Megan McBride

Mentor: Dr. Joseph McNamara
College of Psychiatry
 
"I have always been fascinated by and interested in psychological research; the questions to be asked about the human mind are infinite. I love learning about how the brain influences human behavior and vice versa. Through working as a research assistant in a medical psychology lab, I have gained an appreciation for the entire research process and now understand just how imperative the use of evidence-based treatments are in a clinical setting. I only hope that my research now, and in the future, will improve human quality of life and will add to the ever-growing body of psychological science."

Major

Psychology

Minor

Spanish, Dance Studies

Research Interests

  • Anxiety Disorders
  • Obsessive-Compulsive Disorder
  • Cognitive Factors

Academic Awards

  • University Scholars
  • Dean's List
  • Florida Bright Futures

Organizations

  • UF Travel and Recreation Program

Volunteer

  • Talk Therapy Inc.
  • Sidney Lanier School

Hobbies and Interests

  • Backpacking
  • Travel
  • Dance and Yoga
  • Reading

Research Description

Effects of Intelligence and Insight on Treatment Outcome in Pediatric Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder (OCD) has been classified as one of the top 10 most debilitating medical conditions by the World Health Organization (World Health Organization, 2001). By the age of 18, approximately 2% of youth in the United States will meet criteria for OCD (Zohar, 1999). OCD is a diagnosis given to people who suffer from a cycle of recurring unwanted obsessions that drive them to perform compulsive behaviors. (American Psychiatric Association, 2014.) Obsessions are anxiety-provoking thoughts that can manifest themselves as distressing images, impulses, or ideas and that persist against the patient’s will. Compulsions are repetitive behavior or mental acts patients perform in an attempt to decrease the distress associated with the obsessions (American Psychological Association, 2014.) OCD causes clinically significant levels of distress, is characterized by symptoms that last at least one hour per day, and impairs normal functioning. OCD is a significant public health problem and when left untreated is frequently unremitting into adulthood (World Health Organization, 2001; Eisen et al., 2006; Stewart et al., 2004). It is critically important that we seek to improve current methods of pediatric OCD treatment. Cognitive-Behavioral Therapy with Exposure and Response Prevention (CBT-E/RP) is the first-line treatment for pediatric cases of OCD (POTS, 2004). Even with CBT-E/RP treatment plans in place, we see that an estimated 20-40% of affected youth receive little to no benefit from CBT-E/RP (Ferrao, et al., 2006). Sixty percent continue to need life-long psychological and/or pharmaceutical care (Stewart et al., 2004). Even more noteworthy, 61% of youth treated with CBT-E/RP may experience a reoccurrence of symptoms that had subsided during treatment. Though our University of Florida OCD Treatment Program exceeds national standards with 85% of patients experiencing a 50% or more reduction in symptoms by the end of their fifteenth session (Storch et al., 2007), there is still an immense need for more research and improvement in OCD therapy. The more we understand factors that predict OCD treatment outcome the better we can implement successful and effective CBT-E/RP that will ameliorate patients’ distressing symptoms. There is an existing gap in the literature when examining the relationships between patient intelligence, patient degree of insight, and treatment outcome. Insight is defined as the extent to which patients affected by OCD acknowledge or understand the irrational, excessive, and unreasonable nature of their symptoms. Initial evidence has suggested that there may be a relationship between neuropsychological functioning and pediatric OCD treatment outcome (Flessner et al., 2010). Initial trials have demonstrated that when considering executive functioning, OCD patients with poor insight perform significantly worse than their counterparts with good insight (Selim et al., 2009). However, no study has yet examined these three variables together in pediatric OCD. I want to investigate how intelligence and insight uniquely impact treatment. The first aim is to examine if pediatric OCD patients with higher levels of intelligence have better treatment outcomes. The second aim will examine if higher levels of patient insight will predict more successful OCD treatment outcomes. A final aim of this proposed study will determine if higher intelligence predicts a greater degree of insight. The Wechsler Intelligence Scale for Children (WISC-IV; Wechsler, 2004) will be used to measure intelligence. The WISC-IV is an extensively validated pediatric intelligence assessment with multiple subtests that capture various domains of intellectual functioning. For this study, we will administer the subtests associated with crystallized intelligence (Information, Vocabulary) and working memory (Digit Span, Letter Number Sequencing). The selected subtests of the WISC-IV will be administered at the beginning of the second session. Treatment outcome will be measured with Children’s Yale-Brown Obsessive Compulsive Scale (CYBOCS). The CYBOCS (Scahill et al., 1997) is a clinician-rated, semi-structured measure of OCD severity rated over the previous week. The CYBOCS will be administered at session 1 (intake), 4, 8, 12, and 15, as well as during the follow-up session. Insight will be measured using a single-item found on the CYBOCS. The item asks, “Do you think your concerns or behaviors are reasonable?” More research is needed to fully understand the relationships between intelligence, insight, and treatment outcome. Such research would allow investigators to examine the predictive power of these variables on pediatric OCD treatment. These findings could have huge potential implications for how we address treatment approaches and implement psycho-education. The focus might shift to actively increasing patient insight (rather than this occurring naturally as a by-product of CBT-E/RP). Additionally, patients with different levels of intelligence might need more individualized treatment plans in order to maximize treatment outcome.