About

Giulia Righi is a Clinical Associate Professor of Psychiatry and Human Behavior at Brown University, with a background in cognitive neuroscience. Her initial research focused on understanding the neural basis of face and language processing in non-clinical populations. This work led her to explore populations with compromised face and language processing systems, particularly individuals with Autism Spectrum Disorder (ASD). She completed a postdoctoral fellowship at Boston Children’s Hospital and Harvard Medical School, where she expanded her methodological skills and gained exposure to both research and clinical aspects of psychopathologies. Her clinical training, including an APA-approved internship and postdoctoral fellowship, involved working with children and adolescents in various clinical settings, providing assessments and treatments, and integrating research with clinical practice. Her expertise in this area culminated in her current position, which combines research and clinical work at Bradley Hospital and the Alpert Medical School of Brown University. Her research interests include psychiatric comorbidities, especially in the context of ASD, developmental disabilities, and anxiety disorders such as OCD. She holds a PhD from Brown University and a BS from Brown University, and is licensed as a psychologist in Rhode Island.

Research topics

• Medicine
• Psychiatry
• Psychology
• Environmental health
• Clinical psychology
• Geography
• Pathology
• Pediatrics
• Demography

Selected publications

• A primer on sleep neuroscience for psychiatry

  NPP—Digital Psychiatry and Neuroscience · 2026-02-17

  articleOpen accessSenior author

  Sleep problems are common in psychiatric and neurodevelopmental disorders, potentially emerging before other symptoms.The neuroscience of sleep offers a rich lens through which novel biomarkers and innovative treatments can be found.Researchers and clinicians alike will benefit from a deeper understanding of the role of sleep in psychiatric disorders.Sleep neurophysiology is typically studied with at-home or laboratory polysomnography: electroencephalography (EEG) with electrooculography (EOG), electromyography (EMG), and relevant peripheral signals such as respiration, airflow, oximetry, and electrocardiography (EKG).These clinical sleep studies are read for sleep disorders (e.g., sleep apnea) and gross sleep architecture (e.g., time in cycling sleep stages of non-rapid-eyemovement (NREM) and rapid eye movement (REM) sleep.However, these studies rarely speak to the relevant specific biology of these states.

  PublisherOA PDFDOI

• Exploring the association between sleep and fear extinction learning in adolescents with anxiety and/or OCD: a study protocol

  SLEEP Advances · 2025-01-01

  articleOpen access

  Abstract Pediatric anxiety disorders (including Obsessive Compulsive Disorder) are prevalent and impairing. Youth with anxiety disorders frequently experience sleep disturbances. Exposure, the primary component of gold-standard Cognitive Behavioral Therapy (CBT) for treating anxiety disorders, works by harnessing fear extinction learning. Given that sleep plays a critical role in the consolidation and retrieval of emotional memories, we hypothesize that shorter sleep quantity and greater sleep disruption are associated with psychophysiological responses indicating reduced fear extinction learning and reduced fear extinction recall in adolescents with anxiety and OCD. In this protocol paper, we describe a pilot study testing this hypothesis in a clinical sample of adolescents participating in a CBT-based partial hospital program (PHP) dedicated to the treatment of anxiety disorders. Participants complete a multi-method sleep assessment over 10 days during the first portion of their admission in the program (within the first 4 weeks) and at the end of their stay (at least over 5-7 days before discharge). Standardized clinical interviews and sleep questionnaires are coupled with multi-modal at-home sleep monitoring using sleep diaries, patch-based actigraphy, and wearable sleep electroencephalography (EEG). Participants also complete a computerized task assessing initial fear learning (day 1), fear extinction learning (day 2), and extinction recall (day 3) as measured by skin conductance responses (SCR). This use of multi-method sleep assessments in a clinical sample of youths with more clinically severe anxiety disorders is innovative and, to our knowledge, has not yet been done. Statement of Significance Results of this study will provide data for understanding sleep problems in relation to one of the underlying mechanisms of exposure therapy among adolescents with anxiety disorders, and evidence for feasibility of multi-method sleep assessments in a relatively acute mental health setting. If this line of research is successful, it will allow for the development and evaluation of augmentation strategies that target specific aspects of sleep that contribute to suboptimal fear extinction learning. Results from this work may serve as proof-of-concept for identifying sleep targets to guide the augmentation of behavioral treatments.

  PublisherDOI

• Cognitive-Behavioral Therapy for Patients with Coronary Artery Disease and Depression: A Systematic Review.

  PubMed · 2025-02-01

  reviewOpen access

  Objective: Objective of this review is to summarize current knowledge on Cognitive Behavioural Therapy (CBT), as treatment for depression in coronary artery disease (CAD). Method: '. Results: in the remaining 4/21 (19.0%) studies; in one study (4.8%), this information was not available. Conclusions: Efficacy of CBT as a treatment for depressive syndromes in patients with CD is still under discussion, partly due to the heterogeneity of the outcome measures, partly due to methodological issues, such as therapist supervision and allegiance. CBT seems to be irrelevant to biological variables, such as inflammatory markers and heart rate variability and not ever superior to other interventions, in the treatment of depressive symptoms.

  PublisherOA PDFDOI

• 1224 Comparing Actigraphy Scoring Protocols in Adolescents with Anxiety and Related Disorders (ARD)

  SLEEP · 2025-05-01

  articleOpen access

  Abstract Introduction Estimating sleep from actigraphy is a challenge in psychiatric populations where criteria may be susceptible to altered physical activity. Expert-consensus procedures may introduce bias. Alternative scoring protocols may resolve ambiguities, avoid the need for consensus, and increase reproducibility. This study compared two scoring procedures in a treatment-seeking sample of adolescents with ARD. Methods Thirty-six adolescents (24 F; ages 13-17yrs [m±sd: 15±1.7yrs]) diagnosed with ARD wore a patch activity monitor on their dominant triceps and completed sleep diaries for 8.7±3.1 nights resulting in 180 unique nights. Sleep was estimated in 1-minute epochs (Sadeh); sleep periods were scored with sleep diaries using two scoring protocols: (1) “3-5” (onset at first of 3 consecutive minutes of sleep; offset at last of 5 consecutive minutes of sleep); and (2) “15-15” (onset at first of 15 consecutive minutes of sleep; offset at last of 15 consecutive minutes of sleep). We tabulated nights requiring group consensus (e.g., ambiguity of sleep within an hour before, or after, the major sleep episode). We examined differences in sleep period time and total sleep time (in minutes) and sleep midpoint, onset, and offset (in decimalized clock-hour) from five randomly selected weeknights. Results 15-15 scoring produced fewer nights requiring consensus (70 nights, average: 17% per participant) compared to 3-5 scoring (147 nights, average: 30% per participant). 15-15 scoring reduced estimated sleep period time by 30.2±51.1 minutes (3-5: 543.4±86.2 min; 15-15: 513.2±71.9 min; difference 95%CI: [-46.91, -13.54]; p=.001), but not total sleep time (3-5: 448.7±69.7 min; 15-15: 443.5±66.2 min; difference: -5.2±33.5 minutes [-16.2, 5.8]; p=.39). 15-15 scoring shifted estimated sleep midpoint 0.25±0.4 hours earlier versus the 3-5 rule [3-5: 4.5h±0.7h; 15-15: 4.3h±0.6h; difference 95%CI: [-0.39h,-0.11h], p=.001). The two procedures did not shift estimates (p’s>.42) of sleep onset (3-5: 19.6h±4.3h, 15-15: 19.4h±4.6h) or offset (3-5: 7.5h±1.3h, 15:15: 7.4h±1.2h). Conclusion The 15-15 scoring protocol reduced ambiguities and the need for consensus compared to the 3-5 protocol in a psychiatric adolescent sample. It affected estimates of sleep period time and sleep midpoint but not total sleep time. These data indicate that alternative scoring may be considered in populations where symptoms may contribute to sedentary activity. Support (if any) P20GM139743 (MAC).

  PublisherOA PDFDOI

• 1218 Relationship Between Subjective Sleep Quality and Objective Sleep Parameters from Wearable EEG in Youth with Significant Anxiety and Related Disorders

  SLEEP · 2025-05-01

  articleOpen access1st authorCorresponding

  Abstract Introduction Sleep problems are prevalent in pediatric anxiety and related disorders (ARD), affecting nearly 90% of patients. Nevertheless, subjective sleep complaints routinely demonstrate poor agreement with objective sleep patterns derived from either actigraphy or polysomnography in non-psychiatric samples. The aim of this submission is to examine the relationship between subjective and objective metrics of sleep quality in youth with moderate-to-severe ARD. Methods We conducted a multi-method study involving a clinical sample of treatment-seeking youth (ages 11-17) participating in a CBT-based partial hospital program specialized in ARD. Participants complete standardized clinical interviews, sleep quality questionnaires, up to 10 nights of sleep diaries and wearable actigraphy, and at-home overnight ZMax EEG (up to 4 nights). To date, 44 participants (54% female, 86% white, mean age 15y) have completed data collection. We analyzed self-report questionnaires and three sleep stage variables from ZMax EEG scored using Dreamento): sleep efficiency (SE%; total sleep time / sleep period time), slow wave sleep (SWS%; minutes of SWS / total sleep time) and a sleep fragmentation index (SFI; the total number of awakenings or shifts to stage 1 divided by total sleep time [in hours]). Results Participants experienced high severity of illness as indexed by Clinical Global Impression (mean CGI = 5.4, sd = 0.8). Sleep disturbances and sleep-related impairments were present in our sample (PROMIS self-report sleep disturbance mean = 61.01 sd = 9.74, sleep-related impairment mean = 61.9, sd = 7.84). Average SE was 77% (sd = 15%) and average SWS% was 60% (sd = 20%; range = 79%). Average SFI was 8.1/h (sd = 4.7). Subjective sleep quality was not significantly correlated to any of our objective sleep indexes (|r|’s < 0.12; p’s > 0.05). Conclusion Our youth with moderate-to-severe ARD report clinically significant problems with sleep and sleep-related impairments. Sleep efficiency may be lower than age-matched non clinical samples. Objective indexes of sleep depth and quality were not related to subjective reports. Next steps will include expanding the analyses to include additional data and examining these relationships with specific clinical symptoms. Support (if any) NIGMS COBRE (P20GM139743)

  PublisherOA PDFDOI

• Open Trial of a Telehealth Adaptation of Team-Based Delivery of Cognitive Behavioral Treatment for Pediatric Anxiety and Obsessive-Compulsive Disorder

  Evidence-Based Practice in Child and Adolescent Mental Health · 2024-01-08 · 3 citations

  article

  This brief report presents the results of an open trial of a telehealth adaptation of a novel team-based approach to cognitive behavioral treatment (CBT) for pediatric anxiety and obsessive-compulsive disorder (OCD). This telehealth modification was necessary as a response to COVID-19 to allow clients to continue to receive treatment during a pause to in-person care in a larger trial of team-based treatment for anxious youth. Participants included 46 youth between the ages of 5 and 18 who received telehealth delivered CBT via a task-sharing model whereby patients and families met monthly with a supervising licensed clinician and with non-licensed staff all other weeks of the month. Participants received treatment for up to 6 months and completed symptom assessments every 6 weeks throughout treatment. Descriptive results demonstrated high patient and caregiver treatment engagement and satisfaction. Anxiety and OCD symptoms decreased significantly from baseline to post-treatment with 68% of participants classified as treatment responders. Patient- and caregiver-reported Top Problems and caregiver-reported quality of life improved significantly from baseline to post-treatment. In addition, the clinical capacity of the licensed provider increased more than two-fold by leveraging non-licensed staff. This novel telehealth delivery model using team-based care has potential to increase provider capacity and reduce barriers to mental health care access for youth.

  PublisherDOI

• The NExT trial: Protocol for a two-phase randomized controlled trial testing transcranial magnetic stimulation to augment exposure therapy for youth with OCD

  Trials · 2024-12-18 · 3 citations

  articleOpen access

  BACKGROUND: Exposure with Response Prevention (ERP) is a first-line treatment for OCD, but even when combined with first-line medications it is insufficiently effective for approximately half of patients. Compulsivity in OCD is thought to arise from an imbalance of two distinct neural circuits associated with specific subregions of striatum. Targeted modulation of these circuits via key cortical nodes (dorsolateral prefrontal cortex [dlPFC] or presupplementary motor area [pSMA]) has the potential to improve ERP efficacy by decreasing compulsions during therapy. METHODS: The NExT (Neuromodulation + Exposure Therapy) trial is a two-phase, multisite early-stage randomized controlled trial designed to examine whether TMS augmentation of ERP alters activity in dlPFC and/or pSMA-associated circuitry and reduces compulsions during therapy in youth with OCD age 12-21 years. Phase 1 (N = 60) will compare two different active TMS regimens with sham: A. continuous theta burst stimulation (cTBS) to pSMA vs. B. intermittent theta burst stimulation (iTBS) to dlPFC. A priori "Go/No-Go" criteria will inform a decision to proceed to Phase 2 and the choice of TMS regimen. Phase 2 (N = 60) will compare the selected TMS regimen vs. sham in a new sample. DISCUSSION: This trial is the first to test TMS augmentation of ERP in youth with OCD. Results will inform the potential of TMS to enhance ERP efficacy and enhance knowledge about mechanisms of change. TRIAL REGISTRATION: ClinicalTrials.gov NCT05931913. Registered prospectively on July 5, 2023.

  PublisherOA PDFDOI

• A Team-Based Partner-Driven Model for Delivering Outpatient Exposure Treatment for Pediatric Anxiety and Obsessive-Compulsive Disorder

  JAACAP Open · 2024-08-23 · 1 citations

  articleOpen access

  Objective: Anxiety disorders are among the most common and earliest forms of psychopathology, yet few providers in community practice settings use or are trained in evidence-based treatments (EBTs) for pediatric anxiety. Delivery of EBTs is further limited by the "provider-centered" manner in which they are often administered (ie, office-based). This paper presents the rationale, design, and methods for a team-based approach to the treatment of pediatric anxiety that was developed with substantial patient, caregiver, and community partner involvement, and that addresses quality and workforce issues inherent in the current child mental health crisis. Method: This study aims to compare team-based community delivered cognitive behavioral treatment (CBT) and office-based CBT for pediatric anxiety and obsessive-compulsive disorder (OCD) in a sample of 333 children and adolescents 5 to 18 years of age. Rather than reporting outcomes, the purpose of this paper is to spotlight study design, methods, and procedures, including processes for fostering and maintaining strong partner engagement, training strategies, supervision structures, and implementation of quality and fidelity monitoring tools. Discussion: Treatment delivered outside of a traditional office setting using a team-based approach has the potential to increase patient access to care. In addition to describing specific design considerations, we provide a roadmap for the integration of community-based partners and for rigorous supervision and quality monitoring. Future directions are discussed, particularly in the context of lack of access to care that has a longstanding disproportionate impact on youth of color and youth from low-income communities. Clinical trial registration information: Improving Access to Child Anxiety Treatment (IMPACT); https://clinicaltrials.gov/study/. Diversity & Inclusion Statement: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group.

  PublisherOA PDFDOI

• Predictors of Treatment Outcome and Length of Stay in a Partial Hospital Program for Pediatric Obsessive-Compulsive Disorder

  Evidence-Based Practice in Child and Adolescent Mental Health · 2023-09-19 · 8 citations

  article

  ABSTRACTPartial hospital programs (PHPs) represent an important part of the continuum of care for youth with severe and/or refractory OCD, yet little is known about clinical or utilization outcomes in this setting. The current study aimed to characterize symptom improvement and length of stay (LOS) among 185 youth with OCD treated in a PHP setting and to identify demographic, clinical, and treatment characteristics that predict these outcomes. Results demonstrate a 77.3% treatment response rate and a median LOS of 52 days. Holding other predictors constant, less symptom improvement was observed for youth with lower symptom severity at admission, in a racial or ethnic minoritized group, without comorbid anxiety, and receiving more treatment hours per day. Shorter LOS was observed among youth with public (vs. commercial) insurance, receiving more hours of treatment per day, and not taking a serotonin reuptake inhibitor (SRI). Clinical implications and directions for future research are discussed, including a critical need to understand and improve outcomes for minoritized youth. Disclosure statementNo potential conflict of interest was reported by the author(s).

  PublisherDOI

• Exploring communicative competence in autistic children who are minimally verbal: The Low Verbal Investigatory Survey for Autism (LVIS)

  Autism · 2022-11-14 · 13 citations

  articleOpen access

  Approximately 30% of autistic children are considered minimally verbal. The field lacks an efficient and reliable measure of communicative capacity among minimally verbal autistic children. Improved methods are needed to determine which children are at greatest risk for minimally verbal outcomes to better target interventions. Here, we present the Low Verbal Investigatory Survey (LVIS), a brief parent-report measure designed to assess communicative capacity among minimally verbal autistic children. The 36-item easy-to-complete LVIS was developed to capture the atypical language trajectories associated specifically with autism. We report pilot results from a sample of 147 children (1–8 years) whose caregivers completed the LVIS as part of other studies. Principal components analysis was used to assess dimensionality of the LVIS; composite scores were compared with existing measures of communicative capacity, all of which take significantly more time and training to administer and score. Scores on the LVIS were strongly correlated with existing gold-standard measures of communication. Presence of atypical vocalizations was determined to be particularly relevant for symptoms of autism as well as language and cognitive abilities. These findings provide initial validation of a tool designed to capture multiple dimensions of communicative capacity in children with minimal or low verbal skills. Lay abstract Approximately one in three autistic children is unable to communicate with language; this state is often described as minimally verbal. Despite the tremendous clinical implications, we cannot predict whether a minimally verbal child is simply delayed (but will eventually develop spoken language) or will continue to struggle with verbal language, and might therefore benefit from learning an alternative form of communication. This is important for clinicians to know, to be able to choose the most helpful interventions, such as alternative forms of communication. In addition, the field lacks a standard definition of “minimally verbal.” Even when we do agree on what the term means (e.g. fewer than 20 words), describing a child based on their lack of words does not tell us whether that child is communicating in other ways or how they are using those 20 words. To address these concerns, we developed the Low Verbal Investigatory Survey (LVIS), a one-page parent-report measure designed to help us characterize how minimally verbal autistic children are communicating. Parents of 147 children (aged 1–8 years) completed the LVIS. Here, we ask (1) whether the survey measures what it was designed to measure, that is, communicative ability in children without much spoken language, and (2) how the LVIS relates to cognitive and language ability, and symptoms of autism. Results suggest that this survey, which takes only 5 min to complete, is a good estimate of the child’s communication skills. Furthermore, LVIS survey scores are correlated with other measures of language and cognitive abilities as well as autism symptomatology. The LVIS has the potential to save time and money in both clinical and research efforts to assess communication skills in minimally verbal autistic children.

  PublisherOA PDFDOI

Recent grants

• COBRE Center for Sleep and Circadian Rhythms in Child and Adolescent Mental Health

  NIH · $17.9M · 2021–2027

Frequent coauthors

• Stephen J. Sheinkopf

  Cohort (United Kingdom)

  65 shared

• Elena J. Tenenbaum

  Duke University

  32 shared

• Eric M. Morrow

  Bradley Hospital

  30 shared

• Kristen Benito

  28 shared

• Erin O’Connor

  John Brown University

  28 shared

• Danielle Sipsock

  Women & Infants Hospital of Rhode Island

  26 shared

• Beth A. Jerskey

  Providence College

  23 shared

• Michael J. Tarr

  Carnegie Mellon University

  22 shared

Labs

• Righi, GiuliaPI

Education

• Ph.D.

  Brown University

  2009

• B.S.

  Brown University

  2004