Evolutionary cognitive therapy versus standard cognitive therapy for depression: a protocol for a blinded, randomized, superiority clinical trial

Abstract

BackgroundDepression is estimated to become the leading cause of disease burden globally by 2030. Despite existing efficacious treatments (both medical and psychotherapeutic), a large proportion of patients do not respond to therapy. Recent insights from evolutionary psychology suggest that, in addition to targeting the proximal causes of depression (for example, targeting dysfunctional beliefs by cognitive behavioral therapy), the distal or evolutionary causes (for example, inclusive fitness) should also be addressed. A randomized superiority trial is conducted to develop and test an evolutionary-driven cognitive therapy protocol for depression, and to compare its efficacy against standard cognitive therapy for depression.Methods/designRomanian-speaking adults (18 years or older) with elevated Beck Depression Inventory (BDI) scores (>13), current diagnosis of major depressive disorder or major depressive episode (MDD or MDE), and MDD with comorbid dysthymia, as evaluated by the Structured Clinical Interview for DSM-IV (SCID), are included in the study. Participants are randomized to one of two conditions: 1) evolutionary-driven cognitive therapy (ED-CT) or 2) cognitive therapy (CT). Both groups undergo 12 psychotherapy sessions, and data are collected at baseline, mid-treatment, post-treatment, and the 3-month follow-up. Primary outcomes are depressive symptomatology and a categorical diagnosis of depression post-treatment.DiscussionThis randomized trial compares the newly proposed ED-CT with a classic CT protocol for depression. To our knowledge, this is the first attempt to integrate insights from evolutionary theories of depression into the treatment of this condition in a controlled manner. This study can thus add substantially to the body of knowledge on validated treatments for depression.Trial registrationCurrent Controlled Trials ISRCTN64664414The trial was registered in June 2013. The first participant was enrolled on October 3, 2012.

Integrating EMDR into an evolutionary‐based therapy for depression: a case study

“…Recently, two evolutionary-based therapies for depression have been suggested [31]; [32]. Despite the similar theoretical basis the suggested interventions are significantly different.…”

“…In their evolutionary-driven cognitive therapy (ED-CT) Giosan et al identify threats to the patient's fitness and target them with cognitive-behavioral methods. The main components of their approach are (1) cognitive restructuring targeting the mismatch between evolutionary-driven beliefs about the requirements for one's fitness and a more adaptive reality-based understanding of one's opportunities and limitations, and (2) behavioral activation targeting the fitness-compromising behaviors [31]. Krupnik's treating depression downhill (TDD) therapy relies heavily on experiential approach.…”

The future of psychotherapy research: stop the waste and focus on issues that matter

“…In addition to that, a considerable number of studies report on the effects of newly developed psychotherapies for depression (e.g., Bédard et al 2014;Giosan et al 2014) and on comparative trials comparing two types of psychotherapies. It is well-established, however, that all therapies for depression are about equally effective and that if a new therapy would indeed be more effective than an existing therapy, it would take a new trial with about 800 patients to show its superiority (Cuijpers & van Straten, 2011).…”

Cognitive evolutionary therapy for depression: a case study

“…A Cognitive Evolutionary Therapy for depression (CET) would focus, besides proximal causes, on distal (ultimate, or evolutionary) mechanisms as well, such as inclusive fitness or reproductive success, which are thought to lead to depression when prevented from functioning optimally . Such an approach enhances the CBT paradigm by including information about the hypothesized adaptive functions of depressive symptoms, along with direct interventions on fitness‐enhancing factors.…”

“…Such an approach enhances the CBT paradigm by including information about the hypothesized adaptive functions of depressive symptoms, along with direct interventions on fitness‐enhancing factors. In addition, attention is paid to unhealthy behaviors that generally lower fitness, targeting them specifically in the therapeutic process .…”