Dr. Katie Fracalanza specializes in cognitive-behavioral therapy (CBT), exposure and response prevention (ERP), and other empirically-supported treatments for adults with mood and anxiety disorders. She is actively involved in research and teaching psychotherapy to graduate students and psychiatry residents.

Clinical Focus

  • Obsessive Compulsive Disorder
  • Anxiety Disorders
  • Clinical Psychology

Academic Appointments

  • Clinical Associate Professor, Psychiatry and Behavioral Sciences

Professional Education

  • PhD Training: Toronto Metropolitan University (2015) Canada
  • Fellowship: Stanford University - Dept of Psychiatry (2016) CA
  • Internship: Centre for Addiction and Mental Health (2015) Canada
  • PhD, Ryerson University, Clinical Psychology (2015)
  • MA, Ryerson University, Clinical Psychology (2010)

Current Research and Scholarly Interests

Dr. Fracalanza is interested in factors underlying the development and maintenance of mood and anxiety disorders. She has conducted research on cognitive factors thought to maintain anxiety, such as intolerance of uncertainty and perfectionism. She is interested in the patient perspective, and conducting research from a qualitative lens to better understand this.

Clinical Trials

  • Imaginal Exposure for Hoarding Disorder Not Recruiting

    The present study will test a potential new treatment strategy, imaginal exposure, for hoarding disorder. Although cognitive behavioral therapy often reduces hoarding, some people do not want to start, or cannot handle, that option. To help such individuals, the present study will provide imaginal exposure therapy to people with hoarding disorder, wherein they imagine discarding possessions as a way of becoming acclimated to the idea. We predict that imaginal exposure will improve hoarding symptoms as well as two psychological experiences linked to the condition: intolerance of uncertainty and emotional avoidance.

    Stanford is currently not accepting patients for this trial. For more information, please contact Tatevik Avanesyan, MD, 650-497-2577.

    View full details

All Publications

  • Written Imaginal Exposure for Hoarding Disorder: A Preliminary Pilot Study. The Journal of nervous and mental disease Fracalanza, K., Raila, H., Avanesyan, T., Rodriguez, C. I. 2024; 212 (5): 289-294


    ABSTRACT: Hoarding disorder (HD) is marked by difficulty discarding possessions. Many refuse treatment or drop out, which may be due to treatment's incorporation of in-home decluttering, which is feared and avoided. Thus, strategies to prepare patients for decluttering/discarding are needed. Imaginal exposure (IE), or imagining one's worst fears about discarding, could be one such strategy. This pilot preliminarily tested a short-duration IE intervention compared with a control intervention. Over 3 days, adults diagnosed with HD (n = 32) were randomly assigned to either write about and imagine their worst fears about discarding (IE condition) or a neutral topic (control writing [CW] condition). The IE condition showed significant improvements in HD symptoms from preintervention to 1-week follow-up, with medium to large effects; however, the CW condition did as well. Comparing change scores between conditions, the IE condition's improvements were not significantly different than the CW condition's. Overall, IE was helpful in improving HD symptoms, but this pilot did not indicate that it was more helpful than CW. This raises important questions about possible demand characteristics, placebo effects, or regression to the mean, and it has implications for the design and methodology of other studies assessing IE's utility.

    View details for DOI 10.1097/NMD.0000000000001719

    View details for PubMedID 38598729

  • Now I Always have to Perform Well! Effects of CBT for Social Anxiety Disorder on Negative Interpretations of Positive Social Events COGNITIVE THERAPY AND RESEARCH Nishikawa, Y., Fracalanza, K., Rector, N. A., Laposa, J. M. 2022
  • Social anxiety and negative interpretations of positive social events: What role does intolerance of uncertainty play? Journal of clinical psychology Nishikawa, Y., Fracalanza, K., Rector, N. A., Laposa, J. M. 2022


    OBJECTIVE: Although previous studies have demonstrated the association between social anxiety symptom severity and the tendency to appraise positive social events negatively among individuals with social anxiety disorder, no study has examined mediators of this relationship. The current study sought to examine whether intolerance of uncertainty and its subfactors mediate the relationship between social interaction anxiety and the tendency to interpret positive social events negatively.METHOD: One hundred and sixty-five individuals with social anxiety disorder completed measures of social interaction anxiety symptom severity, intolerance of uncertainty, and negative interpretations of positive social events.RESULTS: Total intolerance of uncertainty and the inhibitory-intolerance of uncertainty subscale scores significantly mediated the relationship between social interaction anxiety and negative interpretations of positive events. Exploratory post-hoc analyses regarding the possible contributing role of depression demonstrated mixed results. The same mediation pattern was found in the full sample as well as those without a secondary comorbid mood disorder diagnosis. In contrast, serial mediation showed a mediating role of depressive symptom severity.CONCLUSION: Inhibitory-intolerance of uncertainty plays a role in the relationship between social interaction anxiety and negative interpretations of positive social events.

    View details for DOI 10.1002/jclp.23363

    View details for PubMedID 35435997

  • Could written imaginal exposure be helpful for hoarding disorder? A case series JOURNAL OF OBSESSIVE-COMPULSIVE AND RELATED DISORDERS Fracalanza, K., Raila, H., Rodriguez, C. I. 2021; 29
  • Does intolerance of uncertainty mediate improvement in anger during group CBT for GAD? A preliminary investigation BEHAVIOURAL AND COGNITIVE PSYCHOTHERAPY Laposa, J. M., Fracalanza, K. 2019; 47 (5): 585–93
  • Does intolerance of uncertainty mediate improvement in anger during group CBT for GAD? A preliminary investigation. Behavioural and cognitive psychotherapy Laposa, J. M., Fracalanza, K. 2019: 1–9


    BACKGROUND: Individuals with generalized anxiety disorder (GAD) have elevated intolerance of uncertainty (IU) and anger, and IU mediates the relationship between GAD symptoms and anger.AIMS: The current pilot study examined whether group cognitive behavioural therapy (CBT) improves anger in people with GAD, and the degree to which change in IU mediates improved anger.METHOD: Individuals diagnosed with GAD completed measures of worry, IU, and facets of anger, before and at the end of group CBT for GAD.RESULTS: Worry, IU, and internally felt and outwardly expressed anger, reduced significantly over treatment, but anger control (inwardly and outwardly) did not. CBT for GAD led to improvement in both internally felt and outwardly expressed anger, even though anger is not directly targeted in this treatment. Improvement in IU significantly mediated improvement in internally felt and outwardly expressed anger.CONCLUSIONS: This preliminary study contributes to the literature on the importance of IU in understanding worry and other symptoms such as elevated anger, experienced by people with excessive worry.

    View details for PubMedID 30914070

  • Treatment of generalized anxiety disorder Evidence-based psychotherapy: The state of the science and practice McCabe-Bennett, H., Fracalanza, K., Antony, M. M. Wiley-Blackwell. 2016
  • Reactivity to 35% carbon dioxide in bulimia nervosa and panic disorder PSYCHIATRY RESEARCH Woznica, A., Vickers, K., Koerner, N., Fracalanza, K. 2015; 228 (3): 571-575


    The inhalation of 35% carbon dioxide (CO₂) induces panic and anxiety in people with panic disorder (PD) and in people with various other psychiatric disorders. The anxiogenic effect of CO₂ in people with eating disorders has received sparse attention despite the fact that PD and bulimia nervosa (BN) have several common psychological and neurobiological features. This study compared CO₂-reactivity across three groups of participants: females with BN, females with PD, and female controls without known risk factors for enhanced CO₂-reactivity (e.g., social anxiety disorder, first degree relatives with PD). Reactivity was measured by self-reported ratings of panic symptomatology and subjective anxiety, analyzed as both continuous variables (change from room-air to CO₂) and dichotomous variables (positive versus negative responses to CO₂). Analyses of each outcome measure demonstrated that CO₂-reactivity was similar across the BN and PD groups, and reactivity within each of these two groups was significantly stronger than that in the control group. This is the first study to demonstrate CO₂-hyperreactivity in individuals with BN, supporting the hypothesis that reactivity to this biological paradigm is not specific to PD. Further research would benefit from examining transdiagnostic mechanisms in CO₂-hyperreactivity, such as anxiety sensitivity, which may account for this study's results.

    View details for DOI 10.1016/j.psychres.2015.05.050

    View details for Web of Science ID 000360251400050

    View details for PubMedID 26141602

  • Behavior therapy Encyclopedia of clinical psychology Gee, B. A., Fracalanza, K. 2015
  • Testing a procedural variant of written imaginal exposure for generalized anxiety disorder JOURNAL OF ANXIETY DISORDERS Fracalanza, K., Koerner, N., Antony, M. M. 2014; 28 (6): 559-569


    This experiment examined the degree to which it is more beneficial for individuals with generalized anxiety disorder (GAD) to engage in repeated exposure to mental imagery of the same feared scenario versus varying the exposure content. On three consecutive days, individuals with GAD (N=57) spent 20min writing about: (1) the same worst case scenario (consistent exposure; CE), (2) variations of their worst case scenario (varied exposure; VE), or (3) a neutral topic (neutral control; NC). Participants in the CE condition displayed significant decreases in worry, acute cognitive avoidance, and intolerance of uncertainty from baseline to 1-week follow-up; participants in the VE and NC conditions did not. Initial activation of self-reported anxiety (observed in the CE and VE conditions) and between-session reduction in anxiety (observed in the CE condition only) were associated with improvement in worry. Including more references to negative emotion and writing in the present tense were also associated with greater improvement in worry in the CE condition. These findings suggest that writing repeatedly about the same worst case scenario may benefit people with GAD. The study also provides information on potential mechanisms of change.

    View details for DOI 10.1016/j.janxdis.2014.05.011

    View details for Web of Science ID 000340864500009

    View details for PubMedID 24983797

  • The effect of comorbid major depressive disorder or bipolar disorder on cognitive behavioral therapy for social anxiety disorder JOURNAL OF AFFECTIVE DISORDERS Fracalanza, K., McCabe, R. E., Taylor, V. H., Antony, M. M. 2014; 162: 61-66


    Major depressive disorder (MDD) and bipolar disorder (BD) commonly co-occur in individuals with social anxiety disorder (SAD), yet whether these comorbidities influence the outcomes of cognitive behavioral therapy (CBT) for SAD is unclear.The present study examined the degree to which individuals with SAD and comorbid MDD (SAD+MDD; n=76), comorbid BD (SAD+BD; n=19), a comorbid anxiety disorder (SAD+ANX; n=27), or no comorbid diagnoses (SAD+NCO; n=41) benefitted from CBT for SAD. Individuals were screened using the Structured Clinical Interview for DSM-IV and then completed the Social Phobia Inventory and the Depression Anxiety Stress Scales before and after 12-weeks of group CBT for SAD.At pretreatment the SAD+MDD and SAD+BD groups reported higher social anxiety symptoms than the SAD+ANX and SAD+NCO groups. All groups reported large and significant improvement in social anxiety with CBT. However, at posttreatment the SAD+MDD and SAD+BD groups continued to have higher social anxiety symptoms than the SAD+NCO group, and the SAD+ANX group did not differ in social anxiety symptoms from any group. The sample also showed small and statistically significant improvement in depressive symptoms with CBT for SAD.Information about medication was not collected in the present study, and we did not assess the long-term effects of CBT.Our results suggest that CBT for SAD is an effective treatment even in the presence of comorbid mood disorders in the short-term, although extending the course of treatment may be helpful for this population and should be investigated in future research.

    View details for DOI 10.1016/j.jad.2014.03.015

    View details for Web of Science ID 000335386000012

    View details for PubMedID 24767007

  • Intolerance of Uncertainty Mediates the Relation Between Generalized Anxiety Disorder Symptoms and Anger COGNITIVE BEHAVIOUR THERAPY Fracalanza, K., Koerner, N., Deschenes, S. S., Dugas, M. J. 2014; 43 (2): 122-132


    Previous research has shown that individuals with generalized anxiety disorder (GAD) report elevated anger compared with nonanxious individuals; however, the pathways linking GAD and anger are currently unknown. We hypothesized that negative beliefs about uncertainty, negative beliefs about worry and perfectionism dimensions mediate the relationship between GAD symptoms and anger variables. We employed multiple mediation with bootstrapping on cross-sectional data from a student sample (N = 233) to test four models assessing potential mediators of the association of GAD symptoms to inward anger expression, outward anger expression, trait anger and hostility, respectively. The belief that uncertainty has negative personal and behavioural implications uniquely mediated the association of GAD symptoms to inward anger expression (confidence interval [CI] = .0034, .1845, PM = .5444), and the belief that uncertainty is unfair and spoils everything uniquely mediated the association of GAD symptoms to outward anger expression (CI = .0052, .1936, PM = .4861) and hostility (CI = .0269, .2427, PM = .3487). Neither negative beliefs about worry nor perfectionism dimensions uniquely mediated the relation of GAD symptoms to anger constructs. We conclude that intolerance of uncertainty may help to explain the positive connection between GAD symptoms and anger, and these findings give impetus to future longitudinal investigations of the role of anger in GAD.

    View details for DOI 10.1080/16506073.2014.888754

    View details for Web of Science ID 000334018200004

    View details for PubMedID 24579760

  • The role of anxiety control strategies in imaginal exposure Exposure Therapy: Rethinking the Model – Refining the Method Koerner, N., Fracalanza, K. 2012
  • The role of anger in generalized anxiety disorder. Cognitive behaviour therapy Deschênes, S. S., Dugas, M. J., Fracalanza, K., Koerner, N. 2012; 41 (3): 261-271


    Little is known about the role of anger in the context of anxiety disorders, particularly with generalized anxiety disorder (GAD). The aim of study was to examine the relationship between specific dimensions of anger and GAD. Participants (N=381) completed a series of questionnaires, including the Generalized Anxiety Disorder Questionnaire (GAD-Q-IV; Newman et al., 2002, Behavior Therapy, 33, 215-233), the State-Trait Anger Expression Inventory (STAXI-2; Spielberger 1999, State-Trait Anger Expression Inventory-2: STAXI-2 professional manual, Odessa, FL: Psychological Assessment Resources) and the Aggression Questionnaire (AQ; Buss & Perry 1992, Journal of Personality and Social Psychology, 63, 452-459). The GAD-Q-IV identifies individuals who meet diagnostic criteria for GAD (i.e. GAD analogues) and those who do not (non-GAD). The STAXI-2 includes subscales for trait anger, externalized anger expression, internalized anger expression, externalized anger control and internalized anger control. The AQ includes subscales for physical aggression, verbal aggression, anger and hostility. The GAD-Q-IV significantly correlated with all STAXI-2 and AQ subscales (r's ranging from .10 to .46). Multivariate analyses of variance revealed that GAD analogues significantly differed from non-GAD participants on the combined STAXI-2 subscales (η2=.098); high levels of trait anger and internalized anger expression contributed the most to GAD group membership. GAD analogue participants also significantly differed from non-GAD participants on the combined AQ subscales (η2=.156); high levels of anger (affective component of aggression) and hostility contributed the most to GAD group membership. Within the GAD analogue group, the STAXI-2 and AQ subscales significantly predicted GAD symptom severity (R2=.124 and .198, respectively). Elevated levels of multiple dimensions of anger characterize individuals who meet diagnostic criteria for GAD.

    View details for DOI 10.1080/16506073.2012.666564

    View details for PubMedID 22429207

  • Bipolar Disorder Comorbidity in Anxiety Disorders: Relationship to demographic profile, symptom severity, and functional impairment EUROPEAN JOURNAL OF PSYCHIATRY Fracalanza, K. A., McCabe, R. E., Taylor, V. H., Antony, M. M. 2011; 25 (4): 223-233