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.
To learn more about ERT, visit EmotionRegulationTherapy.com
One issue with delineating the role of emotion dysfunction in psychopathology is sound measurement for this construct outside the laboratory. To address this issue, previous studies focusing on the daily emotional reaction and regulation strategies in individuals with or without GAD (with or without MDD) and controls in their everyday environments used a technique known as experience sampling methodology (ESM). Individuals are followed over a number of weeks and prompted randomly twice throughout the day and at a set time once per night to fill out a brief online questionnaire in order to capture typical patterns of emotional response outside the laboratory.
We are currently developing a study in which participants will be administered a baseline diagnostic and experimental session followed by a 1-week ambulatory monitoring of cardiovascular and subjective naturalistic responses, and blood withdrawal to obtain serum-derived inflammatory markers. Participants will be asked to repeat baseline procedures, and blood withdrawal in a 1-year follow-up session. It is expected that, for those with GAD/MDD but not controls, electrocortical biomarkers of perseveration (a cognitive trait associated with worry and anxiety) will predict changes in chronic inflammation across the follow-up period, and that this effect will be mediated by reduced vagal tone in the lab and during ambulation.
Biobehavioral Mechanisms of Emotion Regulation-Based Intervention
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.