A model for streamlining psychotherapy in the RDoC era: the example of ‘Engage’
Open accessAbstract
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. 'Engage' is an example of such a streamlined therapy. It targets behavioral domains of late-life depression grounded on RDoC constructs using efficacious behavioral strategies selected for their simplicity. 'Reward exposure' targeting the behavioral expression of positive valence systems' dysfunction is the principal therapeutic vehicle of 'Engage'. Its first three sessions consist of direct 'reward exposure', but the therapists search for barriers in three behavioral domains, that is, 'negativity bias' (negative valence), 'apathy' (arousal) and 'emotional dysregulation' (cognitive control), and add strategies targeting these domains when needed. The end result is a structured, stepped approach using neurobiological constructs as targets and as a guide to personalization. We argue that the 'reduction' process needed in order to arrive to simplified effective therapies can be achieved in three steps: (1) identify RDoC constructs driving the syndrome's psychopathology; (2) create a structured intervention utilizing behavioral and ecosystem modification techniques targeting behaviors related to these constructs; (3) examine whether the efficacy of the new intervention is mediated by change in behaviors related to the targeted RDoC constructs.
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ENGAGE therapy has been the first attempt to streamline psychotherapy for LLD using neurobiological constructs.
“ENGAGE therapy has been the first attempt to streamline psychotherapy for LLD using this approach170.”
From Mechanisms and treatment of late-life depression (2019) · cites this paper as [170]
Engage aims to systematically address disengagement from participation in pleasurable activities in a structured approach by incorporating reward exposure and addressing barriers in 3 behavioral domains: negativity bias, apathy, and emotional dysregulation.
“An example is the streamlined, evidence-based psychotherapeutic strategy called Engage [7], which aims to systematically address disengagement from participation in pleasurable activities in a structured approach by incorporating reward exposure and addressing barriers in 3 behavioral domains: negativity bias, apathy, and emotional dysregulation.”
From Behavioral Activation and Depression Symptomatology: Longitudinal Assessment of Linguistic Indicators in Text-Based Therapy Sessions (2021) · cites this paper as [7]
Dysfunction of reward networks, especially in reward valuation, effort valuation, action selection, preference-based decision making, and reward learning, is a central process perpetuating depression.
“Neurobiological findings suggest that dysfunction of reward networks (especially in reward valuation, effort valuation, action selection, preference-based decision making, and reward learning) is a central process perpetuating depression [7,8].”
From Behavioral Activation and Depression Symptomatology: Longitudinal Assessment of Linguistic Indicators in Text-Based Therapy Sessions (2021) · cites this paper as [7]
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Self-citation
- Authors
- Alexopoulos, G. S., & Arean, P.
- Affiliations
- Cornell University (US)
- Corresponding author
- Alexopoulos, G S
- ORCID
- Alexopoulos, G S
- Venue
- Molecular Psychiatry
- Published
- 2013-11-26
- Volume
- 19
- Issue
- 1
- Pages
- 14-19
- ISSN
- 1359-4184 (ISSN-L)
- 1476-5578
- PMC
- PMC4337206
- OpenAlex
- W2092676606
- Cited by
- 95
- References
- 86
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 5 · 2023: 6 · 2022: 8 · 2021: 15 · 2020: 9 · 2019: 7 · 2018: 5 · 2017: 10 · 2016: 8 · 2015: 3 · 2014: 10
- FWCI
- 1.03
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Molecular Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH075900, R01MH075897, P30MH085943, MH074717, R01MH075900, R01MH102304, MH077192, K24MH074717, R01MH102252, R24MH077192)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- Research Domain Criteria, geriatric depression, negativity bias, apathy, emotional dysregulation, personalized treatment, behavior change, positive valence systems, negative valence, arousal, cognitive control, community clinicians
- MeSH terms
- Mental Disorders, Behavioral Symptoms, Humans, Models, Psychological, Psychotherapy, Biomedical Research
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