The need for effective treatments and treatment accessibility for obsessive-compulsive disorder (OCD) in childhood is evident given that as many as 50% of individuals with OCD report symptom onset before age 15. Despite the growing evidence supporting the efficacy of Exposure and Response Prevention (ERP) for youth with OCD, children seeking services for their OCD symptoms often do not receive ERP. Intensive treatment programs may be a feasible treatment option for children and their families who do not have access to ERP treatment and/or live in an area where therapists trained in ERP are limited. Preliminary studies have shown initial promise for 5-day intensive treatment programs, which have collapsed one-month intensive programs into an even shorter duration. This study serves as the first controlled, one-week intensive intervention for pediatric OCD. To evaluate the efficacy, feasibility, and acceptability of this brief, one-week intensive ERP program for pediatric OCD, nine children with OCD were randomized to a one-week, two-week, or three-week baseline period in a single-case, non-concurrent multiple baseline experimental design. Although symptoms were relatively stable during the baseline period, most participants showed reductions in OCD symptoms with the implementation of treatment. Treatment gains were maintained at a 3-month follow-up assessment; 67% of children were considered treatment responders. Children and families perceived the program to be acceptable, feasible, and beneficial. This study provides support for the efficacy and feasibility of a 5-day intensive treatment program for pediatric OCD. / Ph. D.

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Injection phobia is a prevalent anxiety disorder that puts youth at risk for adverse health outcomes. There is a need to develop accessible, timely, and effective treatments for injection phobia. Combining telehealth and intensive treatment approaches is a promising new direction for the treatment of youth injection phobia as it could address common accessibility barriers and help youth return to healthier functioning more quickly. In addition to testing a telehealth-delivered, intensive treatment for youth injection phobia, this dissertation project includes a critical review of measures of cognitive biases, which have been proposed to contribute to and maintain anxiety disorders. Chapter 1 presents the results of a novel telehealth-delivered, intensive treatment for youth injection phobia. The study used a multiple baseline design to investigate the acceptability, feasibility, and preliminary efficacy of this intervention in 11 youth with injection phobia (Mage=12.5). I hypothesized that the intervention would be rated as feasible and acceptable, and that youth participants would show significant reductions in injection fear and avoidance following treatment. These hypotheses were supported by the study’s results. Chapter 2 is a case series report that describes how the novel telehealth-delivered, intensive treatment for youth injection phobia was tailored to address factors (i.e., attentional difficulties low motivation, and high clinical acuity) that can interfere with the appropriateness and efficacy of telehealth treatment. Clinical implications are then discussed. Chapter 3 provides a comprehensive review of measures commonly utilized to quantify attentional, interpretation, and memory biases in anxious samples. In this review, I highlight how the psychometric and theoretical shortcomings of current measures limit the field’s ability to accurately capture cognitive biases, and in turn, the nuanced relationship between cognitive biases and anxiety symptoms. I also detail specific measurement considerations that can help guide future research focused on anxiety-linked cognitive biases. Overall, this project 1) demonstrates that a combined telehealth-delivered and intensive treatment approach appears to be a viable and effective delivery format for treating youth injection phobia and 2) provides recommendations for how to improve the measurement of cognitive biases so as to enhance our understanding of the etiology of youth anxiety disorders. / 2026-10-02

Abstract Background: Individuals with nonfluent aphasia may have significant difficulties with functional spoken communication tasks in their daily life. Aphasia treatment held in a group setting may provide an enriched communicative context wherein the requirements of spoken language are similar to those within functional day-to-day communicative situations. Thus engaging in a spoken language activity in a group setting may directly target generalization of trained skills to those required in real-life, social communication situations. The present study is concerned with an aphasia group treatment that requires focused practice of spoken language during a social-functional communication task. Intensive Language Action Therapy (ILAT) has demonstrated positive communication outcomes in some individuals with chronic aphasia. However, it remains to be seen which clinical measures best index outcomes for ILAT. The purpose of the current study was to determine the effectiveness of ILAT in individuals with nonfluent aphasia by exploring multiple, potential ILAT outcomes. The outcomes included change in performance on assessments of directly trained spoken social-functional communication abilities (proximal outcomes), untrained social-functional communication abilities and language abilities (primary outcomes), and cognitive-communication abilities (secondary outcome). Additionally, the project aimed to explore the participants' perceptions of ILAT (secondary outcome). Methods and Procedures: ILAT was implemented with four individuals with nonfluent aphasia, using a single-subject multiple baseline design. The treatment was conducted daily for 10 consecutive week days, totaling 25 hours of treatment. Treatment probes (i.e., using trained and untrained picture cards and an unrelated control-task of nonword repetition), a pre/post assessment battery, and a post-treatment survey/interview were administered to assess performance on the treatment task, generalization to other potential ILAT outcomes, and participants' perceptions. Outcomes & Results: Increased accuracy was observed for trained and untrained items. However, two of the four participants were not able to reach a criteria determined a priori for treatment performance. Performance on items that were untrained resulted in some improvements in performance for all participants. Three of the four participants demonstrated small effect sizes in response to ILAT. One participant who demonstrated a medium effect size in response to ILAT also demonstrated a clinical significant change in discourse abilities, a measure of spoken social-functional communication abilities. All participants demonstrated improvements on at least one primary outcomes measure. Two participants, however, demonstrated a decline. All participants, however, perceived a positive experience with ILAT on a qualitative posttreatment survey/interview. Conclusions: Patterns were found between skills directly trained during ILAT, proximal outcomes, and performance on primary and secondary outcome measures of language, social-functional communication, and cognitive-communication, meant to assess generalization of trained skills to similar or potentially related untrained skills. A substantial amount of change (e.g., at least a medium effect size) on proximal outcome measures may be required in order for improvements to occur in primary and secondary outcome measures. Participants' perceptions of a positive treatment experience associated with the ILAT program further supports the value of the treatment. Future research should aim to further examine the influence of ILAT treatment components and participants' characteristics.

Bakgrund: Glykemisk kontroll hos personer med typ 1 diabetes kräver stöd och utbildning av vårdpersonal inom diabetesvården. För att förbättra behandlingsresultat och livskvalitet samt minska risken för komplikationer kan intensiva behandlingsstrategier användas för att sträva efter optimal glykemisk kontroll och hälsa. Syfte: Syftet är att beskriva hur intensivbehandling påverkar HbA1c och hälsa hos personer med diabetes typ 1. Metod: En retrospektiv studie, deskriptiv design med kvantitativ ansats. Urvalet skedde från en diabetesmottagning och utgick från redan insamlade data från ett intensivbehandlingsprojekt. 42 patienter med diabetes typ 1 och HbA1c ≥70 mmol/mol inkluderades i intensivbehandlingsprojektet. De variabler som undersöktes var HbA1c och EQ-VAS, för att undersöka sambandet mellan glykemiskkontroll och skattad hälsa. Huvudresultat: Resultatet visade ett svagt samband mellan sjunkande HbA1c och stigande EQ-VAS vid uppföljningen. Det starkaste signifikanta sambandet sågs i kategorin kontakt med dietist, kopplat till HbA1c och EQ-VAS. I kategorierna patienter med flerdosbehandling av insulinpenna, behandling med insulinpump samt utebliven kontakt med dietist visade inget signifikant samband kopplat till sjunkande HbA1c och stigande EQ-VAS.  Slutsats: Studien visar betydande förbättringar i både HbA1c och EQ-VAS hos patienter med diabetes typ 1 efter intensivbehandling. Positiva samband observerades mellan insulinpumpbehandling och högre EQ-VAS, samt dietistkontakt och minskat HbA1c. Fynden tyder på att intensivbehandlingen, särskilt med dietistrådgivning, effektivt förbättrar glykemisk kontroll och livskvalitet. Ytterligare forskning behövs för att bekräfta dessa resultat. / Background: Glycemic control in individuals with type 1 diabetes requires support and education from diabetes care professionals. To improve treatment outcomes and quality of life while reducing the risk of complications, intensive treatment strategies can be employed to achieve optimal glycemic control and health. Purpose: The purpose is to describe how intensive treatment affects HbA1c and health in individuals with type 1 diabetes. Method: A retrospective study with a descriptive design using a quantitative approach. The sample was selected from a diabetes clinic and relied on previously reported data from an intensive treatment project. 42 patients with type 1 diabetes and HbA1c ≥70 mmol/mol were included in the intensive treatment project. Data were analyzed using Spearman's rank correlation analysis to identify relationships between HbA1c and health. Main Results: The results showed a weak correlation between decreasing HbA1c and increasing EQ-VAS scores at follow-up. The strongest significant correlation was observed in the category of contact with a dietitian, linked to HbA1c and EQ-VAS. In the categories of patients using multiple daily injections with insulin pens, insulin pump therapy, and lack of contact with a dietitian, no significant correlation was found related to decreasing HbA1c and increasing EQ-VAS. Conclusion: The study shows significant improvements in both HbA1c and EQ-VAS in patients with type 1 diabetes after intensive treatment. Positive correlations were observed between insulin pump therapy and higher EQ-VAS scores, as well as between dietitian contact and reduced HbA1c. The findings suggest that intensive treatment, especially with dietitian counseling, effectively enhances glycemic control and quality of life. Further research is needed to confirm these results.