Effective exposure therapies for anxiety disorders have been available for half a century. Over that time we have made great strides increasing the potency of these powerful methods. Yet, most of us in practice still have a conversation like the following with our new patients: Therapist: "So what treatments have you had for your anxiety symptoms to date?" METHODS "I have seen numerous therapists over the last 10 years." Therapist: "Great, so what did you do?" METHODS "We talked about things. And I learned relaxation and breathing techniques." Therapist: "Did a therapist ever help you face your fears?" METHODS "What do you mean?" Therapist: "I mean did you directly confront feared situations, perhaps with your therapist outside the office?" METHODS "No, why, is that important?" This oft-repeated conversation highlights the disconnect between the well-established efficacy of exposure-based treatments for pathological anxiety and their inaccessibility to most anxious clients. This failure to successfully disseminate exposure-based empirically supported treatments is the motivation for this special issue. The articles that follow consider the causes of this dissemination failure, highlight areas of success, and offer constructive remedies for addressing this important public health problem.