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

Next-Generation Cognitive-Behavioral Therapy for Depression: Integrating Digital Tools, Teletherapy, and Personalization for Enhanced Mental Health Outcomes

Background and Objectives: This systematic review aims to present the latest developments in next-generation CBT interventions of digital support tools, teletherapies, and personalized treatment modules in enhancing accessibility, improving treatment adherence, and optimizing therapeutic outcomes for depression. Materials and Methods: This review analyzed 81 PRISMA-guided studies on the efficacy, feasibility, and applicability of NG-CBT approaches. Other important innovations include web-based interventions, AI-operated chatbots, and teletherapy platforms, each of which serves as a critical challenge in delivering mental health care. Key messages have emerged regarding technological readiness, patient engagement, and the changing role of therapists within the digital context of care. Results: Findings indicate that NG-CBT interventions improve treatment accessibility and engagement while maintaining clinical effectiveness. Personalized digital tools enhance adherence, and teletherapy platforms provide scalable and cost-effective alternatives to traditional therapy. Conclusions: Such developments promise great avenues for decreasing the global burden of depression and enhancing the quality of life through novel, accessible, and high-quality therapeutic approaches.

Cognitive evolutionary therapy versus standard cognitive therapy for depression: A single-blinded randomized clinical trial

OBJECTIVE

To compare the efficacy of cognitive evolutionary therapy (CET) with cognitive therapy (CT) for depression.

METHODS

Ninety-seven participants (78 females/19 males) were randomized to a single-blinded controlled trial (CET: n = 51 vs. CT: n = 46). Assessments were conducted at baseline, Sessions 4 and 8, posttreatment, and 3-month follow-up. Clinical diagnoses were made with Structured Clinical Interview for DSM-IV (SCID) and self-reports for depression and secondary outcomes.

RESULTS

Although both groups showed significant reductions in depressive symptomatology, the overall Time × Treatment group interaction in the intent to treat analysis was not significant (p = .770, posttreatment: d = 0.39). However, CET was superior to CT at increasing engagement in social and enjoyable activities (p = .040, posttreatment: d = 0.83, p = .040) and showed greater reductions than the CT group in behavioral inhibition/avoidance (p = .047, d = 0.62). The between-group differences generally diminished at the 3-month follow-up.

CONCLUSIONS

CET is a novel therapy for depression that may add therapeutic benefits beyond those of CT.

Differential Effects of an Evolutionary-Based EMDR Therapy on Depression and Anxiety Symptoms: A Case Series Study

A novel evolutionary-based therapy, treating depression downhill (TDD), was designed as a specific therapy for depression as a syndrome (Krupnik, 2014) and later integrated with eye movement desensitization and reprocessing (EMDR) therapy into a combined TDD-EMDR treatment. The combined therapy integrates modified EMDR procedures into the theoretical context of TDD. These procedures are applied during the second (acceptance) stage of TDD-EMDR’s three-stage proltocol with the focus on acceptance of defeat/failure/loss rather than on distressing memories. Here, we report a case series of 21 military personnel diagnosed with depressive disorders, who received a course of TDD-EMDR. Eighty percent of completers (n= 15) did not meet the criteria of depressive disorder by the treatment’s end. After 12 sessions, they showed a significant reduction on the Beck’s Depression Inventory-II (BDI-II) with a large effect size (d= 2.8) and an increase in accepting disposition (d= 1.8) on the Acceptance and Action Questionnaire. Noncompleters showed similar to completers decrease of BDI-II scores at mid-treatment. We observed no statistically significant decrease of the anxiety symptoms on the Beck’s Anxiety Inventory. These results suggest that TDD-EMDR may be an effective treatment for depressive disorders. They also indicate that it may preferentially target depressive over anxiety symptoms, as was previously observed for TDD. Suggestions are made for future research.

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

We present an intervention in a case of major depression, where eye movement desensitization and reprocessing (EMDR) therapy was integrated into an evolutionary-based psychotherapy for depression. At the end of the treatment and at follow up assessment we observed a more accepting disposition and decreased depressive but not anxiety symptoms.

Integrating EMDR Into a Novel Evolutionary-Based Therapy for Depression: A Case Study of Postpartum Depression

Depression is one of the most common psychiatric disorders. Postpartum depression affects about 9% of women who give birth. Despite significant advances in research and in pharmacotherapy and psychotherapy, depressive disorders remain difficult to treat. The application of eye movement desensitization and reprocessing (EMDR) therapy to depression has lagged behind its applications to trauma-related and anxiety disorders. I present 2 cases of postpartum depression successfully treated with a combined therapy, where EMDR is integrated into a novel therapeutic framework developed specifically for depressive disorders and based on evolutionary theory of depression, treating depression downhill (TDD). In the integrated TDD-EMDR therapy, I have made adjustments to the standard EMDR protocol such that the choice and nature of targets, the cognitive frame, and the objective for change in affect are determined by TDD framework. The described cases demonstrate the treatment process, including the modifications made to the standard EMDR procedures, and the treatment’s outcome. I identify and discuss the differences between theories of EMDR and TDD.

Cognitive evolutionary therapy for depression: a case study

KEY CLINICAL MESSAGE

We present an evolutionary-driven cognitive-behavioral intervention for a moderately depressed patient. Standard cognitive and behavioral therapy techniques focused on the patient's perfectionistic and self-downing beliefs, while novel, evolutionary-informed techniques were used to guide behavioral activation and conceptualize secondary emotional problems related to anger. The treatment reduced depressive symptomatology and increased evolutionary fitness.