Having cancer is definitely rough — but so is being a family member or friend serving as a cancer patient’s caregiver.
“Studies of biomarkers such as inflammation or gastric processes show that caregivers can have even higher stress-hormone levels than the patient because they often feel more out of control,” says Teachers College Clinical Psychology Professor Douglas Mennin.
Over the past 20 years, Mennin, who joined TC’s faculty in Fall 2017 after serving the prior 16 years as a professor at Yale and the City University of New York, has developed and honed an approach called Emotion Regulation Therapy (ERT) for helping people who are chronically stressed and worry or ruminate a lot. A paper he authored in 2018 on the effectiveness of ERT in treating generalized anxiety disorder (with and without co-occurring depression) was among the 10 most most-downloaded papers in all of psychology that year.
More recently, Mennin has applied this approach to improving the mental health of caregivers of those with cancer — historically a difficult group to help given the great amount of life difficulties they face. Interestingly, Mennin has found that the therapy not only improved the clinical picture of caregivers but also appeared to exponentially increase quality of life for the loved ones (cancer patients) themselves.
Now, Mennin, former Chair of the Scientific Council of the Anxiety and Depression Association of America, is testing a modified, more abbreviated form of ERT to help people suffering from elevated rumination, worry and distress related to COVID-19. Mennin’s study enrolls New Yorkers who are suffering in the wake of the COVID-19 pandemic —including those who are healthcare or essential workers, have contracted the illness, lost a loved one, lost employment, or are generally distressed over an increase sense of threat and decreased opportunities. The study particularly reaches out to individuals from low-income and communities of color, which have been disproportionately hit by COVID-19. Participants receive eight Zoom-screen sessions over four-week periods, free of charge. The study also provides participants with a web app that reinforces behavior change.
Anxiety and sadness become naturally aggravated at these times. Like a snowball picking up sticks and rocks, people began reacting to these understandable emotions with negative responses of worrying, ruminating and criticizing oneself. Our therapy helps you learn, step by step, how to catch your mind in these instances.
— Douglas Mennin
“Other apps have no scientific backing, but ours goes beyond providing ‘things that calm you’ to help you get better at in-the-moment responses to your emotions when you’re in internal conflict about, say, creating safety versus pursuing rewards,” Mennin says. “For example, you might be trying to decide whether to go to the store or stay home — or to engage with loved ones versus disengaging due to grief and loss. Anxiety and sadness become naturally aggravated at these times. Like a snowball picking up sticks and rocks, people began reacting to these understandable emotions with negative responses of worrying, ruminating and criticizing oneself. Our therapy helps you learn, step by step, how to catch your mind in these instances.”
Such approaches are not new. CBT has been in use for 60 years but its mechanism is theoretical — that is, it can achieve good outcomes for some patients, but those improvements haven’t been well mapped onto changes in the brain.
In contrast, in studies of patients conducted before, during and after they receive treatment, Mennin has shown that ERT, which is effective in patients who are not helped by CBT, is associated with changes in regions of the brain concerned with salience (what draws attention and gets noticed) and decision-making, including the insula and the medial prefrontal cortex, located in the cerebral cortex — and that those changes predict better mental health outcomes.
“When someone is making goal decisions, the front part of the brain is in better connection with the rear,” he says. “So, you see a cookie and you want it — but then you say, no, I’m trying to be healthier right now. Or you’re upset and you’re about to yell, but then you stop yourself. ERT acts on that process.”
Mennin has also shown a correlation between brain changes associated with ERT and improved “task proficiency” — for example, “the ability to compartmentalize emotions in a healthy way that enables you to keep functioning while still allowing yourself a space to feel sadness or fear.”
ERT currently is widely used in a number of countries including developing ones (for instance, the approach has been translated into Farsi in Iran, for example) but currently is more of a specialized treatment in the United States as it undergoes testing and refinement. As the COVID crisis increases worldwide, a need for such an approach on a grander scale may be warranted.
“With evidence of the approach helping individuals to cope with COVID-19 related distress, we hope to expand the criteria for those who could benefit from the program,” Mennin says. “Further, we are seeking private and federal funding to scale up the trial and deliver therapy to more people. But it’s a tough time right now for the NIH [National Institutes of Health]. It’s not like after the recession of 2008, when there was a stimulus package, or after 9/11, when special grants were being made available.”
With cases significantly down in New York City right now, the worried well have had something of a respite. However, many people continue to be apprehensive and fear a second spike in cases as the weather gets colder in late fall.
“Unfortunately, there’s likely to be a real need for this for some time,” he says.
— Joe Levine