David H. Barlow

Boston University, Boston, Massachusetts, United States

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Publications (488)1882.29 Total impact

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    ABSTRACT: Objective: This study tested a motivational text message treatment adjunct for individuals with eating disorders (EDs) who exhibited high dietary restraint/restriction. Method: A replicated single-case alternating treatment design was used to examine 1) the feasibility of combining a brief motivational interview with subsequent text messages and 2) the influence of the text messages on eating behaviors and motivation to change in individuals with EDs (N = 12). The protocol was eight weeks and the text messages were adjunctive to cognitive behavioral therapy. Results: The intervention was well accepted (mean rating = 7/10) and feasible within the context of monetary compensation (mean daily-monitoring compliance = 91%). Text messages did not impact behavioral outcomes: dietary restraint and kilocalorie intake. They had mixed effects on motivation to change dietary restraint, measured by the Readiness and Motivation Questionnaire (RMQ). When receiving text messages, RMQ precontemplation scores (desire to restrict) significantly increased, indicating decreased motivation; however, action scores (effort towards reducing dietary restraint) significantly increased, indicating increased motivation. These effects were moderated by weight status. Underweight individuals (n = 4; BMI < 19.0) reported increased ambivalence, that is increased desire to restrict and increased action toward reducing restriction, in response to the text messages. Normal-weight participants (n = 8; BMI > 19.0) reported only increased action towards reducing restriction in response to the text messages. Discussion: These data demonstrate text messages are a potentially feasible and acceptable treatment adjunct and may be effective at increasing motivation to change for normal-weight individuals, while their influence on underweight patients is more complex. These findings provide a foundation for future research in technology-based motivational interventions for EDs and offer preliminary evidence for using these methods among normal-weight individuals.
    No preview · Article · Jan 2016
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    ABSTRACT: The present study explored whether distress reduction in response to strong negative emotions, a putative transdiagnostic mechanism of action, is facilitated by mindfulness strategies. Seven patients (mean age = 31.14 years, SD = 12.28, range 19-48 years, 43% female, 86% Caucasian) with heterogeneous anxiety disorders (i.e., panic disorder with or without agoraphobia, social anxiety, generalized anxiety) were assigned a randomized order of week-long blocks utilizing either mindfulness- or avoidance-based strategies while ascending a 6-week emotion exposure hierarchy. Participants completed three exposures per block and provided distress and avoidance use ratings following each exposure. Anxiety severity, distress aversion, and distraction/suppression tendencies were also assessed at baseline and the conclusion of each block. Visual, descriptive, and effect size results showed exposures utilizing mindfulness were associated with higher overall distress levels, compared to those utilizing avoidance. Within blocks, the majority of participants exhibited declining distress levels when employing mindfulness strategies, as opposed to more static distress levels in the avoidance condition. Systematic changes in anxiety severity, distress aversion, and distraction/suppression were not observed. These results suggest mindfulness strategies may be effective in facilitating emotion exposure; however, a minimum dosage may be necessary to overcome initial distress elevation. Potential transdiagnostic change mechanisms and clinical implications are discussed.
    Full-text · Article · Jan 2016
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    ABSTRACT: Objective: A subset of individuals with bulimia nervosa (BN) have borderline personality disorder (BPD) symptoms, including chronic negative affect and interpersonal problems. These symptoms predict poor BN treatment outcome in some studies. The broad version of Enhanced Cognitive Behavior Therapy (CBT-E) was developed to address co-occurring problems that interfere with treatment response. The current study investigated the relative effects, predictors, and moderators of CBT-E for BN with BPD and co-occurring mood/anxiety disorders. Method: Fifty patients with BN and threshold or sub-threshold BPD and current or recent Axis I mood or anxiety disorders were randomly assigned to receive focused CBT-E (CBT-Ef) or broad CBT-E (CBT-Eb) specifically including an interpersonal module and additional attention to mood intolerance. Results: Forty-two percent of the sample reported remission from binge eating and purging at termination. Significant changes across symptom domains were observed at termination and at 6-month follow-up. Though CBT-Ef predicted good outcomes in multivariate models, the severity of affective/interpersonal problems moderated treatment effects: participants with higher severity showed better ED outcomes in CBT-Eb, whereas those with lower severity showed better outcomes in CBT-Ef. Severity of affective/interpersonal BPD symptoms at baseline predicted negative outcomes overall. Follow-up BPD affective/interpersonal problems were predicted by baseline affective/interpersonal problems and by termination EDE score. Discussion: This study supports the utility of CBT-E for patients with BN and complex comorbidity. CBT-Ef appears to be more efficacious for patients with relatively less severe BPD symptoms, whereas CBT-Eb appears to be more efficacious for patients with more severe BPD symptoms. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015;).
    No preview · Article · Dec 2015 · International Journal of Eating Disorders
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    ABSTRACT: Background: Cognitive behavioral therapy (CBT) and pharmacotherapy are efficacious for the short-term treatment of panic disorder. Less is known about the efficacy of these therapies for individuals who do not respond fully to short-term CBT. Method: The current trial is a second-step stratified randomized design comparing two treatment conditions-selective serotonin reuptake inhibitor (SSRI; paroxetine or citalopram; n = 34) and continued CBT (n = 24)-in a sample of individuals classified as treatment nonresponders to an initial course of CBT for panic disorder. Participants were randomized to 3 months of treatment and then followed for an additional 9 months. Only treatment responders after 3 months were maintained on the treatment until 12-month follow-up. Data analysis focused on panic disorder symptoms and achievement of response status across the first 3 months of treatment. Final follow-up data are presented descriptively. Results: Participants in the SSRI condition showed significantly lower panic disorder symptoms as compared to continued CBT at 3 months. Results were similar when excluding individuals with comorbid major depression or analyzing the entire intent-to-treat sample. Group differences disappeared during 9-month naturalistic follow-up, although there was significant attrition and use of nonstudy therapies in both arms. Conclusions: These data suggest greater improvement in panic disorder symptoms when switching to SSRI after failure to fully respond to an initial course of CBT. Future studies should further investigate relapse following treatment discontinuation for nonresponders who became responders. Clinicaltrials.gov Identifier: NCT00000368; https://clinicaltrials.gov/show/NCT00000368.
    No preview · Article · Dec 2015 · Depression and Anxiety
  • Hannah Boettcher · C.Alex Brake · David H. Barlow
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    ABSTRACT: Background and objectives: Interoceptive exposure (IE) is a behavioral intervention that reduces anxiety sensitivity and distress associated with somatic sensations. In this discussion, we describe the history, current applications and additional clinical potential of IE. Method: We review the origins of IE and its historical application to panic disorder, as well as the accumulating evidence for transdiagnostic application to other disorders including post-traumatic stress disorder, social anxiety disorder, specific phobias and physical disorders. Then, we discuss ways in which IE could contribute to the treatment of additional disorders. Results: IE is well-established in the treatment of panic disorder and increasingly used to target anxiety-provoking physical sensations in other disorders. Research and clinical evidence suggests that anxiety sensitivity is present across a range of disorders, and may actually be one variation on a broader phenomenon of interoceptive sensitivity, or anxiety focused on physical sensations that have been conditioned to unpleasant emotional states. Moreover, somatic symptoms are central to the experience of most emotions and may contribute to avoidant coping, a maintenance factor for disorders of emotion. IE has potential as a transdiagnostic intervention targeting interoceptive sensitivity in disorders such as depression and eating disorders. Nevertheless, IE is underutilized by clinicians in practice. Recent research in inhibitory learning and extinction suggests strategies for maximizing the effectiveness of IE. Limitations: This review is not exhaustive in nature, and systematic research on transdiagnostic applications of IE remains scarce. Conclusions: IE is a potentially powerful yet understudied transdiagnostic intervention.
    No preview · Article · Nov 2015 · Journal of Behavior Therapy and Experimental Psychiatry
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    ABSTRACT: Both maladaptive and adaptive emotion regulation strategies have been linked with psychopathology. However, previous studies have largely examined them separately, and little research has examined the interplay of these strategies cross-sectionally or longitudinally in patients undergoing psychological treatment. This study examined the use and interplay of adaptive and maladaptive emotion regulation strategies in 81 patients receiving cognitive-behavioral interventions for comorbid alcohol use and anxiety disorders. Patients completed measures of emotion regulation strategy use and symptoms of psychopathology pre- and post-treatment. Cross-sectionally, higher use of maladaptive strategies (e.g., denial) was significantly related to higher psychopathology pre- and post-treatment, whereas higher use of adaptive strategies (e.g., acceptance) only significantly related to lower psychopathology post-treatment. Prospectively, changes in maladaptive strategies, but not changes in adaptive strategies, were significantly associated with post-treatment psychopathology. However, for patients with higher pre-treatment maladaptive strategy use, gains in adaptive strategies were significantly associated with lower post-treatment psychopathology. These findings suggest that psychological treatments may maximize efficacy by considering patient skill use at treatment outset. By better understanding a patient's initial emotion regulation skills, clinicians may be better able to optimize treatment outcomes by emphasizing maladaptive strategy use reduction predominately, or in conjunction with increasing adaptive skill use. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Aug 2015 · Behaviour Research and Therapy
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    ABSTRACT: Although direct-to-consumer (DTC) marketing of pharmacologic interventions is effective and common, similar approaches have yet to be evaluated in the promotion of psychological treatments (PTs). This is the first randomized controlled trial evaluating the potential of DTC marketing of PTs. Participants (N = 344; 75.0% female, mean age = 18.6 years, 48.5% non-Hispanic White) were randomly assigned to consume one of four extended commercial campaigns embedded within unrelated programming across 3 weeks. The four campaign conditions were a PT campaign, a PT informing about medication side effects campaign, a medication campaign, and a neutral campaign. Attitudes about and intention to seek psychological treatment were assessed prior to campaign exposure (T1), 1 week following the final week of campaign exposure (T2), and at a 3-month follow-up evaluation (T3). The percentage of participants who newly intended psychological treatment at T2 or T3 differed by condition, with those assigned to the PT campaign slightly more likely to have intended to receive psychological treatment at T2 or T3 than those in other conditions. Baseline reports of emotional symptoms moderated the effect of condition on attitudes toward PT and perceived likelihood of seeking treatment in the future. Findings support the preliminary utility of DTC marketing of psychological treatments. Increasing consumer knowledge of PTs may be a worthwhile complement to current dissemination and implementation efforts aimed at promoting the uptake of PTs in mental health care. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    No preview · Article · Jun 2015 · Journal of Consulting and Clinical Psychology
  • James F. Boswell · Kate H. Bentley · David H. Barlow

    No preview · Chapter · Jun 2015
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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.
    No preview · Article · May 2015 · Comprehensive psychiatry
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    ABSTRACT: Background: The Overall Depression Severity and Impairment Scale (ODSIS) is a brief, five-item measure for assessing the frequency and intensity of depressive symptoms, as well as functional impairments in pleasurable activities, work or school, and interpersonal relationships due to depression. Although this scale is expected to be useful in various psychiatric and mental health settings, the reliability, validity, and interpretability have not yet been fully examined. This study was designed to examine the reliability, factorial, convergent, and discriminant validity of a Japanese version of the ODSIS, as well as its ability to distinguish between individuals with and without a major depressive disorder diagnosis. Methods: From a pool of registrants at an internet survey company, 2830 non-clinical and clinical participants were selected randomly (619 with major depressive disorder, 619 with panic disorder, 576 with social anxiety disorder, 645 with obsessive-compulsive disorder, and 371 non-clinical panelists). Participants were asked to respond to the ODSIS and conventional measures of depression, functional impairment, anxiety, neuroticism, satisfaction with life, and emotion regulation. Results: Exploratory and confirmatory factor analysis of three split subsamples indicated the unidimensional factor structure of ODSIS. Multi-group confirmatory factor analysis showed invariance of factor loadings between non-clinical and clinical subsamples. The ODSIS also showed excellent internal consistency and test-retest intraclass correlation coefficients. Convergence and discriminance of the ODSIS with various measures were in line with our expectations. Receiver operating characteristic curve analyses showed that the ODSIS was able to detect a major depressive syndrome accurately. Conclusions: This study supports the reliability and validity of ODSIS in a non-western population, which can be interpreted as demonstrating cross-cultural validity.
    Full-text · Article · Apr 2015 · PLoS ONE
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    Full-text · Article · Apr 2015 · American Journal of Psychiatry
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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.
    No preview · Article · Feb 2015 · Clinical Psychology Review

  • No preview · Article · Feb 2015
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    Matthew W. Gallagher · Kate H. Bentley · David H. Barlow
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    ABSTRACT: Contemporary theories of psychopathology suggest a lack of perceived control as central to the experience of negative emotion and to be particularly relevant to the development of anxiety disorders. The present study meta-analytically reviewed the relationship between perceived control and both trait and disorder-specific measures of anxiety in order to determine whether current evidence is consistent with perceived control functioning as a transdiagnostic vulnerability factor. A comprehensive literature review identified 51 studies with a total of 11,218 participants that were determined to meet eligibility criteria. The mean effect sizes between perceived control and trait measures of anxiety (k = 29) and disorder specific measures of anxiety (k = 37) were calculated using random-effects methods. Results indicated a large, negative association between perceived control and both trait measures of anxiety and disorder-specific measures of anxiety, with the largest associations being between perceived control and generalized anxiety disorder. Moderator analyses indicated that the associations between perceived control and trait anxiety were greater in adults than children, and varied across different measures of perceived control. These results underscore the importance of perceived control as a transdiagnostic vulnerability factor across the anxiety disorders.
    Full-text · Article · Dec 2014 · Cognitive Therapy and Research
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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.
    Full-text · Article · Nov 2014 · Behavior Therapy
  • 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.
    No preview · Article · Nov 2014 · Behaviour Research and Therapy
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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.
    No preview · Article · Nov 2014 · Depression and Anxiety
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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.
    No preview · Article · Nov 2014 · Comprehensive Psychiatry
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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.
    No preview · Article · Oct 2014 · Behavior Modification
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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).
    No preview · Article · Sep 2014 · Psychological Assessment

Publication Stats

26k Citations
1,882.29 Total Impact Points


  • 1996-2016
    • Boston University
      • • Department of Psychology
      • • Center for Anxiety and Related Disorders
      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
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States
    • Honolulu University
      Honolulu, Hawaii, United States
  • 2010
    • University of Missouri - St. Louis
      • Department of Psychology
      Saint Louis, MI, United States
  • 2008
    • Mount Sinai School of Medicine
      • Department of Psychiatry
      Manhattan, NY, United States
  • 2005-2008
    • Center for Autism and Related Disorders
      Burbank, California, United States
  • 2006
    • University of Glasgow
      Glasgow, Scotland, United Kingdom
  • 1997-2006
    • University of Oxford
      • Nuffield Department of Obstetrics and Gynaecology
      Oxford, England, United Kingdom
  • 1996-2006
    • Oxford University Hospitals NHS Trust
      • • Department of Paediatrics
      • • Department of Cellular Pathology
      Oxford, England, United Kingdom
  • 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
  • 2003
    • Rhode Island Hospital
      Providence, Rhode Island, United States
  • 2001
    • Columbia University
      • Department of Psychiatry
      New York, New York, United States
  • 1969-2001
    • University of Vermont
      • Department of Psychology
      Burlington, VT, 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
  • 1995
    • University of Iowa
      • Department of Psychology
      Iowa City, Iowa, United States
  • 1990-1994
    • University of California, Los Angeles
      • Department of Psychology
      Los Ángeles, California, United States
  • 1980-1994
    • University at Albany, The State University of New York
      • Department of Psychology
      New York City, New York, United States
  • 1992
    • University of Queensland 
      • School of Psychology
      Brisbane, Queensland, Australia
  • 1989
    • State University of New York College at Oneonta
      • Department of Psychology
      ONH, New York, United States
  • 1987
    • Indiana State University
      HUF, Indiana, United States
  • 1980-1981
    • University of Pittsburgh
      • Psychology
      Pittsburgh, Pennsylvania, United States
  • 1978-1980
    • Brown University
      Providence, Rhode Island, 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
      • Department of Psychiatry and Human Behavior
      Jackson, Mississippi, United States