Katie Fracalanza

All Publications

• Does intolerance of uncertainty mediate improvement in anger during group CBT for GAD? A preliminary investigation. Behavioural and cognitive psychotherapy Laposa, J. M., Fracalanza, K. 2019: 1?9

  Abstract

  BACKGROUND: Individuals with generalized anxiety disorder (GAD) have elevated intolerance of uncertainty (IU) and anger, and IU mediates the relationship between GAD symptoms and anger.AIMS: The current pilot study examined whether group cognitive behavioural therapy (CBT) improves anger in people with GAD, and the degree to which change in IU mediates improved anger.METHOD: Individuals diagnosed with GAD completed measures of worry, IU, and facets of anger, before and at the end of group CBT for GAD.RESULTS: Worry, IU, and internally felt and outwardly expressed anger, reduced significantly over treatment, but anger control (inwardly and outwardly) did not. CBT for GAD led to improvement in both internally felt and outwardly expressed anger, even though anger is not directly targeted in this treatment. Improvement in IU significantly mediated improvement in internally felt and outwardly expressed anger.CONCLUSIONS: This preliminary study contributes to the literature on the importance of IU in understanding worry and other symptoms such as elevated anger, experienced by people with excessive worry.

  View details for PubMedID 30914070

• Treatment of generalized anxiety disorder Evidence-based psychotherapy: The state of the science and practice McCabe-Bennett, H., Fracalanza, K., Antony, M. M. Wiley-Blackwell. 2016
• Reactivity to 35% carbon dioxide in bulimia nervosa and panic disorder PSYCHIATRY RESEARCH Woznica, A., Vickers, K., Koerner, N., Fracalanza, K. 2015; 228 (3): 571-575

  Abstract

  The inhalation of 35% carbon dioxide (CO?) induces panic and anxiety in people with panic disorder (PD) and in people with various other psychiatric disorders. The anxiogenic effect of CO? in people with eating disorders has received sparse attention despite the fact that PD and bulimia nervosa (BN) have several common psychological and neurobiological features. This study compared CO?-reactivity across three groups of participants: females with BN, females with PD, and female controls without known risk factors for enhanced CO?-reactivity (e.g., social anxiety disorder, first degree relatives with PD). Reactivity was measured by self-reported ratings of panic symptomatology and subjective anxiety, analyzed as both continuous variables (change from room-air to CO?) and dichotomous variables (positive versus negative responses to CO?). Analyses of each outcome measure demonstrated that CO?-reactivity was similar across the BN and PD groups, and reactivity within each of these two groups was significantly stronger than that in the control group. This is the first study to demonstrate CO?-hyperreactivity in individuals with BN, supporting the hypothesis that reactivity to this biological paradigm is not specific to PD. Further research would benefit from examining transdiagnostic mechanisms in CO?-hyperreactivity, such as anxiety sensitivity, which may account for this study's results.

  View details for DOI 10.1016/j.psychres.2015.05.050

  View details for Web of Science ID 000360251400050

  View details for PubMedID 26141602

• Behavior therapy Encyclopedia of clinical psychology Gee, B. A., Fracalanza, K. 2015
• Testing a procedural variant of written imaginal exposure for generalized anxiety disorder JOURNAL OF ANXIETY DISORDERS Fracalanza, K., Koerner, N., Antony, M. M. 2014; 28 (6): 559-569

  Abstract

  This experiment examined the degree to which it is more beneficial for individuals with generalized anxiety disorder (GAD) to engage in repeated exposure to mental imagery of the same feared scenario versus varying the exposure content. On three consecutive days, individuals with GAD (N=57) spent 20min writing about: (1) the same worst case scenario (consistent exposure; CE), (2) variations of their worst case scenario (varied exposure; VE), or (3) a neutral topic (neutral control; NC). Participants in the CE condition displayed significant decreases in worry, acute cognitive avoidance, and intolerance of uncertainty from baseline to 1-week follow-up; participants in the VE and NC conditions did not. Initial activation of self-reported anxiety (observed in the CE and VE conditions) and between-session reduction in anxiety (observed in the CE condition only) were associated with improvement in worry. Including more references to negative emotion and writing in the present tense were also associated with greater improvement in worry in the CE condition. These findings suggest that writing repeatedly about the same worst case scenario may benefit people with GAD. The study also provides information on potential mechanisms of change.

  View details for DOI 10.1016/j.janxdis.2014.05.011

  View details for Web of Science ID 000340864500009

  View details for PubMedID 24983797

• The effect of comorbid major depressive disorder or bipolar disorder on cognitive behavioral therapy for social anxiety disorder JOURNAL OF AFFECTIVE DISORDERS Fracalanza, K., McCabe, R. E., Taylor, V. H., Antony, M. M. 2014; 162: 61-66

  Abstract

  Major depressive disorder (MDD) and bipolar disorder (BD) commonly co-occur in individuals with social anxiety disorder (SAD), yet whether these comorbidities influence the outcomes of cognitive behavioral therapy (CBT) for SAD is unclear.The present study examined the degree to which individuals with SAD and comorbid MDD (SAD+MDD; n=76), comorbid BD (SAD+BD; n=19), a comorbid anxiety disorder (SAD+ANX; n=27), or no comorbid diagnoses (SAD+NCO; n=41) benefitted from CBT for SAD. Individuals were screened using the Structured Clinical Interview for DSM-IV and then completed the Social Phobia Inventory and the Depression Anxiety Stress Scales before and after 12-weeks of group CBT for SAD.At pretreatment the SAD+MDD and SAD+BD groups reported higher social anxiety symptoms than the SAD+ANX and SAD+NCO groups. All groups reported large and significant improvement in social anxiety with CBT. However, at posttreatment the SAD+MDD and SAD+BD groups continued to have higher social anxiety symptoms than the SAD+NCO group, and the SAD+ANX group did not differ in social anxiety symptoms from any group. The sample also showed small and statistically significant improvement in depressive symptoms with CBT for SAD.Information about medication was not collected in the present study, and we did not assess the long-term effects of CBT.Our results suggest that CBT for SAD is an effective treatment even in the presence of comorbid mood disorders in the short-term, although extending the course of treatment may be helpful for this population and should be investigated in future research.

  View details for DOI 10.1016/j.jad.2014.03.015

  View details for Web of Science ID 000335386000012

  View details for PubMedID 24767007

• Intolerance of Uncertainty Mediates the Relation Between Generalized Anxiety Disorder Symptoms and Anger COGNITIVE BEHAVIOUR THERAPY Fracalanza, K., Koerner, N., Deschenes, S. S., Dugas, M. J. 2014; 43 (2): 122-132

  Abstract

  Previous research has shown that individuals with generalized anxiety disorder (GAD) report elevated anger compared with nonanxious individuals; however, the pathways linking GAD and anger are currently unknown. We hypothesized that negative beliefs about uncertainty, negative beliefs about worry and perfectionism dimensions mediate the relationship between GAD symptoms and anger variables. We employed multiple mediation with bootstrapping on cross-sectional data from a student sample (N = 233) to test four models assessing potential mediators of the association of GAD symptoms to inward anger expression, outward anger expression, trait anger and hostility, respectively. The belief that uncertainty has negative personal and behavioural implications uniquely mediated the association of GAD symptoms to inward anger expression (confidence interval [CI] = .0034, .1845, PM = .5444), and the belief that uncertainty is unfair and spoils everything uniquely mediated the association of GAD symptoms to outward anger expression (CI = .0052, .1936, PM = .4861) and hostility (CI = .0269, .2427, PM = .3487). Neither negative beliefs about worry nor perfectionism dimensions uniquely mediated the relation of GAD symptoms to anger constructs. We conclude that intolerance of uncertainty may help to explain the positive connection between GAD symptoms and anger, and these findings give impetus to future longitudinal investigations of the role of anger in GAD.

  View details for DOI 10.1080/16506073.2014.888754

  View details for Web of Science ID 000334018200004

  View details for PubMedID 24579760

• The role of anxiety control strategies in imaginal exposure Exposure Therapy: Rethinking the Model ? Refining the Method Koerner, N., Fracalanza, K. 2012
• The role of anger in generalized anxiety disorder. Cognitive behaviour therapy Deschênes, S. S., Dugas, M. J., Fracalanza, K., Koerner, N. 2012; 41 (3): 261-271

  Abstract

  Little is known about the role of anger in the context of anxiety disorders, particularly with generalized anxiety disorder (GAD). The aim of study was to examine the relationship between specific dimensions of anger and GAD. Participants (N=381) completed a series of questionnaires, including the Generalized Anxiety Disorder Questionnaire (GAD-Q-IV; Newman et al., 2002, Behavior Therapy, 33, 215-233), the State-Trait Anger Expression Inventory (STAXI-2; Spielberger 1999, State-Trait Anger Expression Inventory-2: STAXI-2 professional manual, Odessa, FL: Psychological Assessment Resources) and the Aggression Questionnaire (AQ; Buss & Perry 1992, Journal of Personality and Social Psychology, 63, 452-459). The GAD-Q-IV identifies individuals who meet diagnostic criteria for GAD (i.e. GAD analogues) and those who do not (non-GAD). The STAXI-2 includes subscales for trait anger, externalized anger expression, internalized anger expression, externalized anger control and internalized anger control. The AQ includes subscales for physical aggression, verbal aggression, anger and hostility. The GAD-Q-IV significantly correlated with all STAXI-2 and AQ subscales (r's ranging from .10 to .46). Multivariate analyses of variance revealed that GAD analogues significantly differed from non-GAD participants on the combined STAXI-2 subscales (?2=.098); high levels of trait anger and internalized anger expression contributed the most to GAD group membership. GAD analogue participants also significantly differed from non-GAD participants on the combined AQ subscales (?2=.156); high levels of anger (affective component of aggression) and hostility contributed the most to GAD group membership. Within the GAD analogue group, the STAXI-2 and AQ subscales significantly predicted GAD symptom severity (R2=.124 and .198, respectively). Elevated levels of multiple dimensions of anger characterize individuals who meet diagnostic criteria for GAD.

  View details for DOI 10.1080/16506073.2012.666564

  View details for PubMedID 22429207

• Bipolar Disorder Comorbidity in Anxiety Disorders: Relationship to demographic profile, symptom severity, and functional impairment EUROPEAN JOURNAL OF PSYCHIATRY Fracalanza, K. A., McCabe, R. E., Taylor, V. H., Antony, M. M. 2011; 25 (4): 223-233

  View details for Web of Science ID 000299191200005