First major RCT on evolutionary psychiatry finds mental health clinicians are five times more likely to say describing anxiety as an evolved survival response will help patients, compared to genetic ideas taught in training.
If GPs are swamped by anxiety-related appointments, evolutionary ideas may help treat people concerned for their wellbeing who don't necessarily need medicalisation.
Dr Adam Hunt
Mental health clinicians are over five times more likely to see evolutionary explanations of anxiety as helpful for their patients, rather than the genetic approaches currently taught to trainee doctors and psychiatrists in the UK and US, a new study shows.*
Research led by the University of Cambridge also found that clinicians across the UK and Ireland are three times more likely to rate a human evolution perspective on anxiety as useful for their own practice and understanding, compared to hereditary accounts.
Explaining how anxiety helped our species to survive and thrive - essentially, a naturally evolved defensive response that can get triggered too easily - provides vital context and a more positive outlook than describing anxiety as possibly "hardwired" into a person's DNA, argue researchers.
They say that anxiety is linked to "ancestral threats": from running out of food to social rejection from early hunter-gatherer tribes. Aspects of the modern world, such as online socialising and constant exposure to news, can "amplify the worry response and push some individuals into the pathological range."
"Anxiety and fear are adaptive responses that evolved to help organisms, including humans, detect and avoid potential threats," said Dr Adam Hunt, a researcher in evolution from Cambridge's Department of Archaeology who led the study, published in the British Journal of Psychiatry.
"Understanding anxiety as a deeply rooted survival function that has overshot the mark helps patients see their symptoms as exaggerated versions of a positive mechanism, and not evidence of a broken or abnormal brain."
In an accompanying report by the Foundation for Evolution and Mental Health, chaired by Hunt, experts call for a few hours of evolutionary teaching to be added to psychiatric and mental health training, along with public resources that outline the evolutionary usefulness of anxiety.
"With the growth of mental health diagnoses in recent years, the question becomes ever more pressing as to why these conditions exist," said Hunt, from the Evolution, Mental Health and Behaviour Lab.
"Neuroscientists spend billions of dollars zooming in on genes and rat brains. The assumption that the right level of magnification will provide answers hasn't been working out. Evolution, the fundamental theory which explains all biology, is an obvious place to look."
"If GPs are swamped by anxiety-related appointments, evolutionary ideas may help treat people concerned for their wellbeing who don't necessarily need medicalisation."
According to the World Health Organisation, 359 million people worldwide lived with an anxiety disorder in 2021, a rise of more than 55% since 1990. A quarter of 16-24-year-olds in England report having a common mental health condition such as anxiety.
For the latest study, an international team of anthropologists and psychiatrists randomly assigned 171 practising mental health clinicians from across the UK and Ireland a 30-minute session on either an evolutionary explanation for anxiety or a genetic one, based on the latest scientific thinking in both fields.**
Pre- and post-session questionnaires assessed clinicians' optimism for how effective they thought each "psychoeducation" intervention was likely to be, and the expected patient willingness to seek help as a result.
Clinicians overwhelmingly favoured evolutionary explanations. They were over five times more likely to find evolution rather than genetics useful for patients, and over three times more likely to believe it would improve their treatment approach.
The clinicians also believed that people would be much more willing to seek psychiatric help if evolutionary explanations were widely known (around 80% higher than for genetic explanations), and were about 60% more likely to think that patients with anxiety could recover when helped by an evolutionary perspective.
"We found a lot of enthusiasm among psychiatrists for the potential of evolutionary ideas to promote more hopeful and therapeutically empowering attitudes," said study co-author Dr Tom Carpenter, a registrar in psychiatry at NHS Greater Glasgow & Clyde.
Importantly, differences between the two groups of clinicians were driven by both positive effects of evolutionary education and negative effects of genetic education.
