Clinical Focus

  • Clinical Psychology

Academic Appointments

  • Clinical Assistant Professor, Psychiatry and Behavioral Sciences

Professional Education

  • Fellowship: Stanford University Adult Psychology Postdoctoral Fellowship (2023) CA
  • Internship: St. Joseph's Healthcare Hamilton (2022) Canada
  • PhD Training: Toronto Metropolitan University (2022) Canada

All Publications

  • Effectiveness and predictors of group cognitive behaviour therapy outcome for generalised anxiety disorder in an out-patient hospital setting. Behavioural and cognitive psychotherapy Malivoire, B. L., Stewart, K. E., Cameron, D., Rowa, K., McCabe, R. E. 2024: 1-16


    BACKGROUND: Cognitive behavioural therapy (CBT) is an empirically supported treatment for generalized anxiety disorder (GAD). Little is known about the effectiveness of CBT for GAD in real-world treatment settings.AIM: This study investigated the effectiveness of group CBT and predictors of treatment response in an out-patient hospital clinic.METHOD: Participants (n = 386) with GAD participated in 12 sessions of group CBT at an out-patient clinic. Of those who provided at least partial data (n = 326), 84.5% completed treatment. Most questionnaires were completed at pre- and post-treatment; worry severity was assessed weekly.RESULTS: Group CBT led to improvements in chronic worry (d = -0.91, n = 118), depressive symptoms (d = -1.22, n = 172), GAD symptom severity (d = -0.65, n = 171), intolerance of uncertainty (IU; d = -0.46, n = 174) and level of functional impairment (d = -0.35, n = 169). Greater pre-treatment GAD symptom severity (d = -0.17, n = 293), chronic worry (d = -0.20, n = 185), functional impairment (d = -0.12, n = 292), and number of comorbid diagnoses (d = -0.13, n = 299) predicted greater improvement in past week worry over treatment. Biological sex, age, depression symptom severity, number of treatment sessions attended, and IU did not predict change in past week worry over time.DISCUSSION: These findings provide support for the effectiveness of group CBT for GAD and suggest the outcomes are robust and are either not impacted or are slightly positively impacted by several demographic and clinical factors.

    View details for DOI 10.1017/S1352465823000632

    View details for PubMedID 38291658

  • An examination of worry and self-distancing as coping strategies for anxiety-provoking experiences in individuals high in worry. Anxiety, stress, and coping Vieira, J. L., Malivoire, B. L., Koerner, N., Sumantry, D. 2023: 1-14


    This preliminary online study investigated the short-term effects of self-distancing, worry, and distraction on anxiety and worry-related appraisals among individuals high in worry.N = 104 community members high in trait worry were randomly assigned to think about a personally identified worry-provoking situation using self-distancing (SC), worry (WC), or distraction (DC). Participants rated their anxiety (Visual Analogue Scale for Anxiety) and appraisals of the situation (Perceived Probability, Coping, and Cost Questions) at post-task and one-day follow-up.Mixed factorial ANOVAs revealed an increase in anxiety within the WC (d = .475) and no difference in anxiety within the SC (d = .010) from pre- to post-task. There was no difference in anxiety within the DC (p = .177). Participants within the SC reported a decrease in the perceived cost associated with their identified situation from pre- to post-task (d = .424), which was maintained at one-day follow-up (d = .034). Participants reported an increase in perceived ability to cope from post-task to one-day follow-up (d = .236), and from pre-task to one-day follow-up (d = .338), regardless of condition.Self-distancing may prevent increases in anxiety and catastrophizing while reflecting on a feared situation.

    View details for DOI 10.1080/10615806.2023.2270417

    View details for PubMedID 37873941

  • A mixed methods investigation of reasons underlying fear of positive evaluation. Clinical psychology & psychotherapy Wilson, G. A., Malivoire, B. L., Cassin, S. E., Antony, M. M. 2023; 30 (2): 473-485


    Fear of negative evaluation (FNE) is a hallmark feature of social anxiety disorder (SAD). There is also evidence that people with SAD fear receiving positive evaluation and that fear of positive evaluation (FPE) is distinct from FNE. However, researchers have speculated that concerns related to negative evaluation may actually underlie FPE. This study sought to advance our understanding of FPE by employing both quantitative and qualitative methods to assess the reasons underlying participants' endorsement of FPE on the Fear of Positive Evaluation Scale and the extent to which these reasons reflect FNE versus FPE in a sample of individuals with SAD (n = 47) and a nonclinical comparison group (n = 49). Results indicated that responses to the FPES items primarily reflected an underlying FNE. Consistent with contemporary cognitive-behavioural theories of SAD, fear of proximal or eventual negative judgement emerged as the most common reason for participants' responses on the FPES. However, participants reported other reasons that did not reflect FNE, such as fear of hurting people's feelings and uncertainty associated with positive evaluation. All of the reasons underlying participants' ratings on the FPES were reported by both the SAD group and the nonclinical comparison group; however, individuals with SAD endorsed each of the reasons to a greater extent. These findings suggest that the FPES does not exclusively assess FPE as intended; however, the emergence and endorsement of reasons other than FNE suggest that FPE exists as a distinct construct.

    View details for DOI 10.1002/cpp.2818

    View details for PubMedID 36523260

  • Correlates of Dampening and Savoring in Generalized Anxiety Disorder. International journal of cognitive therapy Malivoire, B. L., Marcotte-Beaumier, G., Sumantry, D., Koerner, N. 2022; 15 (4): 414-433


    Chronic worry and generalized anxiety disorder (GAD) symptoms are associated with infrequent savoring, and high dampening, of positive emotions. The goal of the present study was to investigate the indirect role of GAD-relevant processes, including intolerance of uncertainty (IU), fear of negative emotional contrasts, and negative beliefs about positive emotion and its regulation, in the relationship between GAD symptom severity and the tendency to engage in dampening and not savor positive emotions. Community participants (N = 233) completed questionnaires online. In separate models, IU, fear of negative emotional contrasts, and negative beliefs about positive emotion and its regulation fully mediated the relationships between GAD symptom severity and greater dampening and lower savoring. However, controlling for depression, only IU remained a significant mediator. A post hoc latent analysis of the mediators provided support for an underlying construct that may reflect intolerance of uncomfortable states. Intolerance of uncomfortable states was found to significantly mediate the relationship between GAD symptoms and greater dampening and lower savoring. Difficulty withstanding uncertainty may be particularly relevant in understanding why people with elevated GAD symptoms engage in efforts to avoid experiencing positive emotions. Further, the findings suggest that there may be a common factor underlying a variety of GAD-associated constructs reflecting a broad intolerance of uncomfortable inner states. Theoretical and clinical implications are discussed.The online version contains supplementary material available at 10.1007/s41811-022-00145-x.

    View details for DOI 10.1007/s41811-022-00145-x

    View details for PubMedID 36161248

    View details for PubMedCentralID PMC9483300

  • Exploring the relationship between contrast avoidance and generalized anxiety disorder symptoms: the mediating roles of fear of emotion and intolerance of uncertainty CURRENT PSYCHOLOGY Marcotte-Beaumier, G., Malivoire, B. L., Koerner, N. 2023; 42 (29): 25185-25192
  • An Investigation of Emotional and Cognitive Responses to Positive, Negative, and Neutral Social Evaluation Using a Face-to-Face Social Interaction Task in Social Anxiety Disorder INTERNATIONAL JOURNAL OF COGNITIVE THERAPY Wilson, G. A., Malivoire, B. L., Cassin, S. E., Antony, M. M. 2022; 15 (3): 255-276
  • Interpersonal dysfunction in individuals high in chronic worry: relations with interpersonal problem-solving. Behavioural and cognitive psychotherapy Malivoire, B. L., Koerner, N. 2022; 50 (2): 142-157


    Interpersonal dysfunction has been proposed as an important maintenance factor in chronic worry and generalized anxiety disorder (GAD). Perceptions of problems and the problem-solving process as threatening, and unhelpful (e.g. avoidant, impulsive) problem-solving styles are implicated in worry and have also been suggested to be associated with dysfunctional interpersonal styles.The present study assessed the relationships between interpersonal dysfunction and problem-solving orientation, approach, and effectiveness in a sample of individuals high in chronic worry and investigated the indirect effect of interpersonal dysfunction on GAD symptom severity through negative problem-solving beliefs and approaches.Fifty-nine community participants completed questionnaires and an interpersonal problem-solving task.Greater interpersonal dysfunction was significantly associated with greater negative problem-solving orientation and greater habitual avoidant and impulsive/careless problem-solving styles. Greater interpersonal dysfunction was associated with poorer effectiveness of solutions when the task problem involved conflict with a romantic partner. Negative problem-solving orientation fully mediated the relationship between interpersonal dysfunction and GAD symptoms.These findings support that problem-solving processes are implicated in interpersonal dysfunction and that negative beliefs about problem-solving account for the relationship between interpersonal dysfunction and GAD symptoms. Theoretical implications are discussed.

    View details for DOI 10.1017/S1352465821000436

    View details for PubMedID 34789349

  • Mechanisms and moderators of behavioural couples therapy for alcohol and substance use disorders: an updated review of the literature. Behavioural and cognitive psychotherapy Mutschler, C., Malivoire, B. L., Schumm, J. A., Monson, C. M. 2022: 1-22


    Behavioural couples therapy (BCT) and alcohol behavioural couples therapy (ABCT) are couples-based interventions for substance use disorders (SUDs) that have been deemed a 'gold standard' treatment. Despite the substantial amount of promising research, there is a lack of research on the active components of treatment and treatment mechanisms and moderators. Since the most recent meta-analysis, a number of studies have been conducted that advance our understanding of the efficacy of BCT and ABCT.The purpose of the present review was to provide an update on the current knowledge of these treatments and to investigate mediators and moderators of treatment.A systematic search strategy of relevant databases from 2008 to 2021 identified 20 relevant articles that were coded for relevant information including study design, treatment, outcomes, as well as mechanisms and moderators.The results indicated that BCT and ABCT are successful in reducing alcohol and substance use for both male and female clients, dual problem couples, and for reducing post-traumatic stress symptoms and intimate partner violence. The reviewed studies discussed a number of treatment mechanisms, with the most studied mechanism being relationship functioning. Moderators included relationship functioning and patient gender.The results point to the need for additional research on active treatment components, mechanisms and moderators, in order to provide a more efficient and cost-effective treatment.

    View details for DOI 10.1017/S1352465822000042

    View details for PubMedID 35190008

  • Family and Couple Integrated Cognitive-Behavioural Therapy for Adults with OCD: A Meta-Analysis. Focus (American Psychiatric Publishing) Stewart, K. E., Sumantry, D., Malivoire, B. L. 2021; 19 (4): 477-489


    Reprinted with permission from Elsevier.

    View details for DOI 10.1176/appi.focus.19404

    View details for PubMedID 35747300

    View details for PubMedCentralID PMC9063581

  • The Role of Overt and Covert Avoidance Strategies in Generalized Anxiety Disorder Symptoms and Fear of Emotion JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT Marcotte-Beaumier, G., Malivoire, B. L., Koerner, N., Ovanessian, M. M. 2022; 44 (2): 344-352
  • A Preliminary Exploration of Behaviours Associated with Negative Urgency in Individuals High and Low in Chronic Worry BEHAVIOUR CHANGE Malivoire, B. L., Stewart, K. E., Koerner, N. 2021; 38 (2): 119-134

    View details for DOI 10.1017/bec.2021.5

    View details for Web of Science ID 000749681400006

  • Interpersonal dysfunction and treatment outcome in GAD: A systematic review. Journal of anxiety disorders Malivoire, B. L., Mutschler, C., Monson, C. M. 2020; 76: 102310


    Interpersonal dysfunction is posited to maintain worry and generalized anxiety disorder (GAD). It has been suggested that the low remission rates in psychotherapy for GAD may be attributable, in part, to inadequately addressing interpersonal dysfunction. This paper systematically reviewed the literature examining the moderating role of interpersonal dysfunction on GAD psychotherapy outcomes and change in interpersonal dysfunction over the course of GAD treatment. Thirteen studies were identified, seven of which examined the relationship between interpersonal dysfunction or distress and treatment outcome and nine investigated change in interpersonal dysfunction over the course of psychotherapy. The majority of studies indicated that interpersonal dysfunction improves following psychotherapy. However, there is preliminary evidence that not all subscales of interpersonal dysfunction improve, including subscales relevant to GAD pathology such as overly-nurturant dysfunction. Further, greater interpersonal dysfunction predicted worse treatment outcomes. As such, interpersonal dysfunction may hinder treatment success and further research is needed to delineate for whom additional or integrated interpersonal interventions may be needed. Approaches to target interpersonal dysfunction in GAD are discussed.

    View details for DOI 10.1016/j.janxdis.2020.102310

    View details for PubMedID 33002755

  • Exploring DBT skills training as a treatment avenue for generalized anxiety disorder CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE Malivoire, B. L. 2020; 27 (4)

    View details for DOI 10.1111/cpsp.12339

    View details for Web of Science ID 000527196000001

  • An examination of emotion dysregulation in maladaptive perfectionism. Clinical psychology review Malivoire, B. L., Kuo, J. R., Antony, M. M. 2019; 71: 39-50


    Maladaptive perfectionism has been shown to be associated with undesirable outcomes, such as elevated negative emotions and psychopathological traits. Perhaps unsurprisingly, there is preliminary evidence that maladaptive perfectionism is also related to emotion dysregulation. However, the nature of emotion dysregulation in perfectionism has not been characterized. In this review, Gross and Jazaieri's (2014) clinically-informed framework of emotion dysregulation is used to review the evidence of emotion dysregulation in maladaptive perfectionism. Specifically, this paper reviews evidence of problematic emotional experiences and unhelpful emotion regulation strategies in maladaptive perfectionism and discusses how poor emotional awareness and emotion regulation goals may also contribute to emotion dysregulation. A conceptual model of these components of emotion dysregulation in maladaptive perfectionism is proposed in which heightened negative affect in response to threatened perfectionistic standards is posited to be at the core of emotion dysregulation, and implicit and explicit unhelpful emotion regulation strategies and poor emotion regulation goals are suggested to contribute to further dysregulation and elevated negative affect. Clinical implications, limitations in the extant research, and future directions are discussed.

    View details for DOI 10.1016/j.cpr.2019.04.006

    View details for PubMedID 31078057