Table 1.

Recommendations for future research.

(1) It is necessary to consider that epigenetic modifications are influenced by multiple environmental variables (such as exercise, diet, or drug use) that may interfere with the assessment of changes produced by psychotherapy.

(2) Because epigenetic changes can vary over a lifetime and even be reverted, long-term studies incorporating a life-cycle approach would be useful.

(3) In addition, it would be interesting to determine the specificity of epigenetic change in psychotherapy. For that purpose, it will be necessary to define and justify with precision both the expected epigenetic changes and the environmental factors that will be studied, describing the psychobiological model in which they are included.

(4) It may be useful to study intermediate phenotypes or endophenotypes such as certain cognitive attributes, personality traits, or the functioning of differentiated neurobiological systems.

(5) It is also necessary to conduct studies with adequate explanatory power, with advance registration of target genes and analysis strategies, and with a focus on transdiagnostic domains of functioning.

(6) Research should incorporate models of “plasticity” and “differentiated susceptibility” in order to measure not only the presence/absence of disease or vulnerability to the environment, but also the potential moderating influence of positive factors such as social support or subjective well-being.

(7) Finally, we highlight the need for multilevel studies that include complex relationships between variables (gene–gene, gene–environment, gene–culture).