The stress–reward–mentalizing model of depression: An integrative developmental cascade approach to child and adolescent depressive disorder based on the Research Domain Criteria (RDoC) approach

Abstract

The Research Domain Criteria (RDoC) propose a much-needed change in approach to the study of vulnerability factors implicated in mental disorders, shifting away from a categorical, disease-oriented model to a dimensional approach that focuses on underlying systems implicated in psychopathology. In this paper we illustrate this approach with a focus on the emergence of depression in childhood and adolescence. Based on evolutionary biological and developmental psychopathology considerations, we present an integrative developmental cascade model of depression that essentially suggests that depression emerges out of a three-pronged series of interacting impairments in the domains of stress regulation, reward, and mentalizing. We discuss the relation of these impairments to the five domains proposed by RDoC. We also focus on how this model may explain in large part the marked comorbidity of depression with other psychiatric disorders, as well as with functional somatic and somatic disorders. Limitations of this theoretical approach are discussed, as well as implications for the development, evaluation, and dissemination of interventions aimed at preventing or treating depression.

Molecular mechanism of reward treatment ameliorating chronic stress-induced depressive-like behavior assessed by sequencing miRNA and mRNA in medial prefrontal cortex

“…Research suggests that major depressive disorder emerges out of a three-pronged series of interacting impairments in the domains of stress regulation, reward and mentalizing [53]. The motivation induced by reward can effectively promote individual's emotional regulation ability [54], and lack of rewards in life can cause the brain's reward circuits to be not sufficiently activated or actively used, which may reduce the function of the brain's reward circuits [7,8].…”

Examining the Influence of Early Life Stress on Serum Lipid Profiles and Cognitive Functioning in Depressed Patients

“…There is some evidence that MDD with ELS reacts much better to cognitive behavioral therapy (Nemeroff et al, 2003; Niciu et al, 2015) or interpersonal therapy (Zobel et al, 2011) than to pharmacotherapy. Psychodynamic therapies, as well as mentalizing-based therapy, can also be beneficial for MDD patients with ELS (Alessi and Kahn, 2017; Luyten and Fonagy, 2018). Our data emphasize the importance of the screening for ELS in the clinical MDD population.…”

“…Recent psychodynamic theories focus on the role of the attachment and attachment-based mentalizing capacities in the etiology and treatment of depressive disorders, and in the development of somatic disorders in individuals with ELS. Adopting a developmental approach, Luyten and Fonagy (2018) emphasized that ELS can lead to insecure attachment that impairs adaptation to stressful social situations and disrupts the regulation of the stress response. If social stress emerges, hypermentalizing and hypomentalizing can occur on the basis of the insecure attachment.…”

Psychotherapy and Genetic Neuroscience: An Emerging Dialog

“…In any case, the RDoC initiative represents an opportunity for research in the study of vulnerability factors involved in mental disorders and hence in a mechanism-based psychotherapy ( Hershenberg and Goldfried, 2015 ; Luyten and Fonagy, 2017 ). The point of view of the RDoC initiative can shed new light on the ‘paradox of equivalence’ in psychotherapy research ( Stiles et al, 1986 ): the so called ‘Dodo bird verdict’ ( Luborsky et al, 1975 ), according to which ‘all psychotherapies have won, all are better than no treatment, but none has shown superiority over other.’ Wampold and Imel (2015) holds that the medical model in psychotherapy, defined as the assumption that the efficacy of psychotherapy is due to specific methods for the treatment of specific problems, has failed to explain the evidence that research has accumulated over more than half a century.…”