Pre-print published: Clinicians' perspectives on evolutionary explanations of anxiety

Our new pre-print was recently published!

“Our  findings  represent  the  most  robust  evidence  to  date  that  evolutionary  psychiatry  offers normalising  causal  stories  with  various  positive  effects,  in  this  case  by  casting  anxiety  as  a calibrated defence system that can overshoot in contemporary contexts.”

This was a mammoth effort: a multi-year, multi-site experiment, with 19 sessions across the UK and Ireland. 171 practicing mental health clinicians received a 30-minute educational presentation on either evolutionary or genetic explanations for anxiety.

Presentations were derived in a standardised manner from a genetics review paper by Ask et al. and a chapter by @RandyNesse. Educators were psychiatrists-in-training, blinded to study design - including the questionnaires given to participants.

The chapter by Nesse (2022, in 'Evolutionary Psychiatry: Current Perspectives on Evolution and Mental Health')

The paper by Ask at al. (2021, Psychological Medicine)

We pre-registered seven primary hypotheses: on clinicians’ optimism regarding patient recovery, the efficacy of psychosocial interventions, expected patient willingness to share diagnoses and engage in help-seeking behavior, and the perceived usefulness of the information.

Results were resoundingly positive: For example, compared to the genetic explanation, clinicians rated the evolutionary explanation as substantially more useful for patients (Odds Ratio [OR] = 5.05) and for clinicians (OR = 3.10]). These showed very large mean effect sizes, of 1.07 SD and 0.76 SD!

In comparison to the genetic explanation, the evolutionary explanation led to a more positive response than the genetics explanation on every single one of the measures we pre-registered as our primary hypotheses!

In exploratory analysis we discovered that most of these pre-post effects were driven by the positive effect of evolutionary education; although evolutionary education actually had a small negative pre-post effect on expected efficacy of psychosocial intervention – but genetics was worse.

Here you can see the raw data plotted for 6 of our primary hypotheses:

We asked other questions which we didn’t pre-register as primary hypotheses – about expected effectiveness of combined medication and psychotherapy, individual’s role to control anxiety, unchangeability of symptoms and depth of understanding anxiety disorder.

These effects derived from more mixed pre-post dynamics – although the evolutionary arm was repeatedly stronger than genetics (an aside: the unchangeability measure was -more- unchangeable, so perhaps aligning with the negative pre-post impact on psychosocial intervention)  

In conclusion: it’s long been recognised that how mental disorders are explained shapes both public and professional attitudes. Preferred explanatory frameworks for mental disorder are often a matter of taste and trend – differing between individuals, disciplines, cultures and generations, with many alternative framings being scientifically compatible.

Our research demonstrates that evolutionary explanations of anxiety are rated highly positively by clinicians in comparison to genetics education – yet genetics is a core part of clinical curriculums, and evolutionary perspectives are absent.

This provokes serious consideration: the curriculum should be designed to best serve both clinicians and the patients they care for.

Thanks to all the psychiatrists involved in the study, particularly the educators – and most of all, my co-first author, Tom Carpenter, who was the man on the ground organising sessions in the UK whilst I was in Switzerland!

The full pre-print is available here: https://osf.io/preprints/psyarxiv/4kwrb_v2

And a podcast episode discussing some of the results is here (and on podcast players): https://youtu.be/rf6x7IyXf74