Christina L Boisseau

• Ph.D.
• Professor (Associate) at Northwestern University, Feinberg School of Medicine

Obsessive-compulsive disorder (OCD) is a heterogeneous and disabling condition; however, no studies have examined symptom categories or subtypes as predictors of long-term clinical course in adults with primary OCD. A total of 213 adults with DSM-IV OCD were recruited from several mental health treatment sites between July 2001 and February 2006 as...

Recent studies suggest that binge eating disorder (BED) is as prevalent among African American and Hispanic Americans as among Caucasian Americans; however, data regarding the characteristics of treatment-seeking individuals from racial and ethnic minority groups are scarce. The purpose of this study was to investigate racial/ethnic differences in...

This study further evaluates the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). A diagnostically heterogeneous clinical sample of 37 patients with a principal anxiety disorder diagnosis was enrolled in a randomized controlled trial (RCT) involving up to 18 sessions of treatment and a 6-month follow-up pe...

This study compared self-reported impulsivity and neurocognitively assessed response inhibition in obsessive-compulsive disorder (OCD), eating disorder (ED), and healthy control participants. Participants completed the Barratt Impulsiveness Scale (BIS-11), stop-signal reaction time task, and measures of OCD and ED symptomatology (Yale-Brown Obsessi...

Background: Obsessive-compulsive disorder (OCD) commonly co-occurs with personality disorders, particularly obsessive-compulsive personality disorder (OCPD). Recent research suggests that personality disorders, especially OCPD, might not be as stable as once thought. The current study investigates the longitudinal stability of OCPD diagnosis and in...

Background: Obsessive-compulsive disorder (OCD) has a chronic course. However, limited longitudinal research exists on whether adults with OCD tend to maintain the same cluster of symptoms and how those symptoms may change over time. The present study aimed to examine the stability of primary OCD symptoms across 5 years and describe how symptoms ch...

Compulsivity is a key feature of obsessive-compulsive disorder (OCD), with compulsions—repetitive, stereotyped behaviors and mental acts meant to relieve distress—often posing significant obstacles to daily function. The last few years have seen increases in compulsive behaviors; yet, the specific mechanisms of compulsions in OCD remain unknown. Pr...

In everyday life, humans perform sequences of tasks. These tasks may be disrupted in people with obsessive–compulsive disorder (OCD). Symptoms, such as compulsions, can be considered sequential and often cause repetitions of tasks that disrupt daily living (e.g., checking the stove while cooking). Motor sequences have been used to study behavioral...

Background: Obsessive-compulsive disorder (OCD) commonly co-occurs with personality disorders, particularly obsessive-compulsive personality disorder (OCPD). Recent research suggests that personality disorders, especially OCPD, might not be as stable as once thought. Thus, the current study aims to investigate the longitudinal stability of OCPD dia...

Background: Obsessive-compulsive disorder (OCD) commonly co-occurs with personality disorders, particularly obsessive-compulsive personality disorder (OCPD). Recent research suggests that personality disorders, especially OCPD, might not be as stable as once thought. The current study investigates the longitudinal stability of OCPD diagnosis and in...

Background: Personality disorders (PDs) are often comorbid with obsessive-compulsive disorder (OCD) which may influence symptom presentation and course. This investigation sought to examine the impact of comorbid PDs on clinical presentation and symptom chronicity in a large, prospective longitudinal OCD study. Methods: Participants (n=263) were tr...

In everyday life, humans carry out sequences of tasks. Such sequential tasks may be disrupted in those with obsessive-compulsive disorder (OCD). Symptoms such as compulsions often cause repetitions of tasks or sequences that disrupt daily living. Such disruptions have been observed experimentally and may be unique to OCD. Deficits in implicitly lea...

Background: Although it has been widely established that poor social functioning is a characteristic of obsessive-compulsive disorder (OCD), little research has examined the relationship between OCD symptom subtypes and domains of social functioning. Thus, the present study sought to examine the specific ways in which impairment in social adjustme...

Major Depressive Disorder (MDD) is often comorbid with obsessive-compulsive disorder (OCD) yet little is known about the directionality of the association between OCD and depression symptoms. We aim to investigate the effect OCD symptoms has on depression symptoms and vice versa over an extended period of time. This is one of the first longitudinal...

Background Personality traits may confer vulnerability to psychopathology. However, few studies have examined the association between personality traits and obsessive-compulsive disorder (OCD) course. The present study investigates personality traits, OCD symptom severity, and illness duration as a predictor of OCD remission. Methods 166 treatment...

Although stay-at-home orders and physical distancing measures are vital to managing the COVID-19 outbreak, there is concern these limitations on in-person contact may increase feelings of loneliness. The present study examined loneliness in relation to living situation, psychiatric symptoms, and coping skills utilization during the COVID-19 pandemi...

Some women are vulnerable to developing new onset obsessive–compulsive disorder (OCD) or having an exacerbation of pre-existing OCD during reproductive cycle events. Reports on the impact of the peripartum period on pre-existing OCD are inconsistent, with both worsening and improving symptom severity described. Studies have primarily been retrospec...

Community mental health centers (CMHCs) provide the majority of mental health services for low-income individuals in the United States. Exposure and Response Prevention (ERP), the psychotherapy of choice for OCD, is rarely delivered in CMHCs. This study aimed to establish the acceptability and feasibility of testing a Behavioral Therapy Teams (BTT)...

Numerous clinical trials support the efficacy of exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD). Accordingly, ERP has been formally recognized as a first-line, evidence-based treatment for OCD. This review discusses the theoretical underpinnings of the treatment from a behavioral and neurobiological...

Importance Dimensional definitions of transdiagnostic mental health problems have been suggested as an alternative to categorical diagnoses, having the advantage of capturing heterogeneity within diagnostic categories and similarity across them and bridging more naturally psychological and neural substrates. Objective To examine whether a self-rep...

Background: Obsessive compulsive disorder (OCD) is associated with elevated suicide risk, but the directionality of the association between OCD severity and suicidal ideation has not been established, which was the goal of this study. Methods: Participants (n = 325) were adults with either a current or past diagnosis of Diagnostic and Statistical M...

Converging lines of research highlight the significance of cognitive and behavioral flexibility in the etiology, maintenance, and treatment of fear and anxiety disorders. We have developed a Special Issue to highlight recent empirical investigations, contemporary theory, and novel directions for future study. It is hoped that this special issue wil...

Obsessive-compulsive disorder (OCD) is chronic psychiatric disorder associated with high rates of functional impairment and decreased quality of life. Although serotonin reuptake inhibitors have demonstrated efficacy in the treatment of OCD, little data is available to guide clinicians on how to manage these medications long-term. Cognitive-behavio...

Research has suggested that the co-occurrence of PTSD in individuals with OCD is associated with more severe symptoms and less responsivity to empirically supported treatment as compared to individuals with OCD and no history of PTSD. However, much of this work has been limited by non-empirical case report design, cross-sectional and retrospective...

This chapter describes the application of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) to eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder, and other specified feeding or eating disorders. We focus on the five core treatment modules, highlighting aspects of each one tha...

Although effective treatments for obsessive–compulsive disorder (OCD) exist, there are significant barriers to receiving evidence-based care. Mobile health applications (Apps) offer a promising way of overcoming these barriers by increasing access to treatment. The current study investigated the feasibility, acceptability, and preliminary efficacy...

Although OCD is a global problem, the literature comparing, in a direct and standardized way, the manifestations across countries is scarce. Therefore, questions remain as to whether some important clinical findings are replicable worldwide, especially in the developing world. The objective of this study was to perform a clinical comparison of OCD...

Quality of life (QoL) is significantly impaired in OCD across several facets of life, such as social, occupational, and family functioning, subjective sense of well-being, and enjoyment of leisure activities. The present study examined the relationship between 5 symptom subtypes of OCD (contamination, symmetry, hoarding, overresponsibility for harm...

Pediatric obsessive–compulsive disorder (OCD) is a chronic condition affecting millions of children. Though well intentioned, accommodation (i.e., a parent’s attempt to assuage their child’s distress and anxiety) is thought to increase OCD symptom severity and may cause greater OCD-related impairment. The present study sought to examine the relativ...

Eating disorders are life-threatening conditions that disproportionately affect females, often during childbearing years. Although the endocrinological and reproductive sequelae of these conditions often fall within the treatment purview of obstetrician-gynecologists, assessment of eating pathology is challenging and often not part of routine clini...

Obsessive Compulsive Disorder (OCD) is a disorder with heterogeneous clinical presentations. To advance our understanding of this heterogeneity we investigated the prevalence and clinical features associated with incompleteness (INC), a putative underlying core feature of OCD. We predicted INC would be prominent in individuals with OCD and associat...

Objective: Few data are available to inform clinical expectations about course and prognosis of severe obsessive-compulsive disorder (OCD). Such information is necessary to guide clinicians and to inform criteria for invasive interventions for severe and intractable OCD. This study sought to examine course and prospective predictors of a chronic c...

The study objective was to apply machine learning methodologies to identify predictors of remission in a longitudinal sample of 296 adults with a primary diagnosis of obsessive compulsive disorder (OCD). Random Forests is an ensemble machine learning algorithm that has been successfully applied to large-scale data analysis across vast biomedical di...

The familial nature of OCD has been well established. Clinical characteristics such as early age of onset, comorbidity with tic disorders, and higher rates of symmetry symptoms have been associated with the familial aggregation of OCD, though little research has examined the differential impact of paternal and maternal OCD. The current study explor...

Objective: This study assesses the long-term course of treatment-seeking youth with a primary diagnosis of DSM-IV OCD. Method: Sixty youth and their parents completed intake interviews and annual follow-up interviews for 3 years using the youth version of the Longitudinal Interval Follow-up Evaluation (Y-LIFE) and Children's Yale-Brown Obsessive...

There is a critical need for increasing the diversity representation among clinicians and researchers in academic medicine, including departments of psychiatry and psychology. Mentorship of under-represented groups has been identified as an important way to remediate diversity-related barriers in the field. This paper outlines the early development...

Objective: Binge eating disorder (BED) is prevalent among individuals from minority racial/ethnic groups and among individuals with lower levels of education, yet the efficacy of psychosocial treatments for these groups has not been examined in adequately powered analyses. This study investigated the relative variance in treatment retention and po...

Background: The study attempted to identify characteristics that differentiate multiple suicide attempters from single attempters in individuals with personality disorders (PDs) and/or major depression. Method: Participants were 431 participants enrolled in the Collaborative Longitudinal Study of Personality Disorders from July 1996 to June 2008...

Perinatal loss, typically defined as fetal death beyond 20 weeks gestation through infant death 1-month postpartum, is a potentially traumatizing experience for parents occurring in approximately 1% of births in the United States. Although many women recover, 15% to 25% have enduring grief-related symptomatology and functional impairment. Perinatal...

Obsessive-compulsive disorder (OCD) is a chronic and debilitating anxiety disorder associated with significant impairment in quality of life and functioning. Research examining the differences in clinical correlates and treatment response associated with different obsessions in OCD has yielded important findings underscoring the heterogeneous natur...

Studies examining trends over time in mainstream magazines observe decreases in women's figure size, and increases in figure exposure and amount of diet/exercise content. Little is known, however, regarding the content of African American magazines. Utilizing methods from classic studies, this investigation examined content in Ebony, a magazine wit...

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

Chapter 2 discusses the nature of emotional disorders (empirical and data-driven conceptions of anxiety and major emotional disorders, emerging research, the body of evidence), etiology (including the triple vulnerabilities theory), and the role of emotion regulation.

Chapter 5 introduces the first module of treatment on motivation enhancement for treatment engagement, and outlines the principles of motivation enhancement (express empathy, develop discrepancy, roll with resistance, support self-efficacy), and motivation enhancement phases.

Chapter 3 addresses the basic principles underlying treatment, its basis in traditional cognitive-behavioral principles, core skills, and premise, and outlines the treatment procedures and modules (motivation enhancement for treatment engagement, psychoeducation and tracking of emotional experiences, emotion awareness training, cognitive appraisal...

Chapter 9 outlines a plan for module four of treatment on cognitive appraisal and reappraisal, including an introduction to cognitive appraisal, a demonstration using the ambiguous picture exercise, automatic appraisal and thinking traps, and cognitive reappraisal.

Chapter 10 discusses the fifth module of treatment on emotion avoidance. Emotion avoidance is introduced and common emotion-avoidance strategies are linked to the disorder with which they are most often associated. In-session exercises are provided to demonstrate emotion avoidance.

Chapter 1 provides introductory information for therapists on a background to the unified protocol (UP), its efficacy, who will benefit from the program, how to use UP if other emotional problems are present, assessment and monitoring, medication, who should administer the program, and the benefits of using a workbook.

Chapter 4 provides an overview of the general treatment format and procedures, including how to introduce the patient to the treatment program, the role that will be taken as therapist, session structure, homework and out-of-session practice, patient commitment, dealing with patient ambivalence and resistance, and reviewing the patient’s presenting...

Chapter 6 discusses the second module on understanding emotions, psychoeducation and the nature of emotions, definitions of emotions and examples of emotion-driven behaviors (EDBs), and the three-component model of emotional experiences (physiological, cognitive, behavioral).

Chapter 7 further disucsses the second module of treatment on how to recognise and track emotional responses, including and introduction to monitoring emotional experiences using the ARC model, learned responses and how to understand emotions and behavior.

Chapter 8 discusses the third module of therapy on emotional awareness training, and introduces nonjudgmental, present-focused emotion awareness, (the importance of emotion awareness, reactions to emotions, judgments about emotions) along with a demonstration of how to practice nonjudgmental emotion awareness, and an emotion induction exercise.

Chapter 12 outlines the sixth module on awareness and tolerance of physical sensations, physical sensations and the emotional response, avoidance of physical sensations, symptom induction exercises, and repeated exposures.

Chapter 11 explores the fifth module on emotion-driven behaviors and further discusses emotion-driven behaviors (EDBs), how EDBs are established and maintained, adaptive versus non-adaptive EDBs, consequences of non-adaptive coping, and eliciting personally relevant examples of EDBs. Methods of countering patterns of avoidance and EDBs are suggeste...

Chapter 15 explores the eighth and final module on reviewing the treatment skills, evaluating progress and accomplishments that have been made, maintenance, relapse prevention, anticipating future difficulties, continuing practice, and establishing long-term goals.

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

Chapter 13 discusses the seventh module on interoceptive and situational emotion exposures, in-session emotion exposures and how to conduct in-session emotion exposures, and suggests processes for moving emotion exposures into the real world.

This online therapist guide is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which...

The Unified Protocol (UP) is a transdiagnostic, emotion-focused cognitive-behavioral treatment developed to be applicable across the emotional disorders. The UP consists of 4 core modules: increasing emotional awareness, facilitating flexibility in appraisals, identifying and preventing behavioral and emotional avoidance, and situational and intero...

A detailed description of treatment utilizing the Unified Protocol (UP), a transdiagnostic emotion-focused cognitive-behavioral treatment, is presented using a clinical case example treated during the most current phase of an ongoing randomized controlled trial of the UP. The implementation of the UP in its current, modular version is illustrated....

This naturalistic study investigated the treatment and outcome of adolescents with eating disorders (EDs) in the community. Clinicians from a practice-research network provided data on ED symptoms, global functioning, comorbidity, treatment, and outcome for 120 adolescents with EDs. ED "not otherwise specified" was the most common ED diagnosed. Aft...

Clinical report suggests that therapists have strong and sometimes difficult-to-manage reactions to patients with eating disorders (EDs); however, systematic research is largely absent. The purpose of this study was to explore the emotional responses, or countertransference (CT) reactions, clinicians experience when working with patients with EDs,...

Impulsivity among individuals with eating disorders (EDs) is associated with severe comorbidities and poor treatment outcome. However, research investigating the construct of impulsivity in EDs is limited. The objectives of the present study were to characterize multiple dimensions of impulsivity in adolescents with EDs; determine if differences in...

Research has identified three personality subtypes in adults with eating disorders (EDs): a high-functioning, an undercontrolled, and an overcontrolled group. The current study investigated whether similar personality prototypes exist in adolescents with EDs, and whether these personality prototypes show relationships to external correlates indicat...