318.) with problematic...