A Randomized Controlled Trial of Emotion Regulation Therapy for Psychologically Distressed Caregivers of Cancer Patients

Abstract

Background Previous cognitive behavioral therapies for informal caregivers (ICs) have produced negligible effects. The purpose of this study was to evaluate, in a randomized controlled trial, the efficacy of Emotion Regulation Therapy adapted for caregivers (ERT-C) on psychological and inflammatory outcomes in psychologically distressed ICs and the cancer patients cared for. Methods A total of 81 ICs with elevated psychological distress were randomly assigned to ERT-C or a waitlist condition and assessed pre-, mid-, and post-treatment. In 52 cases, the patient cared for by the IC was included. Patients did not receive ERT-C. Both the ERT-C and waitlist groups were followed 3 and 6 months post-treatment. Data were analyzed with multilevel models, and P values were two-sided. Results Compared with ICs in the waitlist condition, ICs in the ERT-C condition experienced medium to large statistically significant reductions in psychological distress (Hedge’s g = 0.86, 95% confidence interval [CI] = 0.40 to 1.32, P < .001), worry (g = 0.96, 95% CI = 0.50 to 1.42, P < .001), and caregiver burden (g = 0.53, 95% CI = 0.10 to 1.99, P = .007) post-treatment. No statistically significant effects were found for rumination (g = 0.24, 95% CI = −0.20 to 0.68, P = .220). Results concerning caregiver burden were maintained through 6 months follow-up. Although the effects on psychological distress and worry diminished, their end-point effects remained medium to large. No statistically significant effects on systemic inflammation were detected (C-reactive protein: g = .17, 95% CI = −0.27 to 0.61, P = .570; interleukin-6: g = .35, 95% CI = −0.09 to 0.79, P = .205; tumor necrosis factor-alpha: g = .11, 95% CI = −0.33 to 0.55, P = .686). Patients whose ICs attended ERT-C experienced a large increase in quality of life post-treatment (g = 0.88, 95% CI = 0.18 to 1.58, P = .017). Conclusions To our knowledge, this is the first randomized controlled trial evaluating the efficacy of ERT-C for ICs. Given the previous disappointing effects of other cognitive behavioral therapies for this population, the present findings are very encouraging. Identifying ICs with elevated psychological distress and providing them with relevant psychotherapy appears an important element of comprehensive cancer care.

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

“…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.…”

“…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. 57 To examine the relationship of these changes to outcomes, we have utilized multiple indices of emotion functions including subjective report, behavioral tasks, and biological indices that have established reliability and validity in lab and analogue studies.…”

“…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). 69…”

Feasibility of an Emotion Regulation Intervention for Patients in Cardiac Rehabilitation

“…Previous literature has documented the importance of the inclusion of psychological support during recovery from a cardiac event (Braun et al, 2017;Chauvet-Gelinier & Bonin, 2017;Pogosova et al, 2014) and the effectiveness of emotion regulation based treatments to address depression and anxiety in other populations (Mennin et al, 2018;O'Toole et al, 2019;Parsons et al, 2017;Renna et al, 2017). Supportive treatment is a key component of recovery following a cardiac event and can include various types of physical or psychosocial support.…”

“…Although emotion regulation interventions are generally effective at improving the ability to use emotion regulation adaptively (Gross, 2015b), they have not been optimized for adults with chronic illness, such as people with CHD. It is clear that emotion regulation interventions can mitigate psychological distress such as depression and anxiety in other populations (Mennin et al, 2018;O'Toole et al, 2019;Parsons et al, 2017;Renna et al, 2017). Situations that provoke an emotional response, whether internal or external, are an everyday occurrence (Sheppes et al, 2015).…”