Journal of Obsessive-Compulsive and Related Disorders, Apr 1, 2021
Abstract Hoarding disorder is a common and debilitating mental illness with a high public health ... more Abstract Hoarding disorder is a common and debilitating mental illness with a high public health burden. Current cognitive behavioral therapy (CBT) improves hoarding disorder symptoms, yet many patients refuse treatment, drop out prematurely, or remain symptomatic at treatment end. Additional approaches are needed to improve CBT engagement and enhance treatment outcomes. One possible strategy is imaginal exposure—or envisioning one’s worst case scenario (e.g., throwing something out that is then needed)—to facilitate learning to tolerate the associated distress and uncertainty. Imaginal exposure has been shown to be efficacious for disorders with similar underlying processes as hoarding disorder, including obsessive-compulsive disorder and generalized anxiety disorder; yet it has not been adapted for or investigated in hoarding disorder. To test the effects of imaginal exposure, eight adults with hoarding disorder participated in a written imaginal exposure for 20 minutes daily for three consecutive days. Participants were asked to write about their worst-case scenario related to discarding a possession. Results indicate that this intervention was tolerable, acceptable, and may reduce hoarding disorder-related symptoms, suggesting that it merits further investigation in a larger pilot trial. To our knowledge, this is the first study testing the effects of imaginal exposure in individuals with hoarding disorder.
Families are invested in an older adolescent gradually separating from the family to live indepen... more Families are invested in an older adolescent gradually separating from the family to live independently as an adult, but for many families, adolescent psychopathology makes this transition difficult. Addressing such psychopathology is critical in preventing “failure to launch,” a breakdown in gaining age-appropriate independence from parents. This case study illustrates a promising approach directed at helping an 18-year-old female with agoraphobia and panic disorder who, upon intake, was at risk for long-lasting, prohibitive dependence on her parents. The clinical approach entails the convergence of two psychological treatments conducted in the same treatment center. One provider, working directly with the patient, delivered traditional cognitive-behavioral therapy (CBT) for anxiety. A second provider, working with the parents, delivered Supportive Parenting for Anxious Childhood Emotions (SPACE) a parent-based treatment focused on reducing family accommodation of the patient’s anxiety. Behavioral indices and self-report scores indicated clinically significant improvement following the combined intervention. Attention is drawn to the convergence of those treatments and the utility and special considerations in taking this kind of approach. Overall, the combined treatment may have been more successful than the sum of its parts at preventing failure to launch. This case study, the first to describe the integration of CBT and SPACE, can provide useful guidance for clinicians helping families of adult children to transition to independence.
Worry and rumination, two cardinal responses to emotional events, are key for maintaining negativ... more Worry and rumination, two cardinal responses to emotional events, are key for maintaining negative emotion and have been implicated in the etiology and maintenance of anxiety and depressive disorders. Though worry and rumination are highly correlated with one another and people who engage in one often engage in both, they may differentially affect emotion. Specifically, previous work suggests that worry helps people avoid (intense) emotion, while rumination provokes it. Examining the ways in which these two forms of repetitive negative thinking (RNT) influence cognitive processing of emotional material may help us better understand the emotional sequelae of worry and rumination. This study examines visual attention to emotional information, since attending to certain types of information opens the door for further processing of it. The current study induced worry and rumination and then used eye tracking to compare how each form of RNT influenced the allocation of attention to emotional scenes. Participants induced to worry, compared with those induced to ruminate, spent less time viewing positive (vs. neutral) scenes and were the only group to preferentially maintain their attention on negative images when they were paired with positive images. These findings suggest that worry, compared with rumination, leads to the relative avoidance of positive information. Implications of these findings for research on mood and anxiety disorders are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Journal of Experimental Psychopathology, May 13, 2013
There is burgeoning interest in the study of positive emotion regulation and psychopathology. Giv... more There is burgeoning interest in the study of positive emotion regulation and psychopathology. Given the significant public health costs and the tremendous variance in national prevalence rates associated with many disorders of positive emotion, it is critical to reach an understanding of how cultural factors, along with biological factors, mutually influence positive emotion regulation. Progress in this domain has been relatively unexplored, however, underscoring the need for an integrative review and empirical roadmap for investigating the cultural neuroscientific contributions to positive emotion disturbance for both affective and clinical science domains. The present paper thus provides a multidisciplinary, cultural neuroscience approach to better understand positive emotion regulation and psychopathology. We conclude with a future roadmap for researchers aimed at harnessing positive emotion and alleviating the burden of mental illness cross-culturally.
The aim of this review is to show the fruitfulness of using images of facial expressions as exper... more The aim of this review is to show the fruitfulness of using images of facial expressions as experimental stimuli in order to study how neural systems support biologically relevant learning as it relates to social interactions. Here we consider facial expressions as naturally conditioned stimuli which, when presented in experimental paradigms, evoke activation in amygdala–prefrontal neural circuits that serve to decipher the predictive meaning of the expressions. Facial expressions offer a relatively innocuous strategy with which to investigate these normal variations in affective information processing, as well as the promise of elucidating what role the aberrance of such processing might play in emotional disorders.
Many people, including nearly half of American households, own a pet dog. Previous work has found... more Many people, including nearly half of American households, own a pet dog. Previous work has found that therapy dog interactions reduce distress, but little work to date has empirically established the mood-enhancing effects of interaction with one's own pet dog. In this study, dog owners (N = 73; 86.3% female, 13.7% male; age 25-77 years) underwent a stress-inducing task followed by random assignment to either (a) interacting with their dog (n = 24), (b) an expectancy control (n = 25; "stress-reducing" coloring books), or (c) a waiting control (n = 24). We compared the effects of each condition on affect and state anxiety. Participants assigned to the dog interaction showed greater increases in positive affect, as well as greater reductions in anxiety compared to both expectancy and waiting controls (ds . 0.72, ps , .018). No significant reductions in negative affect were detected. Second, we found that self-reported experiences with animals, attitudes toward animals, or bondedness with their dog did not differentially predict the condition's impact on the owner's mood. Finally, we coded participants' degree of engagement (e.g., time spent playing) with the dog and found that higher engagement predicted reduced negative affect. Overall, interacting with one's own pet dog reduced owners' distress. Such interactions, which occur commonly in daily life, may have the potential to alleviate distress at a large scale. Precisely how this works and for whom it is especially well suited remain intriguing open questions.
Intolerance of uncertainty (IU), the dispositional tendency to fear the unknown, has clinical imp... more Intolerance of uncertainty (IU), the dispositional tendency to fear the unknown, has clinical implications across a variety of disorders. While research has linked IU and OCD, relatively little is known about this association. Previous studies have focused on IU’s association with overall OCD severity and specific symptom dimensions, but we do not yet understand to what degree this cognitive vulnerability is associated with each of the two cardinal symptoms: obsessions and compulsions. Additionally, few studies have examined the established IU subtypes—prospective and inhibitory IU—as unique contributors to OCD severity. Given the ubiquity of uncertainty in daily life and the potential for IU to influence obsessive-compulsive processes, further investigation of this cognitive vulnerability in OCD is warranted. In a sample of patients diagnosed with OCD, partial correlations were conducted to determine the association between OCD severity (separately examining obsessions and compulsi...
Background: Global initiatives to train lay counselors in mental health care delivery have been e... more Background: Global initiatives to train lay counselors in mental health care delivery have been effective with depressed patients in low-income countries. However, lay-counselor models have not been employed to address mental health disparities in high-income countries (HICs). This article presents a lay-counselor program for providing mental health interventions to uninsured, undocumented immigrants in a low-resource setting in the United States.Methods: Mental health professionals trained students as lay counselors to deliver psychoeducation, reduction of psychosocial stressors, and behavioral activation interventions to Spanish-speaking, undocumented immigrants with symptomatic depression. Changes in depressive symptoms prior to and after participation in the program were assessed with the Patient Health Questionnaire-9 (PHQ-9). The educational component of the program was examined administering a survey to the lay counselors.Results: Twenty-five patients enrolled in the program,...
Given the many benefits conferred by trait happiness and life satisfaction, a primary goal is to ... more Given the many benefits conferred by trait happiness and life satisfaction, a primary goal is to determine how these traits relate to underlying cognitive processes. For example, visual attention acts as a gateway to awareness, raising the question of whether happy and satisfied people attend to (and therefore see) the world differently. Previous work suggests that biases in selective attention are associated with both trait negativity and with positive affect states, but to our knowledge, no previous work has explored whether trait-happy individuals attend to the world differently. Here, we employed eye tracking as a continuous measure of sustained overt attention during passive viewing of displays containing positive and neutral photographs to determine whether selective attention to positive scenes is associated with measures of trait happiness and life satisfaction. Both trait measures were significantly correlated with selective attention for positive (vs. neutral) scenes, and this general pattern was robust across several types of positive stimuli (achievement, social, and primary reward), and not because of positive or negative state affect. Such effects were especially prominent during the later phases of sustained viewing. This suggests that people who are happy and satisfied with life may literally see the world in a more positive light, as if through rose-colored glasses. Future work should investigate the causal relationship between such attention biases and one's happiness and life satisfaction.
There is burgeoning interest in the study of positive emotion regulation and psychopathology. Giv... more There is burgeoning interest in the study of positive emotion regulation and psychopathology. Given the significant public health costs and the tremendous variance in national prevalence rates associated with many disorders of positive emotion, it is critical to reach an understanding of how cultural factors, along with biological factors, mutually influence positive emotion regulation. Progress in this domain has been relatively unexplored, however, underscoring the need for an integrative review and empirical roadmap for investigating the cultural neuroscientific contributions to positive emotion disturbance for both affective and clinical science domains. The present paper thus provides a multidisciplinary, cultural neuroscience approach to better understand positive emotion regulation and psychopathology. We conclude with a future roadmap for researchers aimed at harnessing positive emotion and alleviating the burden of mental illness cross-culturally.
The aim of this review is to show the fruitfulness of using images of facial expressions as exper... more The aim of this review is to show the fruitfulness of using images of facial expressions as experimental stimuli in order to study how neural systems support biologically relevant learning as it relates to social interactions. Here we consider facial expressions as naturally conditioned stimuli which, when presented in experimental paradigms, evoke activation in amygdala–prefrontal neural circuits that serve to decipher the predictive meaning of the expressions. Facial expressions offer a relatively innocuous strategy with which to investigate these normal variations in affective information processing, as well as the promise of elucidating what role the aberrance of such processing might play in emotional disorders.
Journal of Obsessive-Compulsive and Related Disorders, Apr 1, 2021
Abstract Hoarding disorder is a common and debilitating mental illness with a high public health ... more Abstract Hoarding disorder is a common and debilitating mental illness with a high public health burden. Current cognitive behavioral therapy (CBT) improves hoarding disorder symptoms, yet many patients refuse treatment, drop out prematurely, or remain symptomatic at treatment end. Additional approaches are needed to improve CBT engagement and enhance treatment outcomes. One possible strategy is imaginal exposure—or envisioning one’s worst case scenario (e.g., throwing something out that is then needed)—to facilitate learning to tolerate the associated distress and uncertainty. Imaginal exposure has been shown to be efficacious for disorders with similar underlying processes as hoarding disorder, including obsessive-compulsive disorder and generalized anxiety disorder; yet it has not been adapted for or investigated in hoarding disorder. To test the effects of imaginal exposure, eight adults with hoarding disorder participated in a written imaginal exposure for 20 minutes daily for three consecutive days. Participants were asked to write about their worst-case scenario related to discarding a possession. Results indicate that this intervention was tolerable, acceptable, and may reduce hoarding disorder-related symptoms, suggesting that it merits further investigation in a larger pilot trial. To our knowledge, this is the first study testing the effects of imaginal exposure in individuals with hoarding disorder.
Families are invested in an older adolescent gradually separating from the family to live indepen... more Families are invested in an older adolescent gradually separating from the family to live independently as an adult, but for many families, adolescent psychopathology makes this transition difficult. Addressing such psychopathology is critical in preventing “failure to launch,” a breakdown in gaining age-appropriate independence from parents. This case study illustrates a promising approach directed at helping an 18-year-old female with agoraphobia and panic disorder who, upon intake, was at risk for long-lasting, prohibitive dependence on her parents. The clinical approach entails the convergence of two psychological treatments conducted in the same treatment center. One provider, working directly with the patient, delivered traditional cognitive-behavioral therapy (CBT) for anxiety. A second provider, working with the parents, delivered Supportive Parenting for Anxious Childhood Emotions (SPACE) a parent-based treatment focused on reducing family accommodation of the patient’s anxiety. Behavioral indices and self-report scores indicated clinically significant improvement following the combined intervention. Attention is drawn to the convergence of those treatments and the utility and special considerations in taking this kind of approach. Overall, the combined treatment may have been more successful than the sum of its parts at preventing failure to launch. This case study, the first to describe the integration of CBT and SPACE, can provide useful guidance for clinicians helping families of adult children to transition to independence.
Worry and rumination, two cardinal responses to emotional events, are key for maintaining negativ... more Worry and rumination, two cardinal responses to emotional events, are key for maintaining negative emotion and have been implicated in the etiology and maintenance of anxiety and depressive disorders. Though worry and rumination are highly correlated with one another and people who engage in one often engage in both, they may differentially affect emotion. Specifically, previous work suggests that worry helps people avoid (intense) emotion, while rumination provokes it. Examining the ways in which these two forms of repetitive negative thinking (RNT) influence cognitive processing of emotional material may help us better understand the emotional sequelae of worry and rumination. This study examines visual attention to emotional information, since attending to certain types of information opens the door for further processing of it. The current study induced worry and rumination and then used eye tracking to compare how each form of RNT influenced the allocation of attention to emotional scenes. Participants induced to worry, compared with those induced to ruminate, spent less time viewing positive (vs. neutral) scenes and were the only group to preferentially maintain their attention on negative images when they were paired with positive images. These findings suggest that worry, compared with rumination, leads to the relative avoidance of positive information. Implications of these findings for research on mood and anxiety disorders are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Journal of Experimental Psychopathology, May 13, 2013
There is burgeoning interest in the study of positive emotion regulation and psychopathology. Giv... more There is burgeoning interest in the study of positive emotion regulation and psychopathology. Given the significant public health costs and the tremendous variance in national prevalence rates associated with many disorders of positive emotion, it is critical to reach an understanding of how cultural factors, along with biological factors, mutually influence positive emotion regulation. Progress in this domain has been relatively unexplored, however, underscoring the need for an integrative review and empirical roadmap for investigating the cultural neuroscientific contributions to positive emotion disturbance for both affective and clinical science domains. The present paper thus provides a multidisciplinary, cultural neuroscience approach to better understand positive emotion regulation and psychopathology. We conclude with a future roadmap for researchers aimed at harnessing positive emotion and alleviating the burden of mental illness cross-culturally.
The aim of this review is to show the fruitfulness of using images of facial expressions as exper... more The aim of this review is to show the fruitfulness of using images of facial expressions as experimental stimuli in order to study how neural systems support biologically relevant learning as it relates to social interactions. Here we consider facial expressions as naturally conditioned stimuli which, when presented in experimental paradigms, evoke activation in amygdala–prefrontal neural circuits that serve to decipher the predictive meaning of the expressions. Facial expressions offer a relatively innocuous strategy with which to investigate these normal variations in affective information processing, as well as the promise of elucidating what role the aberrance of such processing might play in emotional disorders.
Many people, including nearly half of American households, own a pet dog. Previous work has found... more Many people, including nearly half of American households, own a pet dog. Previous work has found that therapy dog interactions reduce distress, but little work to date has empirically established the mood-enhancing effects of interaction with one's own pet dog. In this study, dog owners (N = 73; 86.3% female, 13.7% male; age 25-77 years) underwent a stress-inducing task followed by random assignment to either (a) interacting with their dog (n = 24), (b) an expectancy control (n = 25; "stress-reducing" coloring books), or (c) a waiting control (n = 24). We compared the effects of each condition on affect and state anxiety. Participants assigned to the dog interaction showed greater increases in positive affect, as well as greater reductions in anxiety compared to both expectancy and waiting controls (ds . 0.72, ps , .018). No significant reductions in negative affect were detected. Second, we found that self-reported experiences with animals, attitudes toward animals, or bondedness with their dog did not differentially predict the condition's impact on the owner's mood. Finally, we coded participants' degree of engagement (e.g., time spent playing) with the dog and found that higher engagement predicted reduced negative affect. Overall, interacting with one's own pet dog reduced owners' distress. Such interactions, which occur commonly in daily life, may have the potential to alleviate distress at a large scale. Precisely how this works and for whom it is especially well suited remain intriguing open questions.
Intolerance of uncertainty (IU), the dispositional tendency to fear the unknown, has clinical imp... more Intolerance of uncertainty (IU), the dispositional tendency to fear the unknown, has clinical implications across a variety of disorders. While research has linked IU and OCD, relatively little is known about this association. Previous studies have focused on IU’s association with overall OCD severity and specific symptom dimensions, but we do not yet understand to what degree this cognitive vulnerability is associated with each of the two cardinal symptoms: obsessions and compulsions. Additionally, few studies have examined the established IU subtypes—prospective and inhibitory IU—as unique contributors to OCD severity. Given the ubiquity of uncertainty in daily life and the potential for IU to influence obsessive-compulsive processes, further investigation of this cognitive vulnerability in OCD is warranted. In a sample of patients diagnosed with OCD, partial correlations were conducted to determine the association between OCD severity (separately examining obsessions and compulsi...
Background: Global initiatives to train lay counselors in mental health care delivery have been e... more Background: Global initiatives to train lay counselors in mental health care delivery have been effective with depressed patients in low-income countries. However, lay-counselor models have not been employed to address mental health disparities in high-income countries (HICs). This article presents a lay-counselor program for providing mental health interventions to uninsured, undocumented immigrants in a low-resource setting in the United States.Methods: Mental health professionals trained students as lay counselors to deliver psychoeducation, reduction of psychosocial stressors, and behavioral activation interventions to Spanish-speaking, undocumented immigrants with symptomatic depression. Changes in depressive symptoms prior to and after participation in the program were assessed with the Patient Health Questionnaire-9 (PHQ-9). The educational component of the program was examined administering a survey to the lay counselors.Results: Twenty-five patients enrolled in the program,...
Given the many benefits conferred by trait happiness and life satisfaction, a primary goal is to ... more Given the many benefits conferred by trait happiness and life satisfaction, a primary goal is to determine how these traits relate to underlying cognitive processes. For example, visual attention acts as a gateway to awareness, raising the question of whether happy and satisfied people attend to (and therefore see) the world differently. Previous work suggests that biases in selective attention are associated with both trait negativity and with positive affect states, but to our knowledge, no previous work has explored whether trait-happy individuals attend to the world differently. Here, we employed eye tracking as a continuous measure of sustained overt attention during passive viewing of displays containing positive and neutral photographs to determine whether selective attention to positive scenes is associated with measures of trait happiness and life satisfaction. Both trait measures were significantly correlated with selective attention for positive (vs. neutral) scenes, and this general pattern was robust across several types of positive stimuli (achievement, social, and primary reward), and not because of positive or negative state affect. Such effects were especially prominent during the later phases of sustained viewing. This suggests that people who are happy and satisfied with life may literally see the world in a more positive light, as if through rose-colored glasses. Future work should investigate the causal relationship between such attention biases and one's happiness and life satisfaction.
There is burgeoning interest in the study of positive emotion regulation and psychopathology. Giv... more There is burgeoning interest in the study of positive emotion regulation and psychopathology. Given the significant public health costs and the tremendous variance in national prevalence rates associated with many disorders of positive emotion, it is critical to reach an understanding of how cultural factors, along with biological factors, mutually influence positive emotion regulation. Progress in this domain has been relatively unexplored, however, underscoring the need for an integrative review and empirical roadmap for investigating the cultural neuroscientific contributions to positive emotion disturbance for both affective and clinical science domains. The present paper thus provides a multidisciplinary, cultural neuroscience approach to better understand positive emotion regulation and psychopathology. We conclude with a future roadmap for researchers aimed at harnessing positive emotion and alleviating the burden of mental illness cross-culturally.
The aim of this review is to show the fruitfulness of using images of facial expressions as exper... more The aim of this review is to show the fruitfulness of using images of facial expressions as experimental stimuli in order to study how neural systems support biologically relevant learning as it relates to social interactions. Here we consider facial expressions as naturally conditioned stimuli which, when presented in experimental paradigms, evoke activation in amygdala–prefrontal neural circuits that serve to decipher the predictive meaning of the expressions. Facial expressions offer a relatively innocuous strategy with which to investigate these normal variations in affective information processing, as well as the promise of elucidating what role the aberrance of such processing might play in emotional disorders.
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Papers by Hannah Raila