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Adverse childhood experiences (ACE) are associated with negative psychological consequences later in life, for both the victims and their children. The present study examines the links between parents’ ACE and psychological outcomes in their adult children. A sample of 162 participants from 54 intact families with adult children was evaluated for ACE history and current mental health. Results showed that ACE was a predictor of mental health for all the participants, explaining 31.2% of the variance. Furthermore, parents’ ACE, negative parenting, and parents’ marital satisfaction had a significant influence on their adult children’s mental health. The results also showed that fathers’ ACE are associated with negative parenting, as well as their adult children’s ACE and self-reported psychopathological symptoms. These results point to the importance of examining multiple familial factors in the development of psychopathology in young adults. Limitations of the study are also presented.

This research report describes the development of a virtual reality (VR) laboratory stressor to study the effects of exposure to stressful events. The aim of the research was to develop a VR simulation that would evoke stressor responses at a level that was tolerable for participants. Veterans with and without warzone-related posttraumatic stress disorder (PTSD) were presented with VR simulations of combat stressors. There was one complaint of feeling hot during simulations but no incidents of simulator sickness. Participants denied experiencing the simulations as overly distressing, and there were no reports of any distress or problems related to study participation when they were contacted two weeks after the VR challenge. Simulations elicited moderate levels of anxiety and mild levels of dissociation that were significantly greater in Veterans with PTSD. Simulations were less successful in eliciting differential heart rate reactivity and stress hormone secretion, though history of civilian trauma exposure was associated with elevated heart rates during the second simulation. The study demonstrated that the VR paradigm was feasible and tolerable and that it holds promise as a new method with which to conduct controlled laboratory research on the effects of exposure to stressful events.

This chapter presents some ethical challenges in evolutionary therapies, such as working with religious patients or with patients of various sexual orientations, as well as strategies of selecting fitness goals that are both appropriate for a patient and free of conflict with societal norms.

Evolutionary psychotherapies stem directly from the tenets of evolutionary psychology. As such, a therapist who is providing this kind of interventions must be well versed in the theoretical aspects of evolutionary psychology. Conversely, the main methods used in Cognitive Evolutionary Therapy for Depression are those also used in CBT and, as such, a therapist with experience in CBT might find it easier to adapt than one specialized in other therapeutic approaches. This chapter presents several aspects specific to Cognitive Evolutionary Therapy that clinicians should be aware of in therapy.

Currently, there are many efficient treatments of depression, among which the most widely used are: (1) Cognitive Behavioral therapy, (2) Mindfulness-based Cognitive Therapy, (3) Behavioral Activation, and (4) Interpersonal Psychotherapy. This chapter briefly presents the theoretical underpinning and merits of these approaches.

A Rwandan man once described the Rwandan treatment for depression to the 2001 National Book Award winner Andrew Solomon in these words: “You know, we had a lot of trouble with Western mental health workers, especially the ones who came here right after the genocide. They came and their practice did not involve being outside in the sunshine… which is, after all, where you begin to feel better. There was no drumming or music to get your blood flowing again – when you’re depressed and low you need to have your blood flowing. There was no sense that everyone had taken the day off so that the entire community could come together to lift you up and bring you back to joy. There was no acknowledgement of the depression as something invasive and external that could actually be cast out of you again. Instead, they would take people one at a time into these dingy little rooms and have them sit around for an hour or so to talk about bad things that had happened to them. We had to ask them to leave the country.”While this description of a psychological intervention for depression is in stark contrast with the standard weekly therapy sessions so common in the Western cultures, it would not make an evolutionary therapist surprised. This chapter presents the theoretical underpinnings of Cognitive Evolutionary Therapy for Depression and the differences between it and Cognitive Therapy.

In this chapter we present a structured therapy protocol of Cognitive Evolutionary Therapy for Depression. It is based on a protocol tested in a randomized clinical trial that compared it to Cognitive Therapy for Depression, but expands on it by incorporating, besides specific cognitive techniques, elements specific to Rational Emotive Behavior Therapy.

Evolutionary psychopathology is the evolutionary discipline that attempts to understand and explain the causes of mental disorders from an evolutionary perspective. Evolutionary psychology and evolutionary psychopathology start from the foundation of a universal human nature and converge on two principles: (1) that there is a universal human nature that has evolved through natural selection, and (2) that some modern environments are toxic and damaging, given our evolved nature. . This chapter presents several evolutionary explanations of depression along with the efforts of incorporating them into psychological interventions.

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.

The study examined a circumscribed class of cognitions (i.e., dispositional optimism and perceived consequences) in connection to the emotional distress experienced in anticipation of a major seismic event (i.e., pre-hazard emotional distress). Grounded on cognitive-behavioral theory, it was argued that dispositional optimism exerts distal influence on distress, while the perceived consequences of a major seismic event are proximal to distress and, therefore, interpose the optimism-distress relationship. The hypothesis was tested via a cross-sectional study on a sample of 189 volunteers located in areas of high seismic hazard. Participants reported their level of pre-hazard emotional distress, their dispositional optimism, and their perceived consequences of a major seismic hazard. The results showed that there was a partial indirect effect from dispositional optimism to emotional distress via perceived consequences, indirect effect = −0.190, SE = 0.114, 95 % CI [−0.487; −0.021], k2 = 0.051. These findings could inform future prevention programs targeting emotional distress in anticipation of a natural hazard with impact on post-disaster recovery.

Background Depression has become one of the leading contributors to the global disease burden. Evidence-based treatments for depression are available, but access to them is still limited in some instances. As technology has become more integrated into mental health care, computerized cognitive behavioral therapy (CBT) protocols have become available and have been recently transposed to mobile environments (e.g., smartphones) in the form of “apps.” Preliminary research on some depression apps has shown promising results in reducing subthreshold or mild to moderate depressive symptoms. However, this small number of studies reports a low statistical power and they have not yet been replicated. Moreover, none of them included an active placebo comparison group. This is problematic, as a “digital placebo effect” may explain some of the positive effects documented until now. The aim of this study is to test a newly developed mobile app firmly grounded in the CBT theory of depression to determine whether this app is clinically useful in decreasing moderate depressive symptoms when compared with an active placebo. Additionally, we are interested in the app’s effect on emotional wellbeing and depressogenic cognitions. Methods/design Romanian-speaking adults (18 years and older) with access to a computer and the Internet and owning a smartphone are included in the study. A randomized, three-arm clinical trial is being conducted (i.e., active intervention, placebo intervention and delayed intervention). Two hundred and twenty participants with moderate depressive symptoms (i.e., obtaining scores >9 and ≤16 on the Patient Health Questionnaire, PHQ-9) will be randomized to the three conditions. Participants undergoing therapy, presenting serious mental health problems, or legal or health issues that would prevent them from using the app, as well as participants reporting suicidal ideation are excluded. Participants randomized to the active and placebo interventions will use the smartphone app for 6 weeks. A short therapist check-in via phone will take place every week. Participants in the delayed-intervention condition will be given access to the app after 6 weeks from randomization. The primary outcome is the level of depressive symptomatology. The intervention delivered through the app to the active condition includes psychoeducational materials and exercises based on CBT for depression, while the placebo intervention uses a sham version of the app (i.e., similar structure of courses and exercises). Discussion To our knowledge, this study protocol is the first to test the efficacy of a smartphone app for depressive symptomatology in the form of a randomized controlled trial (RCT) that includes an active placebo condition. As such, this can substantially add to the body of evidence supporting the use of apps designed to decrease depression. Trial registration ClinicalTrials.gov, identifier: NCT03060200. Registered on 1 February 2017. The first participant was enrolled on 17 February 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1960-1) contains supplementary material, which is available to authorized users.

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.

Objective The objective of the present study was to examine the associations between sleep disturbance, posttraumatic stress disorder (PTSD), and functional disability in a population exposed to a singular traumatic event. Method The participants were a population of 2,453 predominantly male utility workers who were deployed to the World Trade Center site in the aftermath of the 9/11 attack. They underwent psychiatric screenings comprising measures of sleep disturbance, PTSD, and functional disability. Results Analyses indicated that (a) rates of sleep disturbances were significantly higher among participants diagnosed with PTSD than those without, (b) PTSD severity was significantly associated with sleep disturbance, and (c) sleep disturbance moderated the relationship between PTSD and disability. Conclusion Sleep disturbance is associated with occupational, social functioning, and PTSD severity, suggesting that ameliorating sleep may lead to increased occupational and social functioning, as well as better treatment responses in PTSD.

The present study examined the associations between a high-K (slow) life history strategy and depressive symptomatology. The participants were a sample of 494 male utility workers who underwent psychological evaluations. It was hypothesised that high-K will correlate negatively with, and will be a negative predictor of, depressive symptomatology. The results confirmed the predictions, showing that high-K accounts for 15% of the variance in depressive symptomatology after controlling for risk factors for depression such as demographics, prior traumatic experiences, past depression, and recent negative life events. Implications of the results are discussed.

Empirical evidence suggests that social and occupational disability plays a significant role in posttraumatic stress disorder (PTSD). The purpose of this study was to assess the role of social/occupational disability and to identify predictors of the development of PTSD in a group of disaster relief workers (DRWs) who had been deployed to the World Trade Center (WTC) following September 11, 2001. Eight hundred forty-two utility workers completed a battery of comprehensive tests measuring PTSD and social occupational functioning. Results indicated a significant association between PTSD symptoms and impaired social/occupational functioning. Symptomatic workers were also more likely to have a history of trauma, panic disorder, and depression. Those with a history of trauma, depression, generalized anxiety disorder or panic reported significantly more disability than those without a psychiatric history. Careful screening of PTSD and social/occupational functioning in DRWs following a disaster is warranted so that early treatment can be undertaken to prevent a chronic and disabling course.

This prospective longitudinal study examined the ability of re-experiencing, avoidance, numbing, and hyperarousal symptoms to predict persistence of posttraumatic stress disorder (PTSD) in disaster workers followed for 2 years. Cluster analyses suggested that overall severity was the best predictor of PTSD at follow up, but for groups with PTSD of moderate severity, numbing symptoms were also associated with PTSD at the 2-year follow up. Regression analyses with all four symptom groups as independent variables found that only numbing and re-experiencing symptoms predicted PTSD at the 1 year follow up, and only numbing symptoms predicted PTSD at the 2-year follow up. Findings suggest that numbing symptom severity could be used as a risk index of very chronic PTSD, especially when the overall PTSD severity falls in the moderate range.

Objective: This preliminary study endeavored to evaluate the use of virtual reality (VR) enhanced exposure therapy for the treatment of posttraumatic stress disorder (PTSD) consequent to the World Trade Center attacks of September 11,2001. Method: Participants were assigned to a VR treatment (N = 13) or a waitlist control (N = 8) group and were mostly middle-aged, male disaster workers. All participants were diagnosed with PTSD according to DSM-IV-TR criteria using the Clinician-Administered PTSD Scale (CAPS). The study was conducted between February 2002 and August 2005 in offices located in outpatient buildings of a hospital campus. Results: Analysis of variance showed a significant interaction of time by group (p

This study examined male utility disaster workers' responses to referral for trauma-specific psychotherapy. Among 328 workers offered referral for symptoms related to the World Trade Center (WTC) attacks during psychological screening, approximately 48% chose to accept, 28% chose to consider only, and 24% chose to decline. Analyses examined predisposing factors, i.e., age, race/ethnicity, marital status, education, previous mental health treatment, and previous disorder; as well as illness level; i.e., posttraumatic stress disorder (PTSD), depression, and general psychiatric distress; current treatment; and time of referral as predictors of referral response. PTSD (specifically reexperiencing and hyperarousal symptoms), depressive symptoms, and previous mental health treatment were positively associated with workers' accepting referral. Implications and limitations of these findings are discussed.

Lay concepts of ‘mental disorder’ were investigated in three countries (U.S.A., Romania and Brazil). Participants judged whether a sample of conditions – some falling inside and some outside the borders defined by DSM-IV – were mental disorders, and rated them on features invoked in professional understandings of ‘mental disorder.’ The concept of mental disorder was considerably more inclusive and convergent with the DSM-IV in the American sample than in the Brazilian sample, and disorder judgments showed only moderate agreement across cultures. Several features of the concept were culturally distinctive, amounting to a more ‘internalist’ or intrapsychic understanding in the American sample.

While anger is an important feature of posttraumatic stress disorder (PTSD) it is unclear whether it is simply concomitant or plays a role in maintaining symptoms. A previous study of disaster workers responding to the terrorist attacks of September 11, 2001 (Evans et al., 2006) indicated that those with PTSD evidenced more severe anger than those without. The purpose of this study was to conduct a one-year follow-up to assess the role of anger in maintaining PTSD. Workers with PTSD continued to report more severe anger than those without; there were statistically significant associations between changes in anger, PTSD severity, depression, and psychiatric distress. Multiple regression analysis indicated initial anger severity to be a significant predictor of PTSD severity at follow-up, which is consistent with the notion that anger maintains PTSD. One implication is that disaster workers with high anger may benefit from early intervention to prevent chronic PTSD.

Depression 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. Romanian-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. This 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. Current Controlled Trials ISRCTN64664414 The trial was registered in June 2013. The first participant was enrolled on October 3, 2012.

This study examined the long-term mental health outcomes of 2,960 nonrescue disaster workers deployed to the World Trade Center site in New York City following the September 11, 2001 (9/11) terrorist attacks. Semistructured interviews and standardized self-report measures were used to assess the prevalence of posttraumatic stress disorder (PTSD) and other psychopathology 4 and 6 years after the attacks. Clinician-measured rates of PTSD and partial PTSD 4-years posttrauma were 8.4% and 8.9%, respectively, in a subsample of 727 individuals. Rates decreased to 5.8% and 7.7% for full and partial PTSD 6 years posttrauma. For the larger sample, self-report scores revealed probable PTSD and partial PTSD prevalence to be 4.8% and 3.6% at 4 years, and 2.4% and 1.8% at 6 years. Approximately 70% of workers never met criteria for PTSD. Although PTSD rates decreased significantly over time, many workers remained symptomatic, with others showing delayed-onset PTSD. The strongest predictors of ongoing PTSD 6 years following 9/11 were trauma history (odds ratio (OR) = 2.27, 95% confidence interval (CI) [1.06, 4.85]); the presence of major depressive disorder 1-2 years following the trauma (OR = 2.80, 95% CI [1.17, 6.71]); and extent of occupational exposure (OR = 1.31, 95% CI [1.13, 1.51]). The implications of the findings for both screening and treatment of disaster workers are discussed.

Background: Recent attention has begun to be focused on the effects of disaster recovery work on nonrescue workers. The goal of this study was to assess the prevalence and predictors of posttraumatic stress disorder (PTSD) and related symptoms in a population of utility workers deployed to the World Trade Center (WTC) site in the aftermath of 9/11. Methods: Utility workers deployed to the WTC site were screened at their place of employment between 10 and 34 months following the WTC attacks, utilizing both structured interviews and self-report measures. PTSD symptoms were assessed by the CAPS and the PCL; co-morbid disorders were also assessed. 2,960 individuals with complete CAPS and PCL data were included in the analyses. Results: Eight percent of participants had symptoms consistent with full PTSD, 9.3% with subthreshold PTSD, 6% with MDD, 3.5% with GAD, and 2.5% with panic disorder. Although risk factors included psychiatric and trauma history, 51% of individuals with probable PTSD had neither; subjective perception of threat to one's life was the best predictor of probable PTSD. Extent of exposure predicted 89% of PTSD cases in those without a psychiatric or trauma history, but only 67% of cases among those with both. Conclusions: Nonrescue workers deployed to a disaster site are at risk for PTSD and depression. Extent of exposure affected the most vulnerable workers differently than the least vulnerable ones. These results suggest that the relationship among predictors of PTSD may be different for different vulnerability groups, and underscore the importance of screening, education, and prevention programs for disaster workers. Depression and Anxiety 0:1-8, 2010. © 2010 Wiley-Liss, Inc. Language: en

This study examined the associations between a high-K fitness strategy and mental health. These associations were tested on a sample of 1400 disaster workers who had exposure to a singular traumatic event and who underwent psychological evaluations. The results showed that high-K was an important negative predictor of psychopathology, accounting for significant variance in PTSD, general psychopathology, functional disability, anger, and sleep disturbances. Implications of the results are discussed.

The present study examined the relationships between memories for a single incident traumatic event – the 9/11 attack on the World Trade Center (WTC) – and posttraumatic stress disorder (PTSD). 2641 disaster restoration workers deployed at the WTC site in the aftermath of the attack were evaluated longitudinally, one year apart, for PTSD, using clinical interviews. Their recollection of the traumatic events was also assessed at these times. The results showed that recall of traumatic events amplified over time and that increased endorsement of traumas at Time 2 was associated with more severe PTSD symptoms. It was also shown that, of all the exposure variables targeted, memory of the perception of life threat and of seeing human remains were differentially associated with PTSD symptoms. Implications of the results are also discussed.

Empirical evidence suggests that anger plays a significant role in posttraumatic stress disorder (PTSD) and may impede recovery from traumatic events. The purpose of this study was to assess the role of anger and its relationship to distress and social/occupational functioning in disaster relief workers (DRWs) who had PTSD symptoms who were deployed to the World Trade Center after September 11, 2001. Six hundred twenty-six utility workers (96% male) completed measures of anger, distress, PTSD severity, and social/occupational functioning. Results indicated that anger was significantly higher in DRWs who had PTSD symptoms than in those who did not, and statistically significant associations were found among anger, distress, PTSD severity, and social/occupational functioning in workers who had PTSD symptoms. Careful assessment of anger in DRWs exposed to traumatic events is warranted as well as longitudinal studies to further understand the relationship between anger and PTSD.

Recent research suggests that virtual reality (VR) enhanced exposure therapy may enhance the efficacy of treatment through increasing patient engagement in the exposure. This study evaluated the use of VR in the treatment of PTSD following the WTC attack of September 11, 2001. Individuals in a 14 session VR-enhanced treatment (n=9) were compared to a waitlist (WL) control group (n=8). ANOVA showed a significant interaction of time by group (p