Two Group Therapies for Adults with Major Depressive Disorder

AI summary

From the trial's eligibility criteria. Machine-read from the registry text on this page, so it can be wrong. The registry text below and the trial team decide who can take part.

The trial is looking for adults with current major depression who can attend group therapy twice a week for 5 weeks. It compares two new group therapies with a waiting list.

Age

18 to 80 years

Sex

All sexes can join.

Disease stage

Current major depressive disorder confirmed by a structured clinical interview, with a Hamilton Depression Rating Scale (HAMD-21) score of 9 or more.

Earlier treatment

People cannot join if they are in ongoing psychotherapy or started a new antidepressant medication within the past 4 weeks.

Main reasons for not taking part

• Bipolar disorder, psychotic disorder, or primary substance use disorder, now or in the past
• High acute suicide risk that needs immediate help
• Severe neurological disorder or brain injury
• Not able to have an MRI scan (for example metal implants or claustrophobia)
• Not enough German to take part in therapy and assessments

The registry criteria, word for word

Check if you might fit

Answer for yourself. This is not a decision: only the study team can say whether you can take part.

• Are you between 18 and 80 years old?YesNo

What the trial wants to find out

Major depressive disorder (MDD) is one of the most common psychiatric conditions and often remains difficult to treat effectively. Many patients continue to experience residual symptoms or relapse even after receiving established forms of psychotherapy. This study tests whether targeting specific psychological mechanisms can improve outcomes for people with depression. We compare two novel group therapies: (1) Expectation-Focused Psychotherapeutic Intervention (EFPI), which aims to modify rigid, negative expectations that maintain depressive symptoms, and (2) Reward Enhancement and Activation Therapy (REACT), which focuses on increasing sensitivity to positive experiences and strengthening reward-related learning. Both are delivered in a group format to foster peer support and shared learning.

The 3 groups in the trial

• Expectation-Focused Psychotherapeutic Intervention (EFPI)Treatment being tested

  Participants receive 10 group therapy sessions (2 sessions per week over 5 weeks) of EFPI, a mechanism-based psychotherapy targeting maladaptive expectations. The intervention combines psychoeducation, structured behavioral experiments, and cognitive restructuring to systematically challenge negative expectations. A central focus is reducing cognitive immunization-the tendency to dismiss or reframe positive disconfirming evidence-to foster more flexible and adaptive belief updating. Sessions are conducted in small groups (5-10 participants) to facilitate peer modeling, social reinforcement, and shared learning. The first session includes baseline clinical assessments, and the final session includes immediate post-treatment assessments. All participants are additionally followed up at 3 and 6 months after the intervention to evaluate the persistence of treatment effects.

  Treatment: Expectation-Focused Psychotherapeutic Intervention

• Reward Enhancement and Activation Therapy (REACT)Treatment being tested

  Participants receive 10 group therapy sessions (2 sessions per week over 5 weeks) of REACT, a mechanism-based psychotherapy designed to enhance reward sensitivity. Core intervention components include attentional retraining toward rewarding stimuli, savoring exercises to prolong positive affect, and structured reinforcement plans to strengthen motivation and engagement in rewarding activities. Group discussions normalize difficulties in experiencing pleasure and provide strategies for sustaining rewarding behavior long-term. Sessions are conducted in small groups (5-10 participants). The first session includes baseline assessments, and the final session includes immediate post-treatment assessments. Long-term outcomes are assessed through follow-up evaluations at 3- and 6-months post-intervention.

  Treatment: Reward Enhancement and Activation Therapy

• Waiting-List ControlNo study treatment, for comparison

  Participants assigned to the waiting-list control condition do not receive active treatment during the initial 3-month period. They complete baseline assessments at study entry and a follow-up assessment after 3 months, corresponding to the time frame of the active intervention arms. After the 3-month assessment, participants are ethically permitted to pursue standard care outside the study. For comparability and long-term analyses, waiting-list participants continue to complete follow-up assessments at 6 months, including questions about any additional treatments received after the waiting-list phase.