Julia Y. Carbonella’s research while affiliated with University of Miami and other places

Obsessive-compulsive disorder (OCD) commonly co-occurs with depression, resulting in heightened severity and poorer treatment response. Research on the associations between specific obsessive-compulsive symptoms (OCS) and depressive symptoms has utilized measures that have not fully considered the relationship across OCS dimensions. Little is known about which factors explain the overlap between OCS and depressive symptoms. OCS and depressive symptoms may be related via depressive cognitive styles, such as rumination or dampening (i.e., down-regulating positive emotions). We evaluated the associations of OCS dimensions with depressive symptoms and cognitive styles. We also examined the indirect effects of rumination and dampening in the relationship between OCS and depressive symptoms. Participants (N = 250) completed questionnaires online. Greater depressive symptoms, rumination, and dampening were associated with greater levels of all OCS dimensions. Path analysis was utilized to examine a model including the direct effect of depressive symptoms on overall OCS and two indirect effects (through rumination and dampening). There was a significant indirect effect of depressive cognitive styles on the relationship between OCS and depressive symptoms, through rumination and dampening. Replication in a clinical sample and experimental manipulations may bear important implications for targeting depressive cognitive styles in treatments for OCD and depression.

There is growing concern that much published research may have questionable validity due to phenomena such as publication bias and p-hacking. Within the psychiatric literature, the construct of expressed emotion (EE) is widely assumed to be a reliable predictor of relapse across a range of mental illnesses. EE is an index of the family climate, measuring how critical, hostile, and overinvolved a family member is toward a mentally ill patient. No study to date has examined the evidential value of this body of research as a whole. That is to say, although many studies have shown a link between EE and symptom relapse, the integrity of the literature from which this claim is derived has not been tested. In an effort to confirm the integrity of the literature of EE predicting psychiatric relapse in patients with schizophrenia, we conducted a p-curve analysis on all known studies examining EE (using the Camberwell Family Interview) to predict psychiatric relapse over a 9- to 12-month follow-up period. Results suggest that the body of literature on EE is unbiased and has integrity, as there was a significant right skew of p-values, a nonsignificant left skew of p-values, and a nonsignificant test of flatness. We conclude that EE is a robust and valuable predictor of symptom relapse in schizophrenia.

Symmetry and ordering obsessions and compulsions are among the most prevalent obsessive-compulsive disorder (OCD) symptom subtypes, often emerging in early childhood or adolescence. This chapter first discusses the phenomenology of this particular subtype, including distinct cognitive and emotional features that underlie symmetry-based concerns. Following is a case study describing Natalie X, a 27-year-old female patient with chronic symmetry-type OCD, the severity of which had fluctuated throughout her lifetime. She presented with persistent worries and rituals revolving around dividing objects and thoughts into gender categories of boy or girl, and she experienced considerable distress if items were not balanced across these boy/girl classes. Exposure response prevention (ERP) and cognitive therapy techniques were implemented in order to break the reinforcing cycle of Natalie’s compulsions and restructure her maladaptive automatic thoughts. Therapy occurred over 23 sessions and included psychoeducation about OCD and corresponding treatment tactics, a functional analysis of her specific triggers and behaviors, and exposures along a fear hierarchy. Motivational interviewing (MI) tactics were incorporated to enhance motivation and adherence to exposure exercises, while cognitive restructuring helped address her dysfunctional beliefs, such as overestimation of danger associated with asymmetry. Continual monitoring of symptoms and a collaborative working approach helped the therapist best tailor the cognitive and behavioral techniques towards Natalie’s needs throughout the treatment. Natalie’s symmetry symptoms and the level of impairment met criteria for remission at termination, illustrating the efficacy of ERP and cognitive therapy in treating this common subtype of OCD.

Executive functioning deficits have been found to underlie primary symptoms of hoarding, such as difficulty discarding belongings and significant clutter. Cognitive flexibility – the ability to inhibit irrelevant material and attend flexibly between different mental sets – may be impaired as well, as individuals experience difficulty staying on task and are often distracted by specific possessions that tend to evoke an exaggerated emotional response. The present study investigated cognitive flexibility deficits via eye-tracking technology as a novel approach. Participants (N = 69) with high and low self-reported hoarding symptoms were asked to respond to a series of auditory cues requiring them to categorize a small target number superimposed on one of three distractor image types: hoarding, nature, or a blank control. Across a range of behavioral and eye-tracking outcomes (including reaction time, accuracy rate, initial orientation to distractors, and viewing time for distractors), high hoarding participants consistently demonstrated greater cognitive inflexibility compared to the low hoarding group. However, high hoarding participants did not evidence context-dependent deficits based on preceding distractor types, as performance did not significantly differ as a function of hoarding versus nature distractors. Current findings indicate a pervasive, more global deficit in cognitive flexibility. Those with hoarding may encounter greater difficulty disengaging from previous stimuli and attending to a given task at hand, regardless of whether the context of the distractor is specifically related to hoarding. Implications and future directions for clarifying the nature of cognitive inflexibility are discussed.

A substantial literature has investigated the role of parenting on a child's development. Several classifications of parenting styles (i.e., permissive, authoritarian, authoritative) have been linked to a wide range of negative outcomes such as mood and anxiety problems; however, their respective associations to anxiety sensitivity (AS) remain unclear. Using a nonclinical sample of young adults (N = 227), this study is the first to empirically investigate whether parenting styles were differentially associated with AS, controlling for general depression and anxiety symptoms. Hierarchical linear regression analyses showed that authoritarian and permissive styles were associated with elevated AS. Permissive parenting was associated with the AS physical subfactor, whereas authoritarian parenting was associated with the AS social subfactor. Moreover, AS was found to mediate the relationship between specific parental styles and anxiety symptoms as well as depressive symptoms. Findings suggest that AS may mediate the relationship between parenting styles and negative psychological outcomes.