BEHAVIORAL ANALYSIS THERAPY OF FEELINGS AND MORAL THEORY OF MIND: CONCEPTUAL AND METHODOLOGICAL DEVELOPMENT FOR RESEARCH IN PSYCHOTHERAPY
Depression; Decision-Making; Psychotherapy; Biomarkers; Randomized Controlled Trial; Normativity.
Although substantial evidence supports the effectiveness of different psychotherapies for the treatment of depression and anxiety, important gaps remain regarding the understanding of therapeutic mechanisms of change and the associated biological processes. The general objective of this dissertation was to develop a protocol for testing a novel psychotherapy, termed Behavioral Analysis Therapy of Feelings (BAFT), as well as to develop its theoretical foundations, culminating in the initial proposition of the Moral Theory of Mind (TMM). To accomplish this development, the dissertation was based on the integration of scientific evidence from neuroscience, biology (allostasis), medicine, psychology, phenomenological philosophy, and moral philosophy. These interdisciplinary foundations guide the development of the new psychotherapy, which will be evaluated in a clinical trial.To achieve this objective, three scientific products were developed: (1) a conceptual article (Article 1); (2) a clinical trial protocol (Article 2); and (3) a systematic review protocol (Article 3). Each article was developed according to its specific methodological framework. The conceptual article (Article 1) presents the initial development of an integrated account of the Moral Theory of Mind through an isomorphic approach, defined as an underlying structural organization shared across different explanatory levels. The central thesis is that moral cognition is structured as a system expressed at the phenomenological, neurocognitive, and metaethical levels, understood not as distinct ontological domains but as different manifestations of a single organizing structure. Accordingly, morality is proposed to possess a common structural basis expressed through three complementary perspectives: the lived experience of morally significant situations (phenomenological level), the mental and neural processes involved in moral evaluation (neurocognitive level), and philosophical reflection on the nature of morality (metaethical level). These levels do not represent independent entities but rather different manifestations of the same underlying structural architecture expressed across different levels of explanation. The Moral Theory of Mind provides the theoretical foundation of BAFT and requires an integrative explanatory model. It proposes a phenomenological descriptive-reflective mode of apprehending moral orientation, integrated with self-regulatory processes, as an organizing dimension of human experience. It articulates affectivity, rationality, and individual moral identity, contributing to the constitution of meaning and purpose in life. The clinical trial protocol (Article 2) synthesized relevant evidence regarding methods for assessing anxiety and depression, including DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision) diagnostic criteria, clinical rating scales, biomarkers, and sleep quality measures. The clinical trial was registered in the Brazilian Registry of Clinical Trials (RBR-10p45rdg), received the Universal Trial Number (UTN) U1111-1313-4499, and was developed in accordance with the SPIRIT 2025 guidelines. In addition, a comprehensive supplementary manual was developed to facilitate replication in future studies, including the theoretical rationale, the proposed mechanism of action, the procedural framework, and the intervention phases of the new psychotherapy. The systematic review protocol (Article 3) was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420261410390) and developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. This systematic review protocol aims to establish the methodology for the future synthesis of evidence from randomized controlled trials investigating the effects of Cognitive Behavioral Therapy (CBT) on biomarker levels and clinical outcomes in individuals with depression. Specifically, it will identify the biomarkers most frequently assessed, evaluate the effects of CBT on biomarker levels and clinical outcomes, and investigate whether biomarker changes are consistently associated with improvements in depressive symptoms. The research question follows the PICOS framework: in individuals with depression (Population), does Cognitive Behavioral Therapy (Intervention), compared with other non-pharmacological interventions (Comparator), result in differences in biomarkers and clinical outcomes (Outcomes)?