UMass researchers study depression and anxiety

BY JACKSON COTE

Ranked in the top 50 in the United States for its graduate clinical psychology program, the University of Massachusetts Amherst Psychological and Brain Sciences Department conducts studies on a broad range of issues, including anxiety and depression — two of the most common mental health disorders.

Sally Powers and Michael Constantino, both professors of clinical psychology at UMass, have researched the causes and treatment of these commonplace conditions.

Both college and relationships are risk factors for depression, experts said. In their research, Powers and Constantino dig deeper to explore specific risks and effective treatment methods, including cognitive behavior therapy and psychotherapeutic treatment. Constantino also delves into something called the "therapist effect."

College as a risk factor

Sally Powers has conducted research UMass for 29 years. As a professor, developmental psychopathologist and associate dean, Powers delves into the origins of depression and anxiety symptoms. In particular, she studies the social conditions that lead to these symptoms in children, adolescents and young adults.

Powers emphasized the endeavor that young adults face when going to college and how this major life change can have a substantial mental effect on students.

“One of the major risk factors for depression is a major life transition and college is nothing if it’s not a major life transition,” Powers said.

According to Powers, having a family history of depression adds risk. “If you have a family history of depression, it means it’s a little higher risk of developing depression at college, or if there’s trauma or major stress in your life,” she said.

“More than two in five (45 percent) college-aged adults have been formally diagnosed with a mental health condition by a doctor/healthcare professional, with common diagnoses being depression (33 percent) and anxiety disorder (27 percent),” stated a 2015 survey of some 2,000 adults on suicide and mental health in the U.S.

Romantic relationships: The pros and the cons

Romantic relationships in college can also be a risk factor for depression and anxiety, according to Powers. In a study she conducted in 2013, Powers examined how couples at UMass deal with conflict.

During the study, Powers and her colleagues examined approximately 200 romantic couples at UMass. The volunteering couples would go to a lab to be videotaped having a “real life” conflict, according to Powers.

“Can you show weakness, but feel safe?”

“This was an issue that hadn’t been resolved in their relationship that was ongoing, that was pretty heated,” Powers said.

These issues included jealousy, drinking or how the couples did and did not spend their time together.

Powers “guinea pigged” her own experiment to test its applicability. Powers' graduate students videotaped Powers having a disagreement with her husband and another with her teenage daughter. She noticed that although there is a certain level of artificiality in being forced into an argument, conflict was still readily faced.

“What is remarkable is as soon as your partner brings up his point of view on something that is a heated argument about real life that isn’t resolved, the cameras fade,” she said.

Through the study, Powers and her colleagues wanted to learn which behavior patterns exhibited in the disagreements led to depression, as well as which patterns protected individuals from it.

According to Powers, good communication is key. Being in a relationship where one “can really feel heard or taken seriously” is important to protect from depression.

“Can you show weakness, but feel safe?” asked Powers. “Not being able to productively argue is actually a risk factor [for depression].”

Powers and her colleagues found that there were major gender differences in how couples approached conflict resolution.

While many of the young men in the study had the habit of withdrawing from conflict — relying instead on the support of their partners to resolve the argument — the majority of young women placed more value on solving the issue at hand, she said.

Psychotherapeutic research and treatment

Michael Constantino, director of the UMass Amherst Psychotherapy Research Lab, studies psychotherapeutic treatment, which involves treating mental illnesses psychologically rather than medically.

“I think a lot of people come to therapy because there’s something tangible they would like to see different,” said Constantino. “But I also think patients come to therapy to improve themselves and their relationships.”

Along with teaching two psychotherapy courses, Constantino has served as director of the research lab for 12 years. He works with graduate and honors undergraduate students.

Constantino considers his primary identity to be a psychotherapy researcher. He says this means he is interested in learning “all that there is to know” about how psychotherapy works, under what conditions it works best and what works best for whom.

“It can get complicated very quickly,” Constantino said.

To tackle the various parts of psychotherapy, Constantino and his lab staff conduct two broad types of psychotherapy research: outcome and process research. Outcome research involves comparing different types of treatments to see what works best for patients. On the other hand, process research addresses what strategies and approaches to therapy lead to healing.

Some of this outcome and process research is conducted in the lab’s training clinic, the Psychological Services Center, located on the first floor of Tobin Hall. The center serves as a mental health clinic and is available to students and the general community.

In November 2016, Constantino’s lab published a study which involved interviewing patients about a course of therapy at the Psychological Services Center. The patients were asked what they found most helpful about their therapy sessions. Their answers were analyzed to determine what aspects of the sessions led to positive change in the patients’ lives.

“We have a lot of theories of how people change, but this is going to the source, the person who really own their own experience,” Constantino said.

Constantino concluded that positive change occurred when both the patient and the therapist were engaged in the therapeutic process, through actions like giving and receiving feedback.

Cognitive behavioral therapy as treatment

Another study by Constantino, published in 2016, focuses on cognitive behavioral therapy (CBT) — a type of treatment that attempts to help patients become aware of and resolve the negative thought processes behind their mental health condition.

While Constantino and many other psychologists consider CBT to be the best form of psychotherapy, he contended that only about half of CBT patients “get better.”

Constantino and his colleagues set out to improve the efficacy of CBT, using one mental health condition, generalized anxiety disorder (GAD), as a constant.

“These are people who, in their daily existence, are constantly bombarded by worrisome thoughts and all that goes with it,” Constantino said of people suffering from GAD. “So high anxiety, high stress and a sense that if they didn’t keep worrying about things that they somehow might drop the ball or become less responsible."

Many GAD patients are ambivalent to letting go of their worrying habits, according to Constantino. However, many of these patients also find their anxiety to be extremely distressing and overwhelming.

“So they carry sort of both sides of this equation around with them, which, as you might imagine, can be stressful in and of itself,” said Constantino.

A tactic called motivational interviewing is meant to help patients resolve whether or not a particular worry is worth holding on to.

Initially developed for addiction therapy, motivational interviewing uses different listening and response tactics to combat patients’ hesitations toward therapy. It is used especially in moments where patients begin to disagree with the direction of their therapy or what the therapist is doing. Constantino believed motivational interviewing would be an effective intervention tactic for GAD patients.

Using this theory, Constantino and his colleagues trained graduate student therapists to deliver CBT to 43 patients with severe GAD. Half of these therapists were also trained to give motivational interviewing to another 42 patients.

Over a one-year follow-up period after the therapy was concluded, the patients who received both CBT and motivational interviewing “continued to get better,” said Constantino, but the condition of people who got only CBT was stagnant or even worsened after the therapy ended.

'Not all therapists are created equal.'

More recently, Constantino got funding to do a three-year study in Massachusetts on insurance provider information. This is the idea that if a patient goes to a hospital, doctor or any medical practitioner, the patient can look up the effectiveness of the hospital or practitioner.

Right now, consumers have access to this information in the field of medicine, but not in psychology.

“I think one of the things that we’re learning in the field is that one of the conditions is that the therapist matters,” he said. “Not all therapists are equal.”

Constantino said that differences in the abilities of therapists is called the “therapist effect.”

In his current study, Constantino is attempting to combat the “therapist effect” by inquiring if patients would be interested in knowing information about the effectiveness of different psychotherapists. He asks if this information would be beneficial when trying to find a mental health provider.

Constantino is already getting positive responses.

“We’re learning straight from the patient's mouth that, yes, they would like this information,” he said.

In terms of what makes a good therapist, Constantino is finding from patients that the best psychotherapists are the warmest and most affiliative.

"They tend to be able to communicate better with their patients,” Constantino said. “They tend to be able to express empathy more.”

Statistically, college-age adults visit mental health professionals more frequently than older adults, according to a 2015 survey on nation-wide mental health and suicide.

UMass students can receive therapy through the Center for Counseling and Psychological Health (CCPH) and the Psychological Services Center. To contact CCPH, call 413-545-2337 or 413-545-0333. For the Psychological Services Center, call 413-545-0041.

Email Jackson at jkcote@umass.edu or follow him on Twitter @jackson_k_cote.