Dissemination is complex. It depends on the value of what is being disseminated to the recipient, and on professional and financial barriers to the adoption of what is being disseminated. Four examples are considered. In the first, an effective treatment program for adult stutterers, the tribal nature of health care slowed adoption. In the second, a model anxiety disorders clinic, a text book and matching video aided dissemination. In the third, government policy made it difficult for primary care physicians to carry out the CBT they had learned. In the fourth, the internet treatment for anxiety and depression succeeded because of the pent up demand for such services among the public.