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Credit: Roy Groething
Bart Rypma, assistant professor of
psychology at Rutgers-Newark, examines
brain scan images with graduate student
Dana Eldreth. The images will help Rypma
and Jan Mohlman, assistant professor of
psychology in New Brunswick/Piscataway,
determine whether cognitive-behavioral
therapy helps seniors cope with anxiety.
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Jan Mohlman, assistant professor of psychology in New Brunswick/Piscataway, knows that anxiety and aging often go together, and she believes that cognitive-behavioral therapy can help keep anxiety under control. Bart Rypma, assistant professor of psychology in Newark, thinks the effects of such therapy might be visible, and thus measurable, in the brain.
The psychologists have joined forces to test their hypotheses with the help of older-adult volunteers, whom they are recruiting for a study. They are looking for people age 60 and older who exhibit symptoms associated with anxiety – frequent worrying, muscle tension, irritability or trouble falling or staying asleep.
Cognitive-behavioral therapy, or CBT, is a type of treatment in which patients learn to change their behaviors and beliefs to cope in more productive ways. Mohlman’s therapeutic goal is to make her patients aware of their thoughts and how those thoughts might influence actions. Excessively negative thoughts, she says, lead to negative actions, such as avoidance or defensiveness, which leads to more negative thoughts and increased anxiety.
“It’s not necessarily a matter of ‘thinking happy thoughts’ – it’s thinking fewer overly negative thoughts or thoughts that are blown out of proportion,” Mohlman says. “A patient’s increased cognitive awareness is often combined with behavioral techniques, such as gradual exposure – in their imaginations – to their most feared outcome. We also ask them to worry on purpose for a set amount of time each day. Research suggests that this leads to a decrease in spontaneous, intrusive worries.”
Mohlman and Rypma have two research goals: to find out if cognitive-behavioral therapy, offered in a one-on-one format, works as well for older adults as it works for younger ones, and to find out how the changes wrought by CBT are accompanied by physical changes in the brain, changes that can be seen and measured in the prefrontal cortex.
Anxiety disorders affect about 12 percent of the adult population, an estimated 19 million people, according to the National Institute of Mental Health. Mohlman says success rates for CBT range from 50 to 85 percent, depending on the specific disorder being treated.
Rypma will collect images of each patient’s brain with a magnetic resonance imaging (MRI) scanner before the patient begins the program and again after the patient has had eight “mood management training” sessions. Mohlman or her graduate students – all of them doctoral candidates who have received training in CBT– will administer treatment.
CBT involves the teaching of executive skills, such as being able to disengage from a task or line of thinking and re-engaging in another. “These activities have been shown to be connected with the prefrontal cortex,” Rypma says.
Rypma and graduate student Dana Eldreth will examine the MRI images taken of each patient before and after the eight-week mood management training. Special software is used to analyze the data and produce a series of images showing brain activity overlaid on brain anatomy for each subject. If the after-therapy images show changes in neural activity, compared with the before-therapy images, Rypma and Mohlman will have support for the theory that CBT produces a physical as well as a psychological effect.
The first challenge, however, is to recruit volunteers. A story about the project in The Record, the daily newspaper in Bergen County, drew in the first volunteers in November, but Mohlman says she has found an even better recruiting tool – ValPak, the direct-marketing advertising packages sent to homes, filled with discount coupons for local businesses, in which she has advertised the project.
Mohlman and Rypma have already begun working with their first few subjects, and expect to recruit 30 by the time they’re finished.
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