Laboratory Examination of Emotion-Related Mechanisms
We are currently conducting a series of laboratory-based experimental studies using a multi-method assessment of the subjective, behavioral, and physiological emotional domains. These methods include EEG, EKG, electrogastrogram (EGG), respiratory sinus arrhythmia (RSA), and event-related potentials (ERP), among others in order to examine questions related to pathological mechanisms of emotional reactivity and dysregulation in individuals with generalized anxiety disorder, major depressive disorder, or neither condition.
Current projects are focused on:
differential patterns of emotion reactivity between these disorders in order to clarify their diagnostic overlap;
the role of various regulation strategies on subsequent levels of reactivity;
implicit characteristics of emotion dysregulation; and
subjective and physiological indicators of relational dysfunction in partnerships with at least one member who has GAD or MDD.
Emotion Regulation Therapy (ERT)
ERT (Mennin & Fresco, 2009) is a recently developed and preliminarily supported manualized treatment that integrates components of cognitive-behavioral, acceptance, dialectical, mindfulness-based, and experiential, emotion-focused, treatments using a mechanistic framework drawn from basic and translational findings in affect science. This mechanism-targeted behavioral intervention focuses on the training of a number of regulatory skills including attentional flexibility, acceptance, cognitive distancing, and cognitive reframing skills. These skills are taught in the first half of treatment and are then utilized by patients in an exposure/behavioral activation phase in the second half of treatment.
The goals of ERT are for individuals to become better able to:
identify, differentiate, and describe their emotions, even in their most intense form;
increase acceptance of affective experience and ability to adaptively manage emotions when necessary;
decrease use of emotional avoidance strategies (e.g., worry); and
increase ability to utilize emotional information in identifying needs, making decisions, guiding thinking, motivating behavior, and managing interpersonal relationships and other contextual demands.
To date, the efficacy of ERT has been demonstrated in recently concluded NIMH-funded trials including NIMH funded open trials and a randomized control trial. Patients in both trials evidenced reductions in measures of GAD severity, worry, trait anxious, and depression symptoms and corresponding improvements quality of life. These gains were maintained for nine months following the end of treatment. Evaluation of efficacy and investigation of treatment mechanisms is on-going in clinics at CUNY Hunter College and Kent State University. Dr. Mennin, along with Dr. David Fresco, is currently writing a book on ERT for Guilford Press, and has been asked to speak about ERT or provide trainings in numerous academic, medical, and private settings nationally and internationally.
Most recently, Dr. Mennin has become interested in delineating biobehavioral markers of targeted interventions, thereby combining interests in delineating experimental and ecological assessments with the testing of interventions for GAD/MDD. In recent work, he has been examining biobehavioral mechanisms of change such as heart rate variability as a result of ERT and its targeted components. Specifically, he found that parasympathetic activity normalized from pre- to mid-treatment of ERT and, further, mediated post-treatment symptomatic and functional outcome. These data suggest that ERT normalizes emotional reactivity patterns and that this normalization plays a role in acute and long-term therapeutic effects of ERT.
In addition, in collaboration with Dr. David Fresco at Kent State University and Dr. Amit Etkin at Stanford University and the Palo Alto VA, he also examined a potential behavioral mechanism of implicit regulation using an established paradigm. Patients who showed the greatest gains in implicit regulation by mid-treatment, showed the greatest pre to post response in anxiety, anhedonic depression, and worry. Building on these pilot findings regarding biobehavioral mechanisms of ERT, Dr. Mennin recently was awarded a PSC-CUNY Enhanced Award to examine neural mechanisms of ERT utilizing functional MRI procedures while administering these explicit and implicit regulation paradigms (in collaboration with Drs. Fresco, Etkin, and Amy Roy at Fordham University).
Finally, recent studies have begun to utilize portable "biofeedback" instrumentation to help individuals identify physiological responses such as respiration and heart rate in stressful situations, and utilize components such as breath awareness (an integral component of ERT) to alter these responses. As a result, we have begun to examine whether this type of autonomic feedback might help improve ERT outcomes for those patients who are refractory to standard methods.
To learn more about ERT, visit EmotionRegulationTherapy.com
Emotion Regulation Training (ERt); BRIEF Intervention Study
Research suggests that high degrees of worry and rumination may underlie anxious and depressive feelings and play a pivotal role in clinical disorders related to anxiety and low mood. One seemingly essential component of both worry and rumination is attention, which normally allows an individual to flexibly orient toward important aspects of their internal and external world as needed. However, difficulties can lead to biases where attention helps sustain negative thought patterns surrounding the future (worry) or past (rumination). A growing number of treatments have specifically sought to retrain attention by asking individuals to mindfully place their focus on the present-moment, away from habitual thought patterns. An area of research that remains relatively unexplored is whether brief doses of mindfulness training are sufficient to relieve chronic worry and rumination, and whether these changes can be captured in the brain or body of participants as they complete various cognitive tasks. Both the Etkin Emotional Stroop and Liston Attentional Shifting tasks are useful for assessing attentional control, and can also index improvements related to attention training across time.
Therapies centered on development and strengthening of metacognitive regulation skills help individuals to respond more adaptively in emotionally evocative situations by fostering the ability to view distressing emotions and thoughts through a healthy cognitive distance to generate emotional clarity (i.e., decentering) and modify one’s evaluation of an event in order to alter its emotional significance (i.e., reframing). Furthermore, imaginal and en-vivo experiential exposure provides individuals opportunities for novel contextual learning where individuals can better get in touch with their ‘reward’ or ‘approach’ pulls and fortify new emotional meanings.
This study employs a dismantling design to examine the attentional, metacognitive, and motivational components of Emotion Regulation Therapy (ERT) over a two-week intervention period using an array of psychophysiological (EEG, EKG, EGG, GSR, respiration), behavioral and subjective measures. A smartphone-based experience sampling method will be used to collect information about an individual’s daily patterns of thoughts and worries and how they effect cognitive and emotional functioning. Participants in this study will be required to come in for a total of two lab visits at the beginning and the end of the study. During these lab visits, participants will be asked to complete questionnaires, computer tasks, and will receive psychoeducation training. In addition, participants will be asked to practice brief doses of mindfulness training, followed by a 48-hour continuous ambulatory recording of cardiovascular and subjective responses.
Health Processes and Perseverative Thinking
Another of the lab's current projects involves examining physiological markers of worry and relaxation on autonomic, endocrine, and immunological processes.
Previous work, in our lab and elsewhere, has examined the Perseverative Cognition Hypothesis (Brosschot, Gerin, & Thayer, 2006) in relation to HPA axis and HRV dysregulation. Generally, this work has demonstrated that people who are high in perseverative processes such as worry and rumination, both at state and trait level, are more likely to experience lower HRV and higher cortisol responses compared to those who are low in these perseverative processes. To date, however, there has been no research examining whether immunological outcomes such as cytokine levels (a marker typically used to assess chronic inflammation) are associated with increased rates of worry and/or rumination and no research has examined the combination of autonomic and immunological processes within the context of perseveration.
This study seeks to examine dynamic changes in chronic inflammatory proteins, HRV, and cortisol throughout a worry and relaxation manipulation in individuals with varying degrees of trait worry. Given that dysregulation of HRV, inflammation, and cortisol have been shown to promote deleterious health outcomes in the long term, it may be important to understand the mechanistic role that perseveration may play in exacerbating these outcomes.
Ultimately, we hope to contribute to a line of research which points toward a potential causal role that perseveration may have on autonomic, endocrine, and immunicological processes. The examination of such data could have important implications in highlighting the necessity of reducing perseveration in an effort to promote better physical health via increased regulation of these physiological processes.