Emotion regulation therapy for cancer caregivers—an open trial of a mechanism-targeted approach to addressing caregiver distress

Abstract

Informal caregivers (ICs) are integral to care provided to patients facing life-threatening or incurable illnesses. This responsibility causes considerable burden, as approximately one half of ICs report clinically significant symptoms of depression and/or anxiety that persist when left untreated. Psychosocial interventions containing efficacious treatment principles (e.g., cognitive behavior therapy [CBT]) show disappointing results in reducing anxiety and depression in ICs. This may reflect failure of these interventions to specifically target crucial mechanisms underlying the central feature of distress caused by the patient’s illness—notably, perseverative negative thinking (PNT). Emotion Regulation Therapy (ERT) is an efficacious CBT developed to explicitly target mechanisms underlying PNT and the emotional concomitants that arise in response to stressful situations. This open trial was conducted to evaluate the acceptability and initial efficacy of ERT adapted to the experience of cancer ICs (ERT-C). Thirty-one ICs provided informed consent and completed eight weekly individual sessions of ERT-C. Participants completed self-report measures of depression and anxiety symptoms, PNT, emotion regulation deficits, and caregiver burden before and after treatment. ERT-C was well tolerated as indicated by 22 treatment completers and feedback provided in exit interviews. ICs demonstrated reduced depression and anxiety symptoms, PNT, and emotion regulation deficits with moderate to large effect sizes (Hedge’s g range: 0.36–0.92). Notably, caregiver burden was not reduced but ICs expressed more ability to confront caregiving-related challenges. Findings offer promising but preliminary support for ERT-C as a conceptual model and treatment modality for distressed cancer ICs.

Randomized controlled trial of a group intervention combining self-hypnosis and self-care: secondary results on self-esteem, emotional distress and regulation, and mindfulness in post-treatment cancer patients

“…As emotion regulation strategies are directly discussed and addressed during the sessions, these results were expected. They are in line with other studies showing the impact of psychological interventions on emotion regulation skills across different populations [53][54][55][56]. Finally, our intervention also improved the participants' level of mindfulness.…”

Emotion Regulation Therapy and Its Potential Role in the Treatment of Chronic Stress-Related Pathology Across Disorders

“…In addition to establishing strong effects for clinical outcomes, the above trials also demonstrated significant treatment-related change from pretreatment to posttreatment and through the follow up in self-reported measures of target mechanisms with moderate to large within (g's ¼ 0.6-2.6) 55,57,68 and between-subjects effect sizes (g's ¼ 0.5-1.0). 57,69 Further, we tested mediational models and found that measures of overall and specific attentional and metacognitive regulatory ability demonstrated indirect effects on primary outcomes of diagnostic anxiety severity, 59 worry, 60 depression, 62 social disability, 64 and quality of life 63 when comparing ERT to the modified attention control comparator.…”

“…Caregivers receiving ERT-C evidenced reductions in worry, 60 rumination, 65 and anxiety and depression symptoms 76 (within-subject effect sizes g ’s = 0.4–0.9). 68 A follow-up RCT in 81 informal caregivers (75% women; mean age = 48; 75% were female caring for male patients) comparing the 8-session ERT-C protocol versus a waitlist control condition further found strong between-subject effects for these indices as well as a measure of caregiver burden ( g ’s = 0.5–1.0). Further, patients whose informal caregivers attended ERT-C experienced a large increase in quality of life posttreatment compared to those whose informal caregiver were in the waitlist condition ( g = 0.9).…”

“…56,57,59 ERT has subsequently also been evaluated in the context of cancer caregivers. 68,69 The contextual demands of caregiving for a loved one with a chronic illness has been found to lead to heightened emotional distress. 70,71 At times, the distress experienced by these caregivers may surpass that of the actual cancer patient.…”

The effect of the emotion regulation training on the resilience of caregivers of patients with schizophrenia: a parallel randomized controlled trial

“…The given treatment was based on cognitive behavioral therapy principles. It is noteworthy that emotion regulation training aimed to reflect mechanisms of perseverative negative thinking and the emotional concomitants in response to stressors [27]. The emotion regulation training attempts to communicate with thoughts that avoid resistance or perceptual analysis rather than to test intrusive thoughts and ineffective beliefs.…”