Mallory Almengual

Mentor: Dr. Joseph McNamara
Psychiatry
 
"The human mind is one of science's final frontiers. It is still relatively uncharted terrain, with each new discovery evoking as many questions as it answers. The mystery surrounding the intricacies of how the mind functions and influences human behavior was what drew me initially to psychological research. Through my experience as a research assistant in the medical psychology lab I gained an appreciation for the ability of experimental design and assessment to glean statistically significant and reproducible data from an inherently elusive and complex subject matter. The development and improvement of treatments for debilitating psychological disorders relies on this meticulous practice. Psychology is sometimes dismissed by other fields of study as a "soft" science due to its seemingly unverifiable nature. I hope that my research, now and in my future career, can not only aid in the dismantling of this misrepresentation, but also contribute to the larger body of scientific knowledge to improve human quality of life. "

Major

Psychology

Minor

Spanish

Research Interests

  • Anxiety Disorders
  • Obsessive-Compulsive Disorder
  • Therapeutic Alliance

Academic Awards

  • Dean's List
  • Florida Bright Futures
  • UF University Scholars Program
  • UF Honors Program

Organizations

  • Golden Key International Honor Society
  • Psi Chi Honor Society
  • E.A.T. Club

Volunteer

  • Talk Therapy Inc.

Hobbies and Interests

  • Travel
  • Yoga
  • Philosophy and Ethics
  • Friends and Family

Research Description

The Effect of Therapeutic Alliance on Treatment Outcome in Pediatric Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is a diagnosis given to patients who suffer from recurring cycles of obsessive thoughts and compulsive behaviors that cause clinically significant levels of distress, have a duration of at least one hour per day, and/or impede normal functioning (American Psychological Association, 2013). By age 18, 2% of American youth meet diagnostic criteria for OCD (Zohar, 1999). OCD has been classified as one of the top 10 most debilitating medical conditions by the World Health Organization (World Health Organization, 2001). This disorder is a considerable public health problem, causes impaired functioning, and, if left untreated in childhood, often persists throughout adulthood (World Health Organization, 2001; Eisen et al., 2006; Stewart et al., 2004). Improving the current treatment approaches for pediatric OCD is an issue of critical importance. Cognitive-Behavioral Therapy with Exposure and Response Prevention (CBT-E/RP) is currently identified as the first-line course of treatment for pediatric cases of OCD (POTS, 2004). Although CBT-E/RP is the most effective treatment option available for pediatric OCD, 20-40% of affected youth are estimated to be treatment non-responders (Ferrao, et al., 2006) and 60% continue to need life-long psychological and/or pharmaceutical care (Stewart et al., 2004). Moreover, the remission rate for youths undergoing CBT-E/RP is 39%. Consequently, approximately 61% of youth being treated with CBT-E/RP may experience a reoccurrence of symptoms that had subsided during treatment. If the effectiveness of CBT-E/RP can be improved, sufferers of pediatric OCD will stand a greater chance of achieving continuous relief from their symptoms. Two treatment-related factors that have emerged as reliable predictors of treatment response are the Therapeutic Alliance (TA) (Hoogduin, de Haan, & Schaap, 1989; Keijsers et al., 1994; Vogel, Hansen, Stiles, & Gotesam, 2006) and patient compliance (Abramowitz, Franklin, Zoellner, & DiBernardo, 2002; De Araujo, Ito, & Marks, 1996; Tolin, Maltby, Diefenbach, Hannan, & Worhunsky, 2004; Whittal, Thordarson, & McLean, 2005). TA is defined as a sophisticated form of the therapeutic relationship that encompasses both cognitive and behavioral components of interaction, as well as affective facets of the therapist-patient interaction (Shirk & Saiz, 1992). TA is of particular interest in CBT-E/RP due to the anxiety-provoking and aversive nature of the exposures that therapists encourage patients to engage in during treatment. To date, only one study has examined TA in pediatric OCD, and no study has utilized multilevel modeling (MLM) to observe the relationship between TA and patient compliance in the form of homework completion. The proposed study will examine this relationship on a patient-by-patient and session-by-session basis, allowing changes in TA and compliance to be examined and to study their effect on symptom severity over the course of treatment, as well as at the time of treatment termination. To measure these variables, patients will be administered several psychological assessments to measure their TA, homework compliance, and symptom severity/dimensionality during the course of their 15 session treatment. The Working Alliance Inventory (WAI; Horvath and Greenberg, 1986) will be administered to youth to assess overall TA and the subscales of Task, Bond, and Goal. The Therapeutic Alliance Scale for Children-Revised (TASC-R; Shirk & Saiz, 1992) will be completed by the child and measures the extent to which a child feels that the therapist is enjoyable to work with and is helping them. Homework compliance (HC) relates the frequency that a patient completes their therapist-assigned out-of-office exposure tasks. The final assessment is the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS; Rosario-Campos et al., 2006). The DY-BOCS measures the severity of obsessive-compulsive symptoms within six symptom domains and will be administered to the child and parents jointly (due to the tendency of youths to underestimate their symptoms).More research is needed to better understand TA and patient compliance within CBT-E/RP for pediatric OCD. Such research would allow investigators to evaluate the predictive power of these two factors on treatment outcome and examine the potential association between strength of TA and degree of patient compliance. Knowledge of these influences has implications for the manner in which therapists approach the establishment of rapport, the development of the TA, and the emphasis placed on compliance with therapeutic tasks. These key components can then be utilized to improve existing treatments of OCD.