Dr. Otero is an Advanced Postdoctoral Fellow at the Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC) at the VA Palo Alto Health Care System, jointly affiliated with the Stanford University School of Medicine. Upon earning a B.A. in Psychology from Cornell University, she was awarded the NIH Post-Baccalaureate Intramural Research Training Award and completed a research fellowship in the Unit on Affective Neuroscience at the National Institute of Mental Health, where she conducted research on cognitive and affective processing in generalized anxiety disorder and social anxiety disorder. She earned her Ph.D. in Clinical Science at the University of California, Berkeley. Her graduate research, partly supported by a NSF Graduate Research Fellowship, investigated emotional reactivity and regulation in neurodegenerative disease using physiological and behavioral methodologies, and subjective self-report. Her secondary line of research examined the adverse effects of patient socioemotional deficits on caregiver mental health, and the association between positive interpersonal processes and long-term marital satisfaction. Dr. Otero’s current research interests include identifying the cognitive and affective mechanisms underlying emotion dysregulation in late-life psychopathology, particularly anxiety and depression, and the development of behavioral interventions aimed at promoting wellbeing in Veterans and their loved ones.

Honors & Awards

  • Trainee Innovator Grant, Department of Psychiatry and Behavioral Sciences (September 2020)

Professional Education

  • Bachelor of Arts, Cornell University (2009)
  • Doctor of Philosophy, University of California Berkeley (2019)
  • Clinical Internship, VA Puget Sound Health Care System, Seattle Division, Geropsychology (2019)
  • Ph.D., University of California, Berkeley, Clinical Science (2019)
  • B.A., Cornell University, Psychology (2009)

Stanford Advisors

All Publications

  • Taming the beast: A commentary on "the effects of different types of treatment for anxiety on repetitive negative thinking: A meta-analysis" CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE Beaudreau, S. A., Otero, M. C., Mashal, N. M. 2020; 27 (2)

    View details for DOI 10.1111/cpsp.12333

    View details for Web of Science ID 000543511800007

  • Behavioral indices of positivity resonance associated with long-term marital satisfaction. Emotion (Washington, D.C.) Otero, M. C., Wells, J. L., Chen, K. H., Brown, C. L., Connelly, D. E., Levenson, R. W., Fredrickson, B. L. 2020; 20 (7): 1225–33


    Positivity resonance-defined as a synthesis of shared positive affect, mutual care and concern, plus behavioral and biological synchrony-is theorized to contribute to a host of positive outcomes, including relationship satisfaction. The current study examined whether, in long-term married couples, behavioral indices of positivity resonance (rated using a new behavioral coding system) are associated with concurrent shared positive affect using a well-established dyadic-level behavioral coding system (i.e., Specific Affect Coding System: SPAFF), and whether positivity resonance predicts concurrent marital satisfaction independently from other affective indices. Long-term married couples completed a self-report inventory assessing marital satisfaction and were then brought into the laboratory to participate in a conversation about an area of marital disagreement while being videotaped for subsequent behavioral coding. Interrater reliability for positivity resonance behavioral coding was high (intraclass correlation coefficient: 0.8). Results indicated that positivity resonance is associated with frequency of shared positive affect using SPAFF. No associations were found between positivity resonance and frequencies of SPAFF-coded individual-level positive affect or shared negative affect. Additionally, positivity resonance predicted marital satisfaction independently from frequencies of SPAFF-coded shared positive affect and individual-level positive affect alone. The effect of positivity resonance on marital satisfaction also remained significant after controlling for overall affective tone of conflict conversation. These findings provide preliminary construct and predictive validity for positivity resonance behavioral coding, and highlight the possible role positivity resonance may play in building relationship satisfaction in married couples. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

    View details for DOI 10.1037/emo0000634

    View details for PubMedID 31259587

    View details for PubMedCentralID PMC6938566

  • Emotion regulation via visual avoidance: Insights from neurological patients NEUROPSYCHOLOGIA Otero, M. C., Levenson, R. W. 2019; 131: 91–101


    Visual avoidance of unpleasant stimuli (i.e., strategic positioning of eyes, head and torso away from an environmental stimulus) is a common attentional control behavior that may down-regulate emotion by reducing visual input. Despite its ubiquity, relatively little is known about how visual avoidance is affected by neurological diseases that impact neural circuits involved in emotional functioning. We examined visual avoidance in 56 behavioral variant frontotemporal dementia (bvFTD) patients, 43 Alzheimer's disease (AD) patients, and 34 healthy controls. Participants came to our laboratory and viewed an extremely disgusting film clip while visual avoidance was measured using behavioral coding of head, body, and eye position. Controlling for differences in cognitive functioning, bvFTD patients were less likely to engage in visual avoidance behaviors than both AD patients and healthy controls. Additional analyses revealed that diminished visual avoidance in this task was associated with lower levels of real-world emotion regulation but not with emotion reactivity as reported by the primary caregiver.

    View details for DOI 10.1016/j.neuropsychologia.2019.05.003

    View details for Web of Science ID 000493913900009

    View details for PubMedID 31082398

    View details for PubMedCentralID PMC6650310

  • Reduced optimism and a heightened neural response to everyday worries are specific to generalized anxiety disorder, and not seen in social anxiety PSYCHOLOGICAL MEDICINE Blair, K. S., Otero, M., Teng, C., Geraci, M., Ernst, M., Blair, R. R., Pine, D. S., Grillon, C. 2017; 47 (10): 1806–15


    Generalized anxiety disorder (GAD) and social anxiety disorder (SAD) are co-morbid and associated with similar neural disruptions during emotion regulation. In contrast, the lack of optimism examined here may be specific to GAD and could prove an important biomarker for that disorder.Unmedicated individuals with GAD (n = 18) and age-, intelligence quotient- and gender-matched SAD (n = 18) and healthy (n = 18) comparison individuals were scanned while contemplating likelihoods of high- and low-impact negative (e.g. heart attack; heartburn) or positive (e.g. winning lottery; hug) events occurring to themselves in the future.As expected, healthy subjects showed significant optimistic bias (OB); they considered themselves significantly less likely to experience future negative but significantly more likely to experience future positive events relative to others (p < 0.001). This was also seen in SAD, albeit at trend level for positive events (p < 0.001 and p < 0.10, respectively). However, GAD patients showed no OB for positive events (t 17 = 0.82, n.s.) and showed significantly reduced neural modulation relative to the two other groups of regions including the medial prefrontal cortex (mPFC) and caudate to these events (p < 0.001 for all). The GAD group further differed from the other groups by showing increased neural responses to low-impact events in regions including the rostral mPFC (p < 0.05 for both).The neural dysfunction identified here may represent a unique feature associated with reduced optimism and increased worry about everyday events in GAD. Consistent with this possibility, patients with SAD did not show such dysfunction. Future studies should consider if this dysfunction represents a biomarker for GAD.

    View details for DOI 10.1017/S0033291717000265

    View details for Web of Science ID 000404354500010

    View details for PubMedID 28290265

    View details for PubMedCentralID PMC5582689

  • Lower Visual Avoidance in Dementia Patients Is Associated with Greater Psychological Distress in Caregivers DEMENTIA AND GERIATRIC COGNITIVE DISORDERS Otero, M. C., Levenson, R. W. 2017; 43 (5-6): 247–58


    Caring for a spouse with dementia can lead to increased health problems in caregivers. The present study examined whether patient deficits in visual avoidance, a common form of emotion regulation, are related to greater psychological distress in caregivers. Participants were 43 Alzheimer disease (AD) patients, 43 behavioral variant frontotemporal dementia (bvFTD) patients, and their spousal caregivers. Patient visual avoidance (e.g., gaze aversion) was measured using behavioral coding of head, body, and eye position while viewing a disgusting film. Caregiver psychological distress was measured using a standard self-report symptom inventory. Lower use of visual avoidance by patients was associated with greater psychological distress in their caregivers. This relationship was partially mediated by patient overall emotional functioning (as reported by caregivers), such that patients with less visual avoidance were seen as having worse emotional functioning, which in turn related to greater caregiver psychological distress. Dementia diagnosis moderated this effect, with diminished patient visual avoidance particularly detrimental to psychological distress of bvFTD caregivers. Findings suggest that the use of visual avoidance may serve as a marker of overall emotional functioning in patients and that preservation of this emotion regulatory behavior may help reduce the negative effects of caregiving.

    View details for DOI 10.1159/000468146

    View details for Web of Science ID 000404364700003

    View details for PubMedID 28395276

    View details for PubMedCentralID PMC5496766

  • Learning from other people's fear: amygdala-based social reference learning in social anxiety disorder PSYCHOLOGICAL MEDICINE Blair, K. S., Otero, M., Teng, C., Geraci, M., Lewis, E., Hollon, N., Blair, R. R., Ernst, M., Grillon, C., Pine, D. S. 2016; 46 (14): 2943–53


    Social anxiety disorder involves fear of social objects or situations. Social referencing may play an important role in the acquisition of this fear and could be a key determinant in future biomarkers and treatment pathways. However, the neural underpinnings mediating such learning in social anxiety are unknown. Using event-related functional magnetic resonance imaging, we examined social reference learning in social anxiety disorder. Specifically, would patients with the disorder show increased amygdala activity during social reference learning, and further, following social reference learning, show particularly increased response to objects associated with other people's negative reactions?A total of 32 unmedicated patients with social anxiety disorder and 22 age-, intelligence quotient- and gender-matched healthy individuals responded to objects that had become associated with others' fearful, angry, happy or neutral reactions.During the social reference learning phase, a significant group × social context interaction revealed that, relative to the comparison group, the social anxiety group showed a significantly greater response in the amygdala, as well as rostral, dorsomedial and lateral frontal and parietal cortices during the social, relative to non-social, referencing trials. In addition, during the object test phase, relative to the comparison group, the social anxiety group showed increased bilateral amygdala activation to objects associated with others' fearful reactions, and a trend towards decreased amygdala activation to objects associated with others' happy and neutral reactions.These results suggest perturbed observational learning in social anxiety disorder. In addition, they further implicate the amygdala and dorsomedial prefrontal cortex in the disorder, and underscore their importance in future biomarker developments.

    View details for DOI 10.1017/S0033291716001537

    View details for Web of Science ID 000386639700006

    View details for PubMedID 27476529

    View details for PubMedCentralID PMC5063696

  • Insular Atrophy and Diminished Disgust Reactivity EMOTION Verstaen, A., Eckart, J. A., Muhtadie, L., Otero, M. C., Sturm, V. E., Haase, C. M., Miller, B. L., Levenson, R. W. 2016; 16 (6): 903–12


    Disgust is an emotion that helps us deal with potential contamination (Rozin & Fallon, 1987). It produces a distinctive facial expression (e.g., wrinkled nose) and a physiological response that is accompanied by strong visceral sensations (e.g., nausea). Given the important role that the anterior insula plays in processing and integrating visceral information (Craig, 2009), it is likely to be centrally involved in disgust. Despite this, few studies have examined the link between insular degeneration and the experience, physiology, and expression of disgust. We studied a group that was heterogeneous in terms of insular damage: 84 patients with neurodegenerative diseases (i.e., frontotemporal dementia, corticobasal syndrome, progressive supranuclear palsy, Alzheimer's disease) and 29 controls. Subjects viewed films that elicit high levels of disgust and sadness. Emotional reactivity was assessed using self-report, peripheral physiology, and facial behavior. Regional brain volumes (insula, putamen, pallidum, caudate, and amygdala) were determined from structural MRIs using the FreeSurfer method. Results indicated that smaller insular volumes were associated with reduced disgust responding in self-report and physiological reactivity, but not in facial behavior. In terms of the specificity of these findings, insular volume did not predict sadness reactivity, and disgust reactivity was not predicted by putamen, pallidum, and caudate volumes (lower self-reported disgust was associated with smaller amygdala volume). These findings underscore the central role of the insula in the experience and physiology of disgust. (PsycINFO Database Record

    View details for DOI 10.1037/emo0000195

    View details for Web of Science ID 000383914800014

    View details for PubMedID 27148847

    View details for PubMedCentralID PMC5009015

  • Reduced Dorsal Anterior Cingulate Cortical Activity During Emotional Regulation and Top-Down Attentional Control in Generalized Social Phobia, Generalized Anxiety Disorder, and Comorbid Generalized Social Phobia/Generalized Anxiety Disorder BIOLOGICAL PSYCHIATRY Blair, K. S., Geraci, M., Smith, B. W., Hollon, N., DeVido, J., Otero, M., Blair, J. R., Pine, D. S. 2012; 72 (6): 476–82


    Generalized social phobia (GSP) and generalized anxiety disorder (GAD) are both associated with emotion dysregulation. Research implicates dorsal anterior cingulate cortex in both explicit emotion regulation (EER) and top-down attentional control (TAC). Although studies have examined these processes in GSP or GAD, no work compares findings across the two disorders or examines functioning in cases comorbid for both disorders (GSP/GAD). Here we compare the neural correlates of EER and TAC in GSP, GAD, and GSP/GAD.Medication-free adults with GSP (EER n = 19; TAC n = 18), GAD (EER n = 17; TAC n = 17), GSP/GAD (EER n = 17; TAC n = 15), and no psychopathology (EER n = 18; TAC n = 18) participated. During EER, individuals alternatively viewed and upregulated and downregulated responses to emotional pictures. During TAC, they performed an emotional Stroop task.For both tasks, significant group × condition interactions emerged in dorsal anterior cingulate cortex and parietal cortices. Healthy adults showed significantly increased recruitment during emotion regulation, relative to emotion-picture viewing. GAD, GSP, and GSP/GAD subjects showed no such increases, with all groups differing from healthy adults but not from each other. Evidence of emotion-related disorder-specificity emerged in medial prefrontal cortex and amygdala. This disorder-specific responding varied as a function of emotion content but not emotion-regulatory demands.GSP and GAD both involve reduced capacity for engaging emotion-regulation brain networks, whether explicitly or via TAC. A reduced ability to recruit regions implicated in top-down attention might represent a general risk factor for anxiety disorders.

    View details for DOI 10.1016/j.biopsych.2012.04.013

    View details for Web of Science ID 000308077100008

    View details for PubMedID 22592057

    View details for PubMedCentralID PMC3424322