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
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.
The BRIEF intervention project was developed by Dr. Douglas Mennin and research staff in the READ Laboratory at Teachers College, Columbia University. Broadly, this work aims to understand how a propensity for engaging in past- and future-oriented thinking relates to cognitive and emotional functioning. Taking an affect science approach, Dr. Mennin's research focuses on assessing and treating complex forms of emotional disorders that implicate a central role for emotion regulation. This has led to the development of an integrative yet mechanism-driven treatment called Emotion Regulation Therapy (ERT) with his colleague Dr. David Fresco (Kent State University). Drawing from treatments related to each core mechanism of ERT, the BRIEF examines implications of different kinds of cognitive training on worry and rumination, and it's therapeutic efficacy using a range of approaches (biological, subjective, behavioral and ecological). This web platform permits the boundaries of the READ Lab's research to extend beyond traditional settings into the individual's environment where these processes most naturally unfold. Through this service, participant's can educate themselves on empirically-supported practices drawn from ERT, practice implementing these strategies and report on their experience of this process at their convenience. In turn, this information can be used to map the nature of mental processes in greater detail and refine our understanding and treatment of perseverative cognition.
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.
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.