A model for streamlining psychotherapy in the RDoC era: the example of ‘Engage’

Abstract

A critical task for psychotherapy research is to create treatments that can be used by community clinicians. Streamlining of psychotherapies is a necessary first step for this purpose. We suggest that neurobiological knowledge has reached the point of providing biologically meaningful behavioral targets thus guiding the development of effective, simplified psychotherapies. This view is supported by the Research Domain Criteria (RDoC) Project, which reflects the field’s consensus and recognizes the readiness of neurobiology to guide research in treatment development.

Dimensional thinking in psychiatry in the era of the Research Domain Criteria (RDoC)

“…'Engage' is a streamlined psychotherapy that uses neurobiological constructs to target the behavioural expression of the positive valence system in late life depression by using reward exposure (activation and retraining of positive valence system) coupled with strategies to mitigate negative valence (negativity bias), arousal (apathy) and cognitive control (Alexopoulos & Arean, 2014). The Training for Awareness, Resilience, and Action treatment programme for adolescents proposes subtypes of adolescent depression driven by limbic hyperactivation related to sustained threat (anxious arousal, increased conflict detection, attentional bias to threat, helplessness behaviour, punishment sensitivity and avoidance) with clinical features such as emotional hyper-reactivity, agitation and dysphoric mood (Henje Blom et al 2014).…”

“Engage” therapy: Prediction of change of late-life major depression

“…Engage is a response to this recommendation. The theory on which Engage was built implicates a dysfunction of reward networks as the principal mechanism mediating depressive symptoms (Alexopoulos & Arean, 2014). This view is supported by extensive clinical and biological findings (Pizzagalli et al, 2009; Robinson, Cools, Carlisi, Sahakian, & Drevets, 2012; Russo & Nestler, 2013; Takahashi et al, 2008).…”

“…Late-life biological changes (e.g. vascular lesions, reduced perfusion, degenerative changes, abnormal inflammatory and neuroendocrine responses) may serve as etiological factors of reward network dysfunction either directly or by compromising frontolimbic circuitry that interacts with the reward networks (Alexopoulos, 2005; Alexopoulos & Arean, 2014). Stress further contributes to this cascade of events by promoting inflammation and production of free radicals, influencing dendritic remodeling, inhibiting neurogenesis, and altering functional connectivity.…”

“…Stress further contributes to this cascade of events by promoting inflammation and production of free radicals, influencing dendritic remodeling, inhibiting neurogenesis, and altering functional connectivity. Regardless of causation, we have argued that reward network dysfunction is the most proximal mechanism to depressive symptoms (Alexopoulos & Arean, 2014). …”

This issue: Clinical and Neurobiological Findings, Treatment Developments in Late-Life Depression

“…We have argued that neurobiological knowledge has reached the point of providing biologically meaningful behavioral targets, thus guiding the development of effective, simplified psychotherapies. 16 This view is supported by the Research Domain Criteria (RDoC) Project and its workshops, which reflect the field's consensus and recognize the readiness of neurobiology to guide research in treatment development. "Engage" is an example of such a streamlined therapy for latelife depression.…”