Michael W Otto

Boston University, Boston, Massachusetts, United States

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Publications (328)1459.6 Total impact

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    ABSTRACT: The use of d-cycloserine (DCS) as a cognitive enhancer to augment exposure-based cognitive-behavioral therapy (CBT) represents a promising new translational research direction with the goal to accelerate and optimize treatment response for anxiety disorders. Some studies suggest that DCS may not only augment extinction learning but could also facilitate fear memory reconsolidation. Therefore, the effect of DCS may depend on fear levels reported at the end of exposure sessions. This paper presents the rationale and design for an ongoing randomized controlled trial examining the relative efficacy of tailoring DCS administration based on exposure success (i.e. end fear levels) during a 5-session group CBT protocol for social anxiety disorder (n=156). Specifically, tailored post-session DCS administration will be compared against untailored post-session DCS, untailored pre-session DCS, and pill placebo in terms of reduction in social anxiety symptoms and responder status. In addition, a subset of participants (n=96) will undergo a fear extinction retention experiment prior to the clinical trial in which they will be randomly assigned to receive either DCS or placebo prior to extinguishing a conditioned fear. The results from this experimental paradigm will clarify the mechanism of the effects of DCS on exposure procedures. This study aims to serve as the first step toward developing an algorithm for the personalized use of DCS during CBT for social anxiety disorder, with the ultimate goal of optimizing treatment outcome for anxiety disorders. Copyright © 2015. Published by Elsevier Inc.
    Contemporary clinical trials 06/2015; DOI:10.1016/j.cct.2015.06.015 · 1.99 Impact Factor
  • International Journal of Cognitive Therapy 05/2015; DOI:10.1521/ijct_2015_8_02 · 0.98 Impact Factor
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    ABSTRACT: Distress intolerance is linked to the maintenance of panic disorder and cigarette smoking, and may underlie both problems. Smokers (n = 54; 40.7% panic disorder) were recruited for an experimental study; half were randomly assigned to 12-hour nicotine deprivation and half smoked as usual. The current investigation consisted of secondary, exploratory analyses from this larger experimental study. Four distress intolerance indices were examined as predictors of anxious responding to an emotional elicitation task (10% carbon dioxide (CO2)-enriched air challenge); anxious responding was in turn examined as a predictor of post-challenge panic and nicotine withdrawal symptoms. The Distress Tolerance Scale (DTS) was significantly negatively associated with anxious responding to the challenge (β = -0.41, p = 0.017). The DTS was negatively associated with post-challenge increases nicotine withdrawal symptoms indirectly through the effect of anxious responding to the challenge (b = -0.485, CI95% (-1.095, -0.033)). This same indirect effect was found for post-challenge severity of panic symptoms (b = -0.515, CI95% (-0.888, -0.208)). The DTS was directly predictive of post-challenge increases nicotine withdrawal symptoms, in the opposite direction (β = 0.37, p = 0.009), but not panic symptom severity. Anxious responding in response to stressful experiences may explain the impact of perceived distress intolerance on panic and nicotine withdrawal symptom expression. © The Author(s) 2015.
    Journal of Psychopharmacology 03/2015; DOI:10.1177/0269881115575536 · 2.81 Impact Factor
  • Kristin L. Szuhany, Michael W. Otto
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    ABSTRACT: Distress intolerance (DI), the inability to tolerate stressful experiences, has been linked to multiple psychiatric conditions and maladaptive coping patterns. Although DI is often considered a trait-like variable, evidence indicates that self-report and behavioral indices of DI can be manipulated by contextual factors. Understanding such contextual influences is important given evidence of unexpected variability in these presumed trait-like measures over brief intervals. The current study examined the influence of context (manipulated by priming concepts of “Interminability” and “Brevity”) in predicting behavioral persistence, in relation to self-reported DI. Results indicated that priming Brevity was associated with terminating a cold-pressor task more quickly. Self-reported DI was linked to earlier termination, but there was no interaction between self-reported DI and priming condition. Results indicate that contextual cues modulate performance on behavioral measures of DI. Hence, models of DI should consider both trait-like and contextual factors in understanding variability in DI measures.
    Cognitive Therapy and Research 03/2015; 39(4). DOI:10.1007/s10608-015-9672-x · 1.70 Impact Factor
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    ABSTRACT: A significant body of research has investigated the effects of physical activity on sleep, yet this research has not been systematically aggregated in over a decade. As a result, the magnitude and moderators of these effects are unclear. This meta-analytical review examines the effects of acute and regular exercise on sleep, incorporating a range of outcome and moderator variables. PubMed and PsycINFO were used to identify 66 studies for inclusion in the analysis that were published through May 2013. Analyses reveal that acute exercise has small beneficial effects on total sleep time, sleep onset latency, sleep efficiency, stage 1 sleep, and slow wave sleep, a moderate beneficial effect on wake time after sleep onset, and a small effect on rapid eye movement sleep. Regular exercise has small beneficial effects on total sleep time and sleep efficiency, small-to-medium beneficial effects on sleep onset latency, and moderate beneficial effects on sleep quality. Effects were moderated by sex, age, baseline physical activity level of participants, as well as exercise type, time of day, duration, and adherence. Significant moderation was not found for exercise intensity, aerobic/anaerobic classification, or publication date. Results were discussed with regards to future avenues of research and clinical application to the treatment of insomnia.
    Journal of Behavioral Medicine 01/2015; 38(3). DOI:10.1007/s10865-015-9617-6 · 3.10 Impact Factor
  • M Alexandra Kredlow, Michael W Otto
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    ABSTRACT: Reactivated memories go through a process of reconsolidation, during which they are malleable and susceptible to modification. Strategies targeting the interruption of memory reconsolidation hold the promise of weakening fear memories that underlie traumatic stress disorders. Although many studies have examined the efficacy of reconsolidation interference strategies with fear memories developed in a laboratory, very few have examined this with trauma-related episodic memories. This study aims to examine whether new learning can interfere with the reconsolidation of trauma-related episodic memories, when the affective content of the new learning and memory match. Boston-area young adults (n = 94) wrote about negative autobiographical memories; specifically, their personal memories of the Boston Marathon bombings. Following reactivation, participants were randomized to receive interference with a negative, positive, neutral, or no story. One week later, participants were tested for memory recall. Comparisons between conditions with relevant covariates revealed a significant interfering effect for a negative story, relative to no story, on recall (P < .05, 95% CI [-3.90, -0.04]), d = 0.62). In contrast, the neutral and positive story, relative to no story, resulted in smaller and nonsignificant effects. These findings indicate that reconsolidation interference effects can be achieved for trauma-related episodic memories and the emotional valence of interference material may be an important contextual factor in achieving these effects. This study provides support for further research translating memory reconsolidation findings into treatments for traumatic stress disorders. © 2014 Wiley Periodicals, Inc.
    Depression and Anxiety 01/2015; 32(1):32-7. DOI:10.1002/da.22343 · 4.29 Impact Factor
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    ABSTRACT: Although cognitive behavioral therapy (CBT) is a generally effective treatment for treating anxiety disorders, there is clearly still room for further improvements. Recent advances in neuroscience of extinction learning led to novel clinical strategies to augment exposure-based treatments with d-cycloserine (DCS), a partial agonist at the glycine recognition site of the glutamatergic N-methyl-D-aspartate receptor. This review provides an update on the current knowledge of DCS as an augmentation strategy of CBT for anxiety disorders. The adequacy of the CBT to be augmented, the dose of DCS, and the timing and duration of augmentation efforts all appear to be important moderating variables. Moreover, there is evidence that DCS may also augment fear memory reconsolidation if the fear level remains high after the exposure. Future studies need to examine whether DCS can augment CBT when administered after exposure in order to develop a tailored administration strategy to maximize its clinical utility.
    Current Psychiatry Reports 01/2015; 17(1):532. DOI:10.1007/s11920-014-0532-2 · 3.05 Impact Factor
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    ABSTRACT: Previous research has shown that families with a parent who has bipolar disorder (BD) may experience family functioning difficulties. However, the association between family functioning and psychopathology among offspring of parents with BD, and offspring characteristics that may moderate this association, remains poorly understood. This study examined the cross-sectional associations between family functioning (cohesion, expressiveness, and conflict) and psychopathology in 117 offspring (ages 5-18) of 75 parents with BD. We also examined whether age and sex differences moderated these associations. We measured offspring psychopathology by examining current dimensional symptoms and DSM-IV emotional and behavioral disorders. Correlational analyses indicated that higher family conflict and lower cohesion were associated with higher internalizing and externalizing symptoms in offspring. Lower family cohesion was also associated with current offspring mood disorders. Moderation analyses indicated, first, that the link between lower family cohesion and internalizing symptoms was stronger for younger offspring compared to older offspring. Second, higher family conflict and current mood disorder were associated in younger males but not in older males or in females. Results remained the same after controlling for parental anxiety or substance use disorder comorbidity. Our study highlights the importance of accounting for family functioning when working with offspring at risk for BD, while also recognizing that the connections between family functioning and offspring outcomes are complex and differ based on offspring sex and developmental stage. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Journal of Family Psychology 12/2014; 29(1). DOI:10.1037/fam0000048 · 1.89 Impact Factor
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    ABSTRACT: Background Individuals with panic disorder (PD) exhibit a hypersensitivity to inhaled carbon dioxide (CO2), possibly reflecting a lowered threshold for sensing signals of suffocation. Animal studies have shown that CO2-mediated fear behavior depends on chemosensing of acidosis in the amygdala via the acid sensing ion channel ASIC1a. We examined whether the human ortholog of the ASIC1a gene, ACCN2, is associated with the presence of PD and with amygdala structure and function. Methods We conducted a case-control analysis (N=414 PD cases, 846 healthy controls) of ACCN2single nucleotide polymorphisms (SNPs) and PD. We then tested whether variants showing significant association with PD are also associated with amygdala volume (n=1,048) and/or task-evoked reactivity to emotional stimuli (n=103) in healthy individuals. Results Two SNPs at the ACCN2 locus showed evidence of association with PD: rs685012 (OR=1.32, gene-wise corrected p=0.011) and rs10875995 (OR=1.26, gene-wise corrected p=0.046). The association appeared to be stronger when early-onset (age ≤ 20) PD cases and when cases with prominent respiratory symptoms were compared to controls. The PD risk allele at rs10875995 was associated with increased amygdala volume (p=0.035), as well as task-evoked amygdala reactivity to fearful and angry faces (p=0.0048). Conclusions Genetic variation at ACCN2 appears to be associated with PD and with amygdala phenotypes that have been linked to anxiety proneness. These results support the possibility that modulation of acid-sensing ion channels may have therapeutic potential for PD.
    Biological psychiatry 12/2014; 76(11). DOI:10.1016/j.biopsych.2013.12.018 · 9.47 Impact Factor
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    ABSTRACT: Abstract Many patients diagnosed with opioid dependence do not adequately respond to pharmacologic, psychosocial, or combination treatment, highlighting the importance of novel treatment strategies for this population. The current study examined the efficacy of a novel behavioral treatment focusing on internal cues for drug use (Cognitive Behavioral Therapy for Interoceptive Cues; CBT-IC) relative to an active comparison condition, Individual Drug Counseling (IDC), when added to methadone maintenance treatment (MMT) among those who had not responded to MMT. Participants (N=78) were randomly assigned to receive 15 sessions of CBT-IC or IDC as an adjunct to ongoing MMT and counseling. Oral toxicology screens were the primary outcome. Results indicated no treatment differences between CBT-IC and IDC and a small, significant reduction of self-reported drug use, but no change on toxicology screens. Tests of potential moderators, including sex, anxiety sensitivity, and coping motives for drug use, did not yield significant interactions. Among opioid-dependent outpatients who have not responded to MMT and counseling, the addition of IDC or CBT-IC did not result in additive outcome benefits. These results highlight the need for more potent treatment strategies for opioid dependence, particularly among those who do not fully respond to frontline treatment.
    Journal of psychoactive drugs 11/2014; 46(5):402-11. DOI:10.1080/02791072.2014.960110 · 1.10 Impact Factor
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    ABSTRACT: Consistent evidence indicates that exercise improves cognition and mood, with preliminary evidence suggesting that brain-derived neurotrophic factor (BDNF) may mediate these effects. The aim of the current meta-analysis was to provide an estimate of the strength of the association between exercise and increased BDNF levels in humans across multiple exercise paradigms. We conducted a meta-analysis of 29 studies (N = 1111 participants) examining the effect of exercise on BDNF levels in three exercise paradigms: (1) a single session of exercise, (2) a session of exercise following a program of regular exercise, and (3) resting BDNF levels following a program of regular exercise. Moderators of this effect were also examined. Results demonstrated a moderate effect size for increases in BDNF following a single session of exercise (Hedges' g = 0.46, p < 0.001). Further, regular exercise intensified the effect of a session of exercise on BDNF levels (Hedges' g = 0.59, p = 0.02). Finally, results indicated a small effect of regular exercise on resting BDNF levels (Hedges' g = 0.27, p = 0.005). When analyzing results across paradigms, sex significantly moderated the effect of exercise on BDNF levels, such that studies with more women showed less BDNF change resulting from exercise. Effect size analysis supports the role of exercise as a strategy for enhancing BDNF activity in humans, but indicates that the magnitude of these effects may be lower in females relative to males.
    Journal of Psychiatric Research 10/2014; 60. DOI:10.1016/j.jpsychires.2014.10.003 · 4.09 Impact Factor
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    ABSTRACT: A moderate to vigorous intensity exercise program is emerging as a promising strategy for reducing anxiety sensitivity (AS). Initial evidence suggests that the effects of exercise on mental health outcomes may vary as a function of gender, with men benefitting more than women. Building upon this evidence, the present study tested the hypothesis that the effect of exercise on AS would vary as a function of gender, such that the effect would be stronger for men than for women. We tested this hypothesis using the data from a published study (Smits et al., 2008). In this study, participants (N = 60) with elevated levels of AS were randomly assigned to a two-week exercise intervention [EX] or a waitlist control condition [WL]. Results revealed that males showed significantly greater initial AS reductions relative to females (following 1 week of exercise). However, these gender differences were no longer evident at the end of the intervention. Possible mechanisms for the observed findings and directions for future research are discussed.
    Mental Health and Physical Activity 09/2014; 7(3). DOI:10.1016/j.mhpa.2014.08.002
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    ABSTRACT: De novo fear conditioning paradigms have served as a model for how clinical anxiety may be acquired and maintained. To further examine variable findings in the acquisition and extinction of fear responses between clinical and non-clinical samples, we assessed de novo fear conditioning outcomes in outpatients with either anxiety disorders or depression and healthy subjects recruited from the community. Overall, we found evidence for attenuated fear conditioning, as measured by skin conductance, among the patient sample, with significantly lower fear acquisition among patients with depression and posttraumatic stress disorder. These acquisition deficits were evident in both the simple (considering the CS + only) and differential (evaluating the CS + in relation to the CS-) paradigms. Examination of extinction outcomes were hampered by the low numbers of patients who achieved adequate conditioning, but the available data indicated slower extinction among the patient, primarily panic disorder, sample. Results are interpreted in the context of the cognitive deficits that are common to the anxiety and mood disorders, with attention to a range of potential factors, including mood comorbidity, higher-and lower-order cognitive processes and deficits, and medication use, that may modulate outcomes in fear conditioning studies, and, potentially, in exposure-based cognitive behavioral therapy.
    Behavior Therapy 09/2014; 45(5). DOI:10.1016/j.beth.2013.12.012 · 2.43 Impact Factor
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    ABSTRACT: Abstract Compensatory eating in response to exercise may be an obstacle to achieving weight loss and fitness goals, yet little is known about how individuals perceive and explain their eating behaviors in response to exercise. In this study we develop and conduct preliminary examination of the psychometric properties of the Compensatory Eating Motives Questionnaire (CEMQ), a self-report questionnaire of motives for compensatory eating. Initial development and testing of the CEMQ was conducted in two samples of college students (n = 119 and n = 174). Seventy-seven percent reported engaging in compensatory eating. Factor analysis of the CEMQ yielded factors representing three domains of motives for compensatory eating: Eating for Reward, Eating for Recovery, and Eating for Relief. Each factor demonstrated adequate internal consistency, and the factor structure of the CEMQ was replicated. Correlational analyses between the three CEMQ subscales and trait questionnaires were consistent with hypotheses for convergent and divergent validity. These results encourage further investigation of compensatory eating as a potential obstacle to weight loss and support the continued assessment of the 15-item CEMQ as a tool to measure three conceptually distinct motives for compensatory eating. Furthermore, they demonstrate that motives for compensatory eating may be differentially predicted by traits and attitudes.
    Behavioral Medicine 08/2014; DOI:10.1080/08964289.2014.955077 · 1.14 Impact Factor
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    ABSTRACT: Objective Offspring of parents with bipolar disorder (BD) are at increased risk for developing a range of psychiatric disorders. Although genetic factors clearly confer risk to offspring, environmental factors also play a role in increasing vulnerability. Such environmental factors may occur at the initial stages of development in the form of obstetric complications (OCs). The current investigation examined the relationship between OCs and the development of psychopathology in offspring at risk for BD and the influence of parental psychopathology in this relationship.Methods This cross-sectional study included 206 offspring of 119 parents with BD. Probit regression analyses examined associations between: (1) OC history and offspring psychopathology; and (2) maternal lifetime comorbid anxiety diagnoses and OCs in pregnancy/delivery with their offspring. Path analyses then tested whether OCs mediate the relationship between maternal comorbid anxiety disorders and offspring lifetime psychopathology.ResultsResults indicated a specific association between OCs, particularly delivery complications, and increased risk for offspring anxiety disorders. Data also showed a significant relationship between maternal anxiety disorder comorbidity and OCs. Finally, path analyses suggested that delivery complications act as a mediator in the relationship between comorbid maternal anxiety disorder and offspring anxiety disorder.Conclusions Our findings lend support to the importance of identifying and reducing anxiety in pregnant woman with BD. The identification of OCs as early vulnerability factors for psychopathology in offspring at familial risk may also lead to earlier detection and intervention in these offspring.
    Depression and Anxiety 07/2014; 31(7). DOI:10.1002/da.22254 · 4.29 Impact Factor
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    Dataset: Jordan
  • International Journal of Cognitive Therapy 06/2014; 7(2):122-135. DOI:10.1521/ijct.2014.7.2.122 · 0.98 Impact Factor
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    ABSTRACT: Background. The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy. Method. Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments. Results. Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10-20 prior episodes of depression [number needed to treat (NNT)=2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT=32.0) or >20 (NNT=9.0) depressive episodes. Conclusions. Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression.
    Psychological Medicine 04/2014; 44(16):1-13. DOI:10.1017/S0033291714000804 · 5.43 Impact Factor
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    ABSTRACT: Panic disorder is characterized by recurrent panic attacks which lead individuals to worry about having another attack or the consequences of the attack or change behaviors to avoid having another attack. Panic with agoraphobia is marked by fear about being in places in which escape would be difficult should a panic attack occur. This chapter outlines a range of psychological and pharmacological treatments for panic disorder. Experts generally agree that at this time, cognitive-behavioral therapies, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines should be considered as first-line treatments for panic disorder as their efficacy and safety have been demonstrated by extensive controlled research. In order to optimize cognitive-behavioral therapy (CBT) for ease of dissemination, researchers have begun to try to identify the crucial components of CBT that lead to change in hopes of making interventions more efficient.
    The Wiley Handbook of Anxiety Disorders, 04/2014: pages 924-963; , ISBN: 9781118775356
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    ABSTRACT: Anxiety sensitivity (AS), or the fear of somatic arousal, has been linked to both maladaptive eating behavior as well as exercise avoidance in both self-report and laboratory-based experiments. The current pilot study sought to extend these finding to the naturalistic setting. A sample of 32 adults completed affect and dietary monitoring and wore actigraphs across a three-day monitoring period. Results indicated that high AS was associated with greater calorie consumption overall in women and less consumption in men, and high AS predicted an increase in calories consumed following participants’ greatest increase in negative affect in both sexes. For physical activity, results indicated an AS by BMI interaction such that obese individuals with high AS engaged in less moderate-intensity physical activity, whereas the opposite was true for normal weight individuals. These results indicate that AS may represent a double-edged risk factor for obesity contributing to both exercise avoidance and calorie consumption.
    Eating Behaviors 04/2014; 15(2). DOI:10.1016/j.eatbeh.2014.03.007 · 1.58 Impact Factor

Publication Stats

12k Citations
1,459.60 Total Impact Points


  • 2005–2015
    • Boston University
      • • Department of Psychology
      • • Center for Anxiety and Related Disorders
      Boston, Massachusetts, United States
  • 2007–2013
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
    • University of Colorado at Boulder
      Boulder, Colorado, United States
  • 1989–2013
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1993–2012
    • Massachusetts General Hospital
      • • Department of Psychiatry
      • • Center for Anxiety and Traumatic Stress Disorders
      Boston, MA, United States
  • 2011
    • New York State
      New York City, New York, United States
  • 2008
    • Hospital De Clínicas De Porto Alegre
      Pôrto de São Francisco dos Casaes, Rio Grande do Sul, Brazil
    • University of Pennsylvania
      • Department of Psychiatry
      Philadelphia, PA, United States
  • 1991–2007
    • Harvard Medical School
      • Department of Psychiatry
      Boston, Massachusetts, United States
  • 2006
    • Center for Autism and Related Disorders
      Burbank, California, United States
  • 2004–2005
    • University of North Carolina at Chapel Hill
      • Department of Psychology
      North Carolina, United States
    • Beth Israel Deaconess Medical Center
      • Neurophysiology Laboratory
      Boston, MA, United States
  • 2002
    • University of British Columbia - Vancouver
      • Department of Psychiatry
      Vancouver, British Columbia, Canada
  • 1999
    • University of Massachusetts Medical School
      • Department of Psychiatry
      Worcester, MA, United States
  • 1994–1996
    • Indiana University-Purdue University Indianapolis
      Indianapolis, Indiana, United States
    • Walter Reed National Military Medical Center
      Washington, Washington, D.C., United States
  • 1987
    • University of New Mexico
      • Department of Psychology
      Albuquerque, NM, United States