Group Therapy for Major Depression: Comparing Expectation-Focused and Reward-Focused Psychotherapy Approaches

NCT07388004 | Recruiting

• 3 other identifiers: PERSPECT CRC393-C0252137961423-272BO
• Study Type: interventional
• Target: 150
• Locations: 1 country
• Sites: 1

Brief Summary

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. A total of 150 adults with a current MDD diagnosis will be randomly assigned to EFPI, REACT, or a waiting-list control. Participants in the intervention groups receive 10 group sessions over five weeks. Waiting-list participants complete baseline and 3-month follow-up assessments before being offered standard treatment options. Clinical outcomes are assessed at baseline, immediately after treatment, and at 3- and 6-month follow-ups (for the intervention groups). Primary outcomes are reductions in depressive symptoms measured by clinician ratings and self-report questionnaires. Secondary outcomes include changes in expectation processes and reward sensitivity. In addition, functional MRI (fMRI) tasks examine brain mechanisms related to expectation updating and reward processing pre- and post-intervention, to help identify neural changes that may underlie symptom improvement. By directly addressing dysfunctional expectations and reduced reward sensitivity, this study seeks to provide evidence for more targeted psychotherapeutic approaches. If successful, the results may support more personalized treatments and better long-term outcomes in MDD.

Conditions

Major Depressive Disorder (MDD)

Keywords

Major Depressive Disorder; Psychotherapy; Group Therapy; Expectation Violation; Reward Sensitivity; Mechanism-Based Intervention; Randomized Clinical Trial

Outcome Measures

Primary Outcomes (1)

• Change in Depressive Symptoms (Beck Depression Inventory-II)

  Change in depressive symptom severity assessed with the Beck Depression Inventory-II (BDI-II), a 21-item self-report questionnaire measuring cognitive, affective, and somatic symptoms of depression. Total scores range from 0 to 63, with higher scores indicating more severe depressive symptoms. The primary endpoint is the change from baseline to post-treatment (5 weeks). Symptom stability and maintenance will be examined at follow-up assessments.

  Baseline, post-treatment (5 weeks), 3-month and 6-month follow-ups

Secondary Outcomes (9)

• Change in Depressive Symptoms (Hamilton Depression Rating Scale, 21-item)

  Baseline and post-treatment (5 weeks)

• Depressive Expectations (Depressive Expectations Scale)

  Baseline, post-treatment (5 weeks), 3-month and 6-month follow-ups

• Hopelessness (Beck Hopelessness Scale)

  Baseline, post-treatment (5 weeks), 3-month and 6-month follow-ups

• Socially Negative Expectations (Social Anxiety-Negative Beliefs Scale, SANB-5)

  Baseline, post-treatment (5 weeks), 3-month and 6-month follow-ups

• Behavioral Activation and Reward Responsiveness (Behavioral Activation System Scale)

  Baseline, post-treatment (5 weeks), 3-month and 6-month follow-ups

Study Arms (3)

Expectation-Focused Psychotherapeutic Intervention (EFPI)

EXPERIMENTAL

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.

Behavioral: Expectation-Focused Psychotherapeutic Intervention

Reward Enhancement and Activation Therapy (REACT)

EXPERIMENTAL

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.

Behavioral: Reward Enhancement and Activation Therapy

Waiting-List Control

NO INTERVENTION

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.

Interventions

Expectation-Focused Psychotherapeutic Intervention BEHAVIORAL

EFPI is a manualized group psychotherapy for major depressive disorder that directly targets maladaptive expectations. The treatment integrates psychoeducation, cognitive restructuring, and behavioral experiments to modify negative expectancies and reduce cognitive immunization, thereby enhancing adaptive expectation updating. Delivery: Group format (5-10 participants), 10 sessions (twice weekly for 5 weeks).

Also known as: EFPI

Expectation-Focused Psychotherapeutic Intervention (EFPI)

Reward Enhancement and Activation Therapy BEHAVIORAL

REACT is a manualized group psychotherapy for major depressive disorder that focuses on enhancing reward sensitivity and motivation. The intervention combines attentional retraining, savoring techniques, and reinforcement-based strategies to increase engagement with rewarding stimuli and experiences. Delivery: Group format (5-10 participants), 10 sessions (twice weekly for 5 weeks).

Also known as: REACT

Reward Enhancement and Activation Therapy (REACT)

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age: 18-80 years
• Current diagnosis of major depressive disorder (MDD) according to DSM-5, confirmed by structured clinical interview (e.g., DIPS)
• Hamilton Depression Rating Scale (HAMD-21) score ≥ 9
• Ability to attend group therapy sessions (2×/week for 5 weeks)
• Ability to undergo MRI scanning (for participants in the fMRI component) Written informed consent

You may not qualify if:

• Current or lifetime diagnosis of bipolar disorder, psychotic disorder, or primary substance use disorder
• High acute suicide risk requiring immediate intervention
• Severe neurological disorder, brain injury, or contraindications for MRI (e.g., metal implants, claustrophobia)
• Ongoing psychotherapy or initiation of a new antidepressant medication within the past 4 weeks
• Insufficient German language proficiency to participate in therapy and complete study assessments
• Cognitive impairment or other conditions interfering with informed consent or study participation

Sponsors & Collaborators

• Philipps University Marburg: lead
• German Research Foundation: collaborator

Study Sites (1)

Philipps-University Marburg

Marburg, Hesse, 35032, Germany

RECRUITING

Related Publications (26)

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Related Links

• World Health Organization. (2023). Mental health at work. WHO.

MeSH Terms

Conditions

Depressive Disorder, Major

Condition Hierarchy (Ancestors)

Depressive Disorder; Mood Disorders; Mental Disorders

Study Officials

• Winfried Rief, Prof. Dr.

  Philipps University Marburg

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Masia Fernanda Hoffmann, M.Sc.

CONTACT

+4917656538480; fernanda.hoffmann@uni-marburg.de

Winfried Rief, Prof. Dr.

CONTACT

+49 6421 282 3657; rief@staff.uni-marburg.de

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Independent outcome assessors conducting clinician-rated measures (e.g., HAMD-21) will remain blinded to group allocation. Participants, therapists, and investigators are not blinded.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Participants will be randomly assigned in equal proportions to one of three parallel groups: EFPI, REACT, or waiting-list control.

Study Record Dates

• First Submitted: December 8, 2025
• First Posted: February 4, 2026
• Study Start: October 13, 2025
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): June 30, 2028
• Last Updated: February 10, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, ANALYTIC CODE
• Time Frame: Data and supporting documents will be available within 12 months after publication of the primary outcomes and will remain accessible for at least 10 years thereafter.
• Access Criteria: De-identified individual participant data (IPD), study protocol, statistical analysis plan, and informed consent form will be made available to qualified researchers upon reasonable request. Access will be provided via the Open Science Framework (OSF) project page once data are curated and anonymized. Requests for access can be directed to the principal investigators of Project C02 within the CRC/TRR 393. Data will be available for scientific use after publication of the main results.

Locations

DE (1)