Dr. Flint Espil researches the etiology and treatment of tic disorders (including Tourette’s), Obsessive-Compulsive Disorder, and body-focused repetitive behaviors. He is interested in how psychosocial factors, the environment, and underlying brain circuitry influence treatment outcomes among individuals seeking treatment. He is also exploring ways to adapt and implement evidence-based mental health approaches in community settings. He is currently collaborating with community-based organizations in East Palo Alto to improve access to care for youth in school settings.

Clinical Focus

  • Obsessive-Compulsive Disorder
  • Tourette Syndrome
  • Trichotillomania
  • Clinical Psychology

Academic Appointments

  • Clinical Associate Professor, Psychiatry and Behavioral Sciences

Honors & Awards

  • Trichotillomania Learning Center Early Career Award, TLC for Body-Focused Repetitive Behaviors (2019)
  • Child Intervention and Prevention Services Research Fellowship, NIMH (2017)
  • Clinical Research Loan Repayment Program, NIH (2016, 2018, 2020)

Boards, Advisory Committees, Professional Organizations

  • Member, Society for Biological Psychiatry (2019 - Present)
  • Member, American Academy of Neurology (2016 - Present)
  • Member, Society of Clinical Child and Adolescent Psychology (2014 - Present)
  • Member, Association for Behavioral and Cognitive Therapies (2009 - Present)

Professional Education

  • Fellowship: UCSF Clinical Psychology Training Program (2016) CA
  • Internship: University of Mississippi Medical Center Psychology Internship (2015) MS
  • PhD Training: University of Wisconsin Milwaukee Registrar (2015) WI
  • NIMH T32 Postdoctoral Fellow, University of California, San Francisco, Clinical Services Research (2016)
  • Residency Training Program, University of Mississippi Medical Center, Clinical Psychology (2015)
  • Ph.D., University of Wisconsin-Milwaukee, Clinical Psychology (2015)
  • M.A., University of Colorado-Denver, Clinical Psychology (2010)

All Publications

  • A randomized waitlist-controlled pilot trial of voice over Internet protocol-delivered behavior therapy for youth with chronic tic disorders JOURNAL OF TELEMEDICINE AND TELECARE Ricketts, E. J., Goetz, A. R., Capriotti, M. R., Bauer, C. C., Brei, N. G., Himle, M. B., Espil, F. M., Snorrason, I., Ran, D., Woods, D. W. 2016; 22 (3): 153-162


    Comprehensive Behavioral Intervention for Tics (CBIT) has been shown to be efficacious for chronic tic disorders (CTDs), but utilization is limited by a lack of treatment providers and perceived financial and time burden of commuting to treatment. A promising alternative to in-person delivery is voice over Internet protocol (VoIP), allowing for remote, real-time treatment delivery to patients' homes. However, little is known about the effectiveness of VoIP for CTDs. Therefore, the present study examined the preliminary efficacy, feasibility, and acceptability of VoIP-delivered CBIT (CBIT-VoIP).Twenty youth (8-16 years) with CTDs participated in a randomized, waitlist-controlled pilot trial of CBIT-VoIP. The main outcome was pre- to post-treatment change in clinician-rated tic severity (Yale Global Tic Severity Scale). The secondary outcome was clinical responder rate (Clinical Global Impressions - Improvement Scale), assessed using ratings of 'very much improved' or 'much improved' indicating positive treatment response.Intention-to-treat analyses with the last observation carried forward were performed. At post-treatment (10-weeks), significantly greater reductions in clinician-rated, (F(1,18) = 3.05, p < 0.05, partial η(2 )= 0.15), and parent-reported tic severity, (F(1,18) = 6.37, p < 0.05, partial η(2 )= 0.26) were found in CBIT-VoIP relative to waitlist. One-third (n = 4) of those in CBIT-VoIP were considered treatment responders. Treatment satisfaction and therapeutic alliance were high.CBIT can be delivered via VoIP with high patient satisfaction, using accessible, low-cost equipment. CBIT-VoIP was generally feasible to implement, with some audio and visual challenges. Modifications to enhance treatment delivery are suggested.

    View details for DOI 10.1177/1357633X15593192

    View details for PubMedID 26169350

  • Posttraumatic Stress Disorder and Depressive Symptoms among Inpatient Adolescents: The Underlying Role of Emotion Regulation Residential Treatment for Children & Youth Espil, F. M., Viana, A. G., Dixon, L. J. 2016
  • Comparing fixed-amount and progressive amount DRO schedules for tic suppression in youth with chronic tic disorders Journal of Applied Behavior Analysis Capriotti, M. R., Turkel, J. E., Johnson, R. A., Espil, F. M., Woods, D. W. 2016
  • Posttraumatic Stress Disorder and Depressive Symptoms among Inpatient Adolescents: The Underlying Role of Emotion Regulation Psychological Trauma: Theory, Research, Practice, and Policy Viana, A. G., Dixon, L. J., Berenz, E. C., Espil, F. M. 2016
  • Manualized and Modular Behavior Therapy for a Child With Tourette’s Disorder, Inattention, and Disruptive Behavior: A Case Example Clinical Case Studies Espil, F. M., Elkin, T. D., Young, J. 2016
  • Associations Between Anxiety Symptoms and Child and Family Factors in Pediatric Obesity JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Lim, C. S., Espil, F. M., Viana, A. G., Janicke, D. M. 2015; 36 (9): 664-672


    This study compared child weight status, social skills, body dissatisfaction, and health-related quality of life (HRQOL), as well as parent distress and family functioning in youth who are overweight or obese (OV/OB) with versus without clinical anxiety symptoms.Participants included 199 children 7 to 12 years of age (mean age = 9.88 years) who were OV/OB, and their parents. Children completed social skills, body dissatisfaction, and HRQOL questionnaires. Parents completed the Child Behavior Checklist (CBCL) and child HRQOL, parent distress, family functioning, and demographic questionnaires. Children were placed in 2 groups based on CBCL anxiety problems scale scores: the OV/OB + clinical anxiety group included children with T scores ≥65 (n = 23) and children with T scores ≤59 comprised the OV/OB group (n = 176).After controlling for covariates, children in the OV/OB + clinical anxiety group reported more body dissatisfaction (F[1,198] = 5.26, p = .023, partial η = .027) and lower total HRQOL (F[1,198] = 8.12, p = .005, η = .041) and had parents who reported higher psychological distress (F[1,198] = 5.48, p = .020, η = .028) and lower child total HRQOL (F[1,198] = 28.23, p < .001, η = .128) compared with children in the OV/OB group. Group differences were not significant for child weight status, social skills, or family functioning.Clinically significant anxiety among children who are OV/OB is associated with increased body dissatisfaction and parent psychological distress, as well as decreased HRQOL. Findings have implications for the assessment and treatment of anxiety symptoms in pediatric obesity.

    View details for DOI 10.1097/DBP.0000000000000225

    View details for Web of Science ID 000364494500002

    View details for PubMedID 26468940

  • Assessing Environmental Consequences of Ticcing in Youth With Chronic Tic Disorders: The Tic Accommodation and Reactions Scale CHILDRENS HEALTH CARE Capriotti, M. R., Piacentini, J. C., Himle, M. B., Ricketts, E. J., Espil, F. M., Lee, H. J., Turkel, J. E., Woods, D. W. 2015; 44 (3): 205-220
  • The Role of Parental Perceptions of Tic Frequency and Intensity in Predicting Tic-Related Functional Impairment in Youth with Chronic Tic Disorders CHILD PSYCHIATRY & HUMAN DEVELOPMENT Espil, F. M., Capriotti, M. R., Conelea, C. A., Woods, D. W. 2014; 45 (6): 657-665


    Tic severity is composed of several dimensions. Tic frequency and intensity are two such dimensions, but little empirical data exist regarding their relative contributions to functional impairment in those with chronic tic disorders (CTD). The present study examined the relative contributions of these dimensions in predicting tic-related impairment across several psychosocial domains. Using data collected from parents of youth with CTD, multivariate regression analyses revealed that both tic frequency and intensity predicted tic-related impairment in several areas; including family and peer relationships, school interference, and social endeavors, even when controlling for the presence of comorbid anxiety symptoms and Attention Deficit Hyperactivity Disorder diagnostic status. Results showed that tic intensity predicted more variance across more domains than tic frequency.

    View details for DOI 10.1007/s10578-013-0434-2

    View details for Web of Science ID 000345140400002

    View details for PubMedID 24395287

  • Behavior Therapy for Stereotypic Movement Disorder in Typically Developing Children: A Clinical Case Series COGNITIVE AND BEHAVIORAL PRACTICE Ricketts, E. J., Bauer, C. C., van der Fluit, F., Capriotti, M. R., Espil, F. M., Snorrason, I., Ely, L. J., Walther, M. R., Woods, D. W. 2013; 20 (4): 544-555
  • Environmental factors as potential determinants of premonitory urge severity in youth with Tourette syndrome JOURNAL OF OBSESSIVE-COMPULSIVE AND RELATED DISORDERS Capriotti, M. R., Espil, F. M., Conelea, C. A., Woods, D. W. 2013; 2 (1): 37-42
  • Tourette Syndrome and Tic Disorders The Wiley Handbook of Cognitive Behavioral Therapy Capriotti, M. R., Espil, F. M., Woods, D. W. John Wiley & Sons. 2013


    Tics are rapid, repetitive, stereotyped movements or vocalizations that arise from neurobiological dysfunction and are influenced by environmental factors. Although persons with tic disorders often experience aversive social reactions in response to tics, little is known about the behavioral effects of such consequences. Along several dimensions, the present study compared the effects of two treatments on tics: response cost (RC) and differential reinforcement of other behavior (DRO). Four children with Tourette syndrome were exposed to free-to-tic baseline, DRO, RC, and quasibaseline rebound evaluation conditions using an alternating treatments design. Both DRO and RC produced substantial decreases in tics from baseline levels. No differential effects of DRO and RC contingencies were seen on self-reported stress or in the strength of the reflexive motivating operation (i.e., premonitory urge) believed to trigger tics, and neither condition produced tic-rebound effects. Implications of these findings and directions for future research are discussed.

    View details for DOI 10.1901/jaba.2012.45-251

    View details for Web of Science ID 000306862100002

    View details for PubMedID 22844135

  • Behavior Therapy A Family Guide to Tourette Syndrome Capriotti, M. R., Espil, F. M., Woods, D. W. Tourette Syndrome Association. 2012
  • Internet Use, Recreational Travel, and HIV Risk Behaviors in Men Who Have Sex With Men JOURNAL OF COMMUNITY HEALTH Benotsch, E. G., Martin, A. M., Espil, F. M., Nettles, C. D., Seal, D. W., Pinkerton, S. D. 2011; 36 (3): 398-405


    Previous studies have documented higher rates of HIV risk behavior in gay and bisexual men traveling for leisure. Most of these studies collected data in high-risk tourist areas known for promoting alcohol and other substance use. The present study sampled a broader range of men by collecting data at a Gay Pride celebration, and asking participants about vacation experiences over the past 12 months. We also collected information about men's use of the Internet to find sexual partners before they traveled. Overall, two-thirds of participants reported recreational travel in the previous year. Of these men, 17% reported having sex with a new partner during their most recent vacation. Forty-three percent of the respondents were sexually active during their vacation. Sexually-active participants reported a mean of 2.01 unprotected anal sex acts during their brief vacation stay (M = 6.2 days). Close to half of the sexually-active men reported having sex with a partner of unknown HIV status. Alcohol and drug use were associated with unprotected sex. Men who used the Internet to set up dates prior to travel reported significantly more sexual partners and were significantly more likely to report having sex with a new partner. Many gay and bisexual men on vacation report behaviors that may place their health at risk, including substance use and unprotected sexual activity. Interventions designed to reduce risk behaviors in this population are needed.

    View details for DOI 10.1007/s10900-010-9321-y

    View details for Web of Science ID 000290321200008

    View details for PubMedID 20924778

  • Cognitive-Behavioral Therapy in Adults Trichotillomania, Skin-Picking, and other Stereotypic Disorders Woods, D. W., Snorrason, I., Espil, F. M. American Psychiatric Publishing. 2011