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1.  Measuring the suicidal mind: implicit cognition predicts suicidal behavior 
Psychological science  2010;21(4):511-517.
Suicide is a leading cause of death worldwide, challenging all theories that assume a universal drive for self-preservation. It is difficult to predict and prevent because people who consider killing themselves often are unwilling or incapable of reporting their intention. Advances in the measurement of implicit cognition provide an opportunity to test whether automatic associations of self with death can provide a behavioral marker of suicide risk. We measured implicit associations about death/suicide in 157 people presenting for treatment at a psychiatric emergency department while they awaited medical attention. Results confirmed that suicide attempters hold a significantly stronger implicit association between death/suicide and self than do psychiatrically distressed nonattempters. Moreover, the implicit association of death/suicide with self was associated with an approximately six-fold increase in the odds of making a suicide attempt in the next 6 months, exceeding the predictive validity of known risk factors (e.g., depression or suicide attempt history) and both patients’ and clinicians’ predictions. These results provide the first evidence of a behavioral marker for suicidal behavior and suggest that measures of implicit cognition may be useful for detecting and predicting sensitive clinical behaviors that are unlikely to be reported.
doi:10.1177/0956797610364762
PMCID: PMC5258199  PMID: 20424092
suicide; suicide attempt; prediction; IAT
2.  Living with Tics: Reduced Impairment and Improved Quality of Life for Youth with Chronic Tic Disorders 
Psychiatry research  2014;225(3):571-579.
Pharmacological and behavioral interventions have focused on reducing tic severity to alleviate tic-related impairment for youth with chronic tic disorders (CTDs), with no existing intervention focused on the adverse psychosocial consequences of tics. This study examined the preliminary efficacy of a modularized cognitive behavioral intervention ("Living with Tics", LWT) in reducing tic-related impairment and improving quality of life relative to a waitlist control of equal duration. Twenty-four youth (ages 7–17 years) with Tourette Disorder or Chronic Motor Tic Disorder and psychosocial impairment participated. A treatment-blind evaluator conducted all pre- and post-treatment clinician-rated measures. Youth were randomly assigned to receive the LWT intervention (n=12) or a 10-week waitlist (n=12). The LWT intervention consisted of up to 10 weekly sessions targeted at reducing tic-related impairment and developing skills to manage psychosocial consequences of tics. Youth in the LWT condition experienced significantly reduced clinician-rated tic-impairment, and improved child-rated quality of life. Ten youth (83%) in the LWT group were classified as treatment responders compared to four youth in the waitlist condition (33%). Treatment gains were maintained at one-month follow-up. Findings provide preliminary data that the LWT intervention reduces tic-related impairment and improves quality of life for youth with CTDs.
doi:10.1016/j.psychres.2014.11.045
PMCID: PMC4314444  PMID: 25500348
cognitive behavior therapy; functional impairment; treatment outcome; quality of life; chronic tic disorders; Tourette Disorder
3.  Does d-Cycloserine Augmentation of CBT Improve Therapeutic Homework Compliance for Pediatric Obsessive–Compulsive Disorder? 
Clinical studies in adults and children with obsessive–compulsive disorder (OCD) have shown that d-cycloserine (DCS) can improve treatment response by enhancing fear extinction learning during exposure-based psychotherapy. Some have hypothesized that improved treatment response is a function of increased compliance and engagement in therapeutic homework tasks, a core component of behavioral treatment. The present study examined the relationship between DCS augmented cognitive-behavioral therapy (CBT) and homework compliance in a double-blind, placebo controlled trial with 30 youth with OCD. All children received 10 CBT sessions, the last seven of which included exposure and response prevention paired with DCS or placebo dosed 1 h before the session started. Results suggested that DCS augmented CBT did not predict improved homework compliance over the course of treatment, relative to the placebo augmented CBT group. However, when groups were collapsed, homework compliance was directly associated with treatment outcome. These findings suggest that while DCS may not increase homework compliance over time, more generally, homework compliance is an integral part of pediatric OCD treatment outcome.
doi:10.1007/s10826-013-9742-1
PMCID: PMC4078886  PMID: 24999301
Obsessive–compulsive disorder; d-Cycloserine; Exposure and response prevention; Homework compliance; Children
4.  Novel approaches in treatment of pediatric anxiety 
F1000Prime Reports  2014;6:30.
Pediatric anxiety disorders have high prevalence rates and morbidity and are associated with considerable functional impairment and distress. They may be predictors for the development of other psychiatric disorders and, without intervention, are more likely to persist into adulthood. While evidence-based pharmacological and behavioral interventions are currently available, there remains a sizable subset of youth who remain only partially treatment-responsive and therefore symptomatic following treatment. Novel methods of treatment, pharmacologic and non-pharmacologic, including acceptance and commitment therapy (ACT), attention bias modification (ABM), d-cycloserine (DCS) augmentation of cognitive behavioral treatment (CBT), and glutamatergic agents such as riluzole, are briefly introduced and discussed.
doi:10.12703/P6-30
PMCID: PMC4017908  PMID: 24860652
5.  The Leyton Obsessional Inventory – Child Version Survey Form Does Not Demonstrate Adequate Psychometric Properties in American Youth with Pediatric Obsessive-Compulsive Disorder 
Journal of anxiety disorders  2011;25(4):10.1016/j.janxdis.2011.01.005.
The psychometric properties of the Leyton Obsessional Inventory–Child Version Survey Form (LOI-CV Survey Form) and the Short Leyton Obsessional Inventory–Child Version Survey Form (Short LOI-CV Survey Form) were examined in a clinical sample of 50 children and adolescents with obsessive-compulsive disorder (OCD). The internal consistency of the LOI-CV and Short LOI-CV Survey Forms were acceptable and poor, respectively (α = .79 and .65). The LOI-CV Survey Form was significantly and moderately correlated with child-rated OCD-related impairment, but was not significantly correlated with any other measures of OCD symptom frequency or severity, OCD-related impairment, global symptom severity, child reports of anxiety and depressive symptoms, and parent reports of children’s obsessive-compulsive, internalizing, and externalizing symptoms. Modest support for the cognitive-behavioral treatment sensitivity of the LOI-CV Survey Form (Cohen’s d = 0.98) but not the Short LOI-CV Survey Form (Cohen’s d = 0.09) was demonstrated. Diagnostic sensitivity was poor for the LOI-CV Survey Form at both pre- (0.14) and post-treatment (0.06). Overall, these results suggest that the psychometric properties of the LOI-CV and Short LOI-CV Survey Forms are not adequate for use as a screening instrument or in assessing symptom severity in pediatric OCD.
doi:10.1016/j.janxdis.2011.01.005
PMCID: PMC3808992  PMID: 21353458
Obsessive-compulsive disorder; Leyton Obsessional Inventory–Child Version Survey Form; Children; Assessment; Reliability; Treatment; Validity
6.  Attentional Bias toward Suicide-Related Stimuli Predicts Suicidal Behavior 
Journal of abnormal psychology  2010;119(3):616-622.
A long-standing challenge for scientific and clinical work on suicidal behavior is that people often are motivated to deny or conceal suicidal thoughts. We proposed that people considering suicide would possess an objectively measurable attentional bias toward suicide-related stimuli, and that this bias would predict future suicidal behavior. Participants were 124 adults presenting to a psychiatric emergency department who were administered a modified emotional Stroop task and followed for six months. Suicide attempters showed an attentional bias toward suicide-related words relative to neutral words, and this bias was strongest among those who had made a more recent attempt. Importantly, this suicide-specific attentional bias predicted which people made a suicide attempt over the next six months, above and beyond other clinical predictors. Attentional bias toward more general negatively-valenced words did not predict any suicide-related outcomes, supporting the specificity of the observed effect. These results suggest that suicide-specific attentional bias can serve as a behavioral marker for suicidal risk, and ultimately improve scientific and clinical work on suicide-related outcomes.
doi:10.1037/a0019710
PMCID: PMC2994414  PMID: 20677851
suicide; attentional bias; Stroop task; prediction

Results 1-6 (6)