Our Research

An Overview

Laboratory Examinations of Emotion-Related Mechanisms

We frequently conduct laboratory-based experimental studies using multi-method assessment of subjective, behavioral, and physiological domains. These methods include electroencephalogram (EEG) and event-related potentials (ERPs), electrocardiogram (EKG/ECG), electrogastrogram (EGG), galvanic skin response (GSR), and respiration. We use these methods to examine questions related to pathological mechanisms of emotional reactivity and dysregulation.

Emotion Regulation Therapy (ERT)

ERT (Mennin & Fresco, 2009) is a recently developed and empirically-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:

1. identify, differentiate, and describe their emotions, even in their most intense form;

2. increase acceptance of affective experience and ability to adaptively manage emotions when necessary;

3. decrease use of emotional avoidance strategies (e.g., worry); and

4. 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 a number of open and randomized clinical trials.

Just prior to the onset of the COVID-19 pandemic, Dr. Mennin and his research team completed an RCT of ERT, comparing two different treatment lengths, that included fMRI acquisition during treatment to further investigate neural mechanisms of change. Outcomes from this trial will be published soon. Presently, Dr. Mennin is the principal investigator of a mobile-based open trial treatment (i.e., teletherapy plus internet-based platform supplement) for individuals directly affected by COVID-19 in the New York area; preliminary findings demonstrate high tolerability and strong indices of efficacy. Studies are currently in development to further evaluate the feasibility, acceptability, and preliminary efficacy of internet-delivered, therapist-supported versions of ERT, with the overarching goal of increasing access to treatment.

In recent years, ERT has been adapted for informal caregivers of clients with cancer, who often report clinically significant symptoms of depression and/or anxiety that persist when left untreated. In an initial OT, caregivers receiving ERT evidenced considerable gains following treatment in worry, rumination, anxiety, and depression symptoms. A follow-up RCT comparing the eight-session ERT caregiver protocol with a waitlist condition further found strong between-subject effects for these indices as well as a measure of caregiver burden. Further, clients whose informal caregivers attended ERT-C experienced a large increase in quality of life post-treatment compared to those whose informal caregivers were in the waitlist condition. 

Future work will seek to identify the ways in which ERT skills target purported mechanisms of action and investigate the contribution of specific skills development to efficacy. To this end, the “BRIEF” study will employ a dismantling, randomized controlled trial (RCT) design to examine the attentional and metacognitive components of Emotion Regulation Therapy (ERT) over a six-week intervention period using an array of psychophysiological (EEG, EKG, GSR, respiration), behavioral and subjective measures. A smartphone-based experience sampling method will also be used to collect information about an individual’s daily patterns of emotionality and emotion regulation skill use and how they affect cognitive and emotional functioning. Participants in this study will be randomized to three conditions: 1) attention and metacognition regulation ERT skills, 2) only attention regulation ERT skills, 3) psychoeducation control. Modules for all conditions will be self-directed and delivered via an internet-based platform with weekly phone coaching support.

Another important focus for ERT will be to delineate the longer-term impact of ERT on the individual’s symptoms and wellbeing. ERT could reach a wider group of individuals through increased efforts at treatment personalization, including addressing specific contextual challenges of diverse groups in terms of race, culture, and socioeconomic status.

To learn more about ERT, visit EmotionRegulationTherapy.com

We are currently wrapping up a no-cost telehealth study of ERT for individuals in New York that are struggling with emotional distress during the COVID-19 pandemic. Between therapy sessions, participants are invited to utilize a novel internet- and mobile-based platform to supplement treatment.

This study is now closed to recruitment.

Findings from both randomized controlled trials and open trials of ERT have demonstrated promising results, as evidenced by statistically and clinically significant improvements in symptom severity, diagnostic status, quality of life, and functional impairment (Mennin, Fresco, Ritter, & Heimberg, 2015; Renna, Quintero, Soffer, Pino, Ader, Fresco, & Mennin, 2018). ERT has also demonstrated changes in outcome areas specific to the purported mechanisms (e.g., decentering, reappraisal; Mennin & Quintero, 2017). However, despite this dearth of evidence, relatively little remains known about the time course of treatment mechanisms during ERT.

Recently, there has been a growing interest in the use of idiographic, time-series designs to examine mechanisms of change in psychotherapy (Barlow et al., 2009; Kazdin, 2011). These types of designs are important in bridging the gap between research and clinical practice as they help elucidate the time course of treatment mechanisms. Therefore, this study employs a multiple case-based time-series design. Specifically, participants will complete a fixed baseline period of 2 weeks. Then, all participants will receive 12 weekly sessions of ERT. Follow-up assessments will occur 1-4 weeks after the final treatment session. Throughout the baseline, treatment, and follow-up periods, participants will complete weekly assessment batteries.

To learn more about this study, visit iERT.site/12-session.

This study is now closed to recruitment.

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.

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 six-week intervention period using an array of psychophysiological (EEG, EKG, 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, one at the beginning and the other at the end of the study. During these lab visits, participants will be asked to complete questionnaires and computerized tasks.

To learn more about this study, visit iERT.site