About

Lily Anna Brown, Ph.D., is an Assistant Professor of Psychiatry at the University of Pennsylvania's Perelman School of Medicine. She is also a Without Compensation Employee at the Michael J. Crescenz Philadelphia VA Medical Center and the Director of the Center for the Treatment and Study of Anxiety. Her research expertise focuses on anxiety disorders, suicide, posttraumatic stress disorder, obsessive-compulsive disorder, and cognitive behavioral therapy. Dr. Brown has contributed to understanding the dynamics of stress and affect, the neural activity linked to obsessive-compulsive behaviors, and the development of interventions for mental health conditions. Her work includes investigating barriers to ART adherence in people with HIV, explaining the link between PTSD and suicide, and optimizing CBT for PTSD. She has authored numerous publications and presented at various conferences, emphasizing her active engagement in advancing mental health research.

Research topics

• Medicine
• Psychology
• Psychiatry
• Medical emergency
• Clinical psychology
• Endocrinology
• Developmental psychology
• Neuroscience
• Chemistry
• Cognitive psychology
• Physiology
• Internal medicine

Selected publications

• Beating OCD and Learning Digitally (BOLD): an open trial of a therapist-supported, self-guided exposure and response prevention app for adults with OCD

  Cognitive Behaviour Therapy · 2026-03-05

  article

  -1.27). Half of participants completed the full intervention and reported high satisfaction and gains in self-efficacy. Two-thirds (62.5%) of treatment completers were classified as treatment responders. When compared to a matched sample receiving traditional EX/RP, BOLD showed comparable treatment outcomes. Time-effectiveness analysis indicated that BOLD required 73.39% less therapist contact time to achieve equivalent symptom reduction than traditional EX/RP. These findings highlight BOLD's potential as a scalable, cost-effective intervention for OCD. Researchers should refine BOLD by optimizing engagement and reducing barriers to participation and investigate its effectiveness in a full-power randomized controlled trial.

  PublisherDOI

• Human orbitofrontal neural activity is linked to obsessive-compulsive behavioral dynamics

  Cell · 2026-01-29 · 2 citations

  articleOpen access

  Biomarkers of obsessive-compulsive disorder (OCD) symptom dynamics and related behavior could advance personalized interventions. Aberrant activity in the orbitofrontal cortex (OFC) has been implicated in symptom exacerbation in OCD. We conducted an intracranial monitoring assay to identify high-resolution neurophysiologic correlates of OCD symptoms in the human OFC. We found that low-gamma power in the anteromedial OFC was consistently elevated during high symptom states in a symptom provocation task. Furthermore, electrical stimulation of the ventral basal ganglia that reduced OCD symptoms also reduced anteromedial OFC gamma power. These results link OFC gamma activity to moment-to-moment expression of OCD symptoms, providing mechanistic insights to guide therapeutic strategies such as deep brain stimulation.

  PublisherOA PDFDOI

• Increasing Safety Plan Use and Reducing Suicidal Ideation Among Emerging Adults: A Pilot Randomized Trial of the <scp>STARS</scp> Intervention

  Suicide and Life-Threatening Behavior · 2026-04-01

  articleOpen access1st authorCorresponding

  INTRODUCTION: Emerging adult sexual and gender minorities (EA-SGM) experience disproportionately high rates of suicide. The Safety Planning Intervention can reduce suicide risk, but its effectiveness for this population may be limited without additional support. The Supporting Transitions to Adulthood to Reduce Suicide (STARS) program was developed to address this gap by integrating a mobile application and peer mentorship to promote consistent Safety Plan use. METHODS: Participants (n = 64) were randomized to receive either SPI alone or SPI plus STARS. Participants were followed for 6 months. RESULTS: STARS was highly acceptable and associated with significantly greater use of the Safety Plan at 2 months compared to SPI alone. While both groups demonstrated significant reductions in suicidal ideation over time, participants in STARS showed sustained nonsignificant improvements through 6 months, whereas SPI alone experienced a slight increase after 4 months. STARS participants used their Safety Plan significantly more frequently than SPI alone (39% vs. 15% for monthly use) at 2 months. CONCLUSIONS: STARS is a feasible and acceptable intervention that enhances Safety Plan engagement and longer-term reductions in suicidal ideation among EA-SGM. These promising findings provide preliminary support for a fully powered effectiveness trial to evaluate STARS' outcomes. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05018143.

  PublisherDOI

• Supporting Evidence-based Responses to Emotional Needs in Emphysema (SERENE): protocol for a randomized, open-label mechanistic trial comparing Coping Skills Training and disease-specific education for depressive symptoms conducted in United States health systems

  Trials · 2026-02-25

  articleOpen access

  BACKGROUND: Depressive symptoms and anxiety are highly prevalent among people with chronic obstructive pulmonary disease (COPD), strongly associated with poor outcomes, and rarely recognized or treated. Integrating families into interventions may amplify supportive care treatment effects and overcome common challenges, yet this strategy is understudied. The Supporting Evidence-based Responses to Emotional Needs in Emphysema (SERENE) trial's main objective is to identify the mechanisms through which a family-partnered Coping Skills Training (CST) reduces depressive symptoms among patients with COPD, testing five putative mechanisms: family relationship quality, patient and caregiver self-efficacy, patient loneliness, and caregiver psychological distress. METHODS: SERENE will enroll 375 patient-support person (i.e., family caregiver) dyads from two academic health systems. Eligible patients have documented COPD, elevated levels of depressive symptoms (i.e. PHQ-8 scores ≥ 8), and age ≥ 18 years old. Ineligible participants are those with new or changing behavioral health treatments or behavioral health emergencies. After enrollment by research staff, we randomize dyads in a 2:1 ratio to receive either a 12-week CST program or a 12-week COPD education program, respectively. Both are delivered to the dyads via phone or videoconferencing sessions and, therefore, arm assignment is not blinded to staff nor participants. We will test whether randomization to receipt of CST leads to improvements in patients' depressive symptoms and test mechanisms of efficacy. The primary efficacy outcome is PHQ-9 scores 14 weeks following enrollment. Our five putative mechanisms, corresponding to those previously specified, are measured with the Family Emotional Involvement and Criticism Scale, the General Self-efficacy Scale, the UCLA Loneliness Scale, the PHQ-9, and the Generalized Anxiety Disorder-7. We will measure secondary outcomes through 12 months. Those performing data analyses will remain blinded to group assignments at the individual level until completion of the primary analyses. The study team identifies and reports serious adverse events (i.e., suicidal behaviors or psychiatric hospitalizations). DISCUSSION: SERENE will determine how scalable supportive care interventions that strengthen existing social networks, including the crucial support of family caregivers, improve outcomes in COPD. The results will lay the foundation for paradigm-shifting approaches to managing COPD and similar illnesses through family-directed supportive care interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT06600126. Registered 6 September 2024, https://clinicaltrials.gov/study/NCT06600126 . The first enrollment occurred on 30 September 2024.

  PublisherDOI

• Graduated exposure to traumatic events decreases distress during prolonged exposure therapy for posttraumatic stress disorder

  Journal of Behavioral Medicine · 2026-05-24

  articleOpen access

  Prolonged exposure (PE) is an evidence-based treatment for PTSD. However, the imaginal exposure portion of PE can be distressing for patients, and despite many service members reporting multiple traumatic events, traditional PE focuses solely on the most distressing event. This article evaluates a modified version of PE that considers the need for distress-reduction in trauma-focused treatments. We compared distress during two methods of imaginal exposure: (1) standard exposure, where participants focused on their most distressing event; and (2) graduated exposure, where participants focused on their top three most distressing events, from third most distressing to most distressing. Mean peak subjective units of distress scores (SUDS) were compared across groups. Participants were 199 active duty personnel and veterans (79.9% men; mean age 38.5 years). There was a significant overall effect of group on peak SUDS, F(3,359) = 12.46, p < .001. Participants receiving standard exposure reported an average peak SUDS of 88.1/100 (SD = 13.4), compared to 75.2 (SD = 22.5) for graduated imaginal exposure participant's most distressing event. Participants in the graduated group also reported significantly lower peak SUDS for their second (M = 72.23, SD = 20.6; t(183) = 5.49, p < .001, d = .81) and third most distressing events (M = 74.63, SD = 21.1; t(183) = 466, p < .001, d = .69) compared to mean SUDS rating for the standard exposure group. Incorporating a graduated approach appears to mitigate average peak distress from participating in the imaginal exposure component of PE.Trial registration These data were collected as part of a larger, randomized clinical trial that was registered with ClinicalTrials.gov (Identifier NCT03529435).

  PublisherDOI

• Predicting next-day suicidal urges, depression, and PTSD symptoms using ecological momentary assessments and passive sensing of sleep among military service members and veterans

  Journal of Affective Disorders · 2026-03-25

  articleOpen accessSenior authorCorresponding

  Suicide risk fluctuates rapidly, highlighting the importance of identifying risk factors for acute suicidal urges. This study examined whether nightly sleep measured actively via self-report ecological momentary assessment (EMA) and passively via wearable sensors predicted next-day suicidal urges, depression, and PTSD symptoms among military service members and veterans. Military service members and veterans with current suicidal ideation or a suicide attempt in the past month ( N = 86) completed seven EMA surveys per day and wore a wearable device (Fitbit) for 28 days. Using multilevel models, we examined sleep assessed by EMA-only, wearable-only, and EMA + wearable as predictors of next-day suicidal urges, depression, and PTSD symptoms, and compared the predictive utility of the three approaches. Participants completed 7898 EMA observations (48.9% adherence) and wore a wearable device (Fitbit) for 79.43% of the study period. More severe nightmares and poorer sleep quality assessed by EMA predicted next next-day suicidal urges (maximum and average), suicidal beliefs, depression, and PTSD symptoms. Wearable-assessed sleep duration deviation significantly predicted next-day maximum suicidal urges. Wearable-assessed sleep regularity index predicted next-day depression. EMA-only models consistently outperformed wearable-only models in predicting next-day suicide risks and mental health outcomes, and combining EMA and wearable demonstrated best model fit. Our findings suggest that self-reported sleep via EMA has strong utility in predicting near-term suicidal risk, depression, and PTSD, while wearable devices can provide low-burden, supplemental information. Integrating wearables and EMA may enhance the prediction and inform just-in-time suicide interventions. • Severe nightmares and poor sleep quality predicted higher next-day suicide risks. • EMA outperformed wearable in assessing sleep as a predictor of suicide risks. • Military personnel showed higher adherence to wearable devices than EMA. • Wearable-assessed sleep added predictive value for suicide urges and depression. • Integrating EMA and wearable sensors enhances real-time detection of suicide risks.

  PublisherDOI

• Self-Reported Psychosis Spectrum Symptoms Among Sexual and Gender Diverse Emerging Adults Screened for a Suicide Prevention Trial

  Archives of Sexual Behavior · 2026-04-24

  articleOpen accessSenior author

  Psychosis spectrum symptoms, including a range of unusual thoughts and perceptual abnormalities, are markers of increased vulnerability to psychotic disorders. Sexual and gender diverse (SGD) populations experience higher rates of psychotic disorders than the general population, raising the possibility that emerging adult SGD individuals may also report elevated psychosis spectrum experiences. We hypothesized that SGD emerging adults would report higher rates of psychosis spectrum symptoms than the general population. In line with intersectional frameworks, we further hypothesized that rates would be higher among individuals with multiple marginalized identities. We screened SGD emerging adults (ages 18-24; N = 376) for a clinical trial of a mobile health intervention to decrease suicide risk. A brief eligibility screening questionnaire assessed racial, ethnic, sexual, and gender identities. The Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders (DIAMOND) psychosis screener questions were used to assess self-reported unusual thoughts and perceptual abnormalities. Psychosis spectrum symptoms were reported by 40% of the screened sample versus 23% in the general population. The probability of endorsing symptoms (OR = 1.528, 95% CI = 1.16-1.99, p = 0.002) increased with each additional minority status identification (i.e., race, ethnicity, sexual identity, gender identity). Future research should explore unique factors contributing to the heightened rates of self-reported psychosis spectrum symptoms among these minority populations and attempt to test the replicability of these findings.

  PublisherOA PDFDOI

• Stereo-encephalography-guided multi-lead deep brain stimulation for treatment-refractory obsessive compulsive disorder – Study design and individualized surgical targeting approach

  Journal of Affective Disorders · 2026-02-05

  article
  PublisherDOI

• Differential Effects of Hazardous Drinking on Post-Traumatic Stress Disorder Outcomes Across Two Prolonged Exposure Treatment Formats.

  PubMed · 2025-07-15

  articleOpen access

  = 0.025) at the 6-month follow-up. There was no significant difference in treatment engagement based on drinking classification and outcomes did not vary based on PE format. The findings suggest that PE is an appropriate treatment for individuals with PTSD and hazardous drinking. However, group differences in PTSD symptom reductions indicate concurrent hazardous drinking reduces treatment benefits of PE.

  PublisherOA PDFDOI

• Taking efficacious treatments for posttraumatic stress beyond the bedside: Exploration of successes and challenges in training community and lay providers across the globe

  Journal of Traumatic Stress · 2025-06-15 · 1 citations

  reviewOpen access

  Although there is considerable data to support the efficacy of several treatments for trauma-related disorders, the traumatic stress field continues to struggle with adequate implementation and uptake of such treatments in real-world settings, which greatly contributes to persistent health disparities in these disorders. Task-shifting, or the ability to train frontline providers in evidence-based treatments for psychological disorders following traumatic events in various local and global community settings, may be one avenue to improve the translatability, scalability, and sustainability of effective traumatic stress treatments. In this paper, we describe a range of implementation and training efforts to bring efficacious treatments for trauma-related disorders beyond the bedside and directly into the communities that could benefit the most. Our descriptions cover the training methodologies utilized and the fidelity measurement of efforts to train frontline providers in several distinct global settings, namely Chile, Portugal, Greece, the Caribbean, and Somaliland. In addition, we describe a large-scale, city-wide implementation and evaluation of providers' fidelity to evidence-based traumatic stress treatment within a major U.S. city for further exemplification around how task-shifting can happen at a larger, systemic, top-down level. In our descriptions, we also critically examine the challenges our teams have encountered when doing such work and highlight successful strategies that could facilitate the reduction of inequities in traumatic stress treatment worldwide.

  PublisherOA PDFDOI

Recent grants

• Developmental Core B

  NIH · $44.1M · 2013–2028

Frequent coauthors

• Ivan W. Miller

  Brown University

  56 shared

• Alan L. Peterson

  41 shared

• Brandon A. Gaudiano

  Providence College

  33 shared

• Raquel E. Gur

  Children's Hospital of Philadelphia

  25 shared

• Brett T. Litz

  VA Boston Healthcare System

  25 shared

• Ran Barzilay

  University of Pennsylvania

  23 shared

• Ruben C. Gur

  Children's Hospital of Philadelphia

  22 shared

• Carmen P. McLean

  Stanford University

  22 shared

Labs

• Center for the Treatment and Study of AnxietyPI