Michael W Otto

University of Texas at Austin, Austin, Texas, United States

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Publications (343)1499.62 Total impact

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    ABSTRACT: Objective: Individuals with bipolar disorder experience a disproportionately high incidence of medical co-morbidity and obesity. These health-related problems are a barrier to recovery from mood episodes and have been linked with unfavorable responses to pharmacological treatment. However, little is known about whether and how these characteristics affect responses to adjunctive psychotherapy. Method: Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy plus pharmacotherapy with collaborative care (a three-session psycho-educational intervention) plus pharmacotherapy. We conducted a post-hoc analysis to evaluate whether medical burden and body mass index predicted and/or moderated the likelihood of recovery and time until recovery from a depressive episode among patients in the two treatments. Results: Participants who had medical co-morbidity and body mass index data constituted 199 of the 293 patients in the original Systematic Treatment Enhancement Program for Bipolar Disorder trial. Higher medical burden predicted a lower likelihood of recovery from depression in both treatment conditions (odds ratio = 0.89), but did not moderate responses to intensive psychotherapy vs collaborative care. Intensive psychotherapy yielded superior recovery rates for individuals of normal body mass index (odds ratio= 2.39) compared with collaborative care, but not among individuals who were overweight or obese. Conclusion: Medical co-morbidity and body weight impacts symptom improvement and attention to this co-morbidity may inform the development of more personalized treatments for bipolar disorder.
    Australian and New Zealand Journal of Psychiatry 11/2015; DOI:10.1177/0004867415616694 · 3.41 Impact Factor

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    Psychosomatic Medicine 10/2015; DOI:10.1097/PSY.0000000000000264 · 3.47 Impact Factor
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    ABSTRACT: Bipolar disorder (BD) is highly heterogeneous, and course variations are associated with patient outcomes. This diagnostic complexity challenges identification of patients in greatest need of intervention. Additionally, course variations have implications for offspring risk. First, latent class analysis (LCA) categorized parents with BD based on salient illness characteristics: BD type, onset age, polarity of index episode, pole of majority of episodes, rapid cycling, psychosis, anxiety comorbidity, and substance dependence. Fit indices favored three parental classes with some substantively meaningful patterns. Two classes, labeled "Earlier-Onset Bipolar-I" (EO-I) and "Earlier-Onset Bipolar-II" (EO-II), comprised parents who had a mean onset age in mid-adolescence, with EO-I primarily BD-I parents and EO-II entirely BD-II parents. The third class, labeled "Later-Onset BD" (LO) had an average onset age in adulthood. Classes also varied on probability of anxiety comorbidity, substance dependence, psychosis, rapid cycling, and pole of majority of episodes. Second, we examined rates of disorders in offspring (ages 4-33, Mage=13.46) based on parental latent class membership. Differences emerged for offspring anxiety disorders only such that offspring of EO-I and EO-II parents had higher rates, compared to offspring of LO parents, particularly for daughters. Findings may enhance understanding of BD and its nosology.
    09/2015; DOI:10.1016/j.psychres.2015.09.011
  • Aliza T Stein · Lee J Greathouse · Michael W Otto ·
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    ABSTRACT: Identifying moderators of compensatory eating is important for understanding the failure of many people to lose weight in response to increased exercise levels. A previous study demonstrated that individuals shown action words (e.g., "active" or "go") were primed by these words to increase energy intake. Further studies have demonstrated that individual differences (e.g. differences in body mass) affect susceptibility to relevant priming cues. Based on these findings, this study examined individual differences, including exercise habits, tendencies toward compensatory eating, dietary restraint, and body mass that may serve as moderators of compensatory eating in the context of conceptual priming. A 2x2 design was utilized to analyze the effects of both priming and a self-control task on energy intake. Participants were presented with several snack foods under the guise of a taste test, with energy intake (kcal) during this taste test as the primary outcome variable. Results of this study indicate that, among those with higher baseline levels of exercise, lower energy intake was found for those exposed to exercise cues relative to those who did not receive these cues. In addition, the influence of the self-control fatigue condition was dependent on body mass index.
    Appetite 09/2015; 96. DOI:10.1016/j.appet.2015.09.007 · 2.69 Impact Factor
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    ABSTRACT: Individuals with elevated levels of anxiety sensitivity (AS) may be motivated to avoid aversive emotional or physical states, and therefore may have greater difficulty achieving healthy behavioral change. This may be particularly true for exercise, which produces many of the somatic sensations within the domain of AS concerns. Cross-sectional studies show a negative association between AS and exercise. However, little is known about how AS may prospectively affect attempts at behavior change in individuals who are motivated to increase their exercise. We recruited 145 young adults who self-identified as having a desire to increase their exercise behavior. Participants completed a web survey assessing AS and additional variables identified as important for behavior change-impulsivity, grit, perceived behavioral control, and action planning-and set a specific goal for exercising in the next week. One week later, a second survey assessed participants' success in meeting their exercise goals. We hypothesized that individuals with higher AS would choose lower exercise goals and would complete less exercise at the second survey. AS was not significantly associated with exercise goal level, but significantly and negatively predicted exercise at Time 2 and was the only variable to offer significant prediction beyond consideration of baseline exercise levels. These results underscore the importance of considering AS in relation to health behavior intentions. This is particularly apt given the absence of prediction offered by other traditional predictors of behavior change. © The Author(s) 2015.
    Behavior modification 09/2015; DOI:10.1177/0145445515603704 · 2.23 Impact Factor
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    ABSTRACT: Advances in the understanding of the neurobiology of fear extinction have resulted in the development of d-cycloserine (DCS), a partial glutamatergic N-methyl-D-aspartate agonist, as an augmentation strategy for exposure treatment. We review a decade of research that has focused on the efficacy of DCS for augmenting the mechanisms (e.g., fear extinction) and outcome of exposure treatment across the anxiety disorders. Following a series of small-scale studies offering strong support for this clinical application, more recent larger-scale studies have yielded mixed results, with some showing weak or no effects. We discuss possible explanations for the mixed findings, pointing to both patient and session (i.e., learning experiences) characteristics as possible moderators of efficacy, and offer directions for future research in this area. We also review recent studies that have aimed to extend the work on DCS augmentation of exposure therapy for the anxiety disorders to DCS enhancement of learning-based interventions for addiction, anorexia nervosa, schizophrenia, and depression. Here, we attend to both DCS effects on facilitating therapeutic outcomes and additional therapeutic mechanisms beyond fear extinction (e.g., appetitive extinction, hippocampal-dependent learning).
    Biological psychiatry 09/2015; DOI:10.1016/j.biopsych.2015.09.007 · 10.26 Impact Factor

  • Addictive Disorders & Their Treatment 08/2015; DOI:10.1097/ADT.0000000000000075
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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; 43. DOI:10.1016/j.cct.2015.06.015 · 1.94 Impact Factor
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    ABSTRACT: Studies show that repeated checking leads to memory distrust in healthy controls. Additionally, the extent of this reduction in memory confidence has been associated with executive control. Utilizing a 2 × 2 design, we examine the role of mood and cognitive training targeting executive control on memory distrust following repeated checking. Participants were 69 individuals with depressed (n = 32) or euthymic (n = 37) mood. Memory distrust following a repeated checking task was assessed before and after 3 sessions of a computerized cognitive training program or a control task. Consistent with previous studies, participants reported reduced meta-memory following repeated checking. Although participants with depressed mood reported lower overall cognitive confidence at a trend level, the effect of repeated checking on memory distrust was not potentiated by depressed mood in our study. A reduction in memory distrust following repeated checking was found over time; however, this effect was not dependent on cognitive training condition, mood status, or their interaction.
    International Journal of Cognitive Therapy 05/2015; 8(3):1-16. 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; 29(7). DOI:10.1177/0269881115575536 · 3.59 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 · 4.41 Impact Factor
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    Stefan G Hofmann · Michael W Otto · Mark H Pollack · Jasper A Smits ·
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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 · 3.24 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 · 10.26 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
  • Kristin L. Szuhany · Matteo Bugatti · Michael W. Otto ·
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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 · 3.96 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

Publication Stats

14k Citations
1,499.62 Total Impact Points


  • 2015
    • University of Texas at Austin
      Austin, Texas, United States
  • 2005-2015
    • Boston University
      • • Department of Psychology
      • • Center for Anxiety and Related Disorders
      Boston, Massachusetts, United States
  • 2013
    • University of Minnesota Duluth
      Duluth, Minnesota, 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
  • 1992-2012
    • Massachusetts General Hospital
      • Department of Psychiatry
      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
  • 1996
    • Indiana University-Purdue University Indianapolis
      Indianapolis, Indiana, United States
  • 1987
    • University of New Mexico
      • Department of Psychology
      Albuquerque, NM, United States