Group therapy comparing expectation-focused and reward-focused approaches for major depression
Official title: Rewiring Expectations and Amplifying Rewards: A Study Protocol for a Randomized Controlled Trial of Mechanism-Based Group Psychotherapy for Major Depressive Disorder
Run by Philipps University Marburg · NCT07388004 · Data updated 2026-11-12
This trial tests whether two group psychotherapies—one that challenges rigid negative expectations and one that increases sensitivity to positive rewards—help adults with major depressive disorder feel less depressed than a wait-list.
Quick facts
| Study type | Interventional |
|---|---|
| Ages | 18 Years to 80 Years |
| Sex | All |
| Enrollment | 150 (estimated) |
| Sponsor | Philipps University Marburg Academic / other |
| Locations | 1 site (Marburg, Hesse) |
| Status | Recruiting |
| Started | October 13, 2025 |
| Main results expected | December 31, 2027 |
| Study ends | June 30, 2028 |
| Registry record updated | February 10, 2026 |
| Trial ID | NCT07388004 on ClinicalTrials.gov |
Is this trial a fit for you?
✓Likely a good fit
Adults aged 18–80 with a current DSM-5 diagnosis of major depressive disorder, a HAMD-21 score of ≥9, who can attend twice-weekly group sessions, speak sufficient German, and give informed consent are the intended participants.
✕Probably not a fit
People with bipolar disorder, psychotic disorders, primary substance use disorder, high acute suicide risk, severe neurological conditions or MRI contraindications, recent changes in psychotherapy or antidepressant medication, or insufficient German proficiency are unlikely to qualify or receive benefit from these interventions.
A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.
What this trial studies
The trial will randomly assign 150 adults with current major depressive disorder to one of two 10-session group therapies (Expectation-Focused Psychotherapeutic Intervention or Reward Enhancement and Activation Therapy) or to a wait-list control. Both active interventions are delivered twice weekly over five weeks in a group format to combine structured exercises with peer support. EFPI uses behavioral experiments and techniques to produce expectation violations and reduce cognitive immunization, while REACT focuses on increasing engagement with positive experiences and strengthening reward-related learning. A subset of participants will also take part in MRI assessments to link clinical change to neural mechanisms.
Why it matters
Potential benefit: If successful, these approaches could provide a targeted, group-based treatment option that reduces depressive symptoms and lowers relapse risk by directly addressing rigid negative expectations or low reward sensitivity.
How similar studies have gone: Related approaches such as behavioral activation and cognitive therapies have demonstrated benefit for depression, but direct, large-scale comparisons of expectation-focused versus reward-enhancing group therapies are relatively novel and have limited prior evidence.
Who can join: the full rules
Show full inclusion / exclusion criteria
Inclusion Criteria: * 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 Exclusion Criteria: * 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
Where it's running
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Philipps-University Marburg
Marburg, Hesse, Germany Recruiting
Study contacts
- Principal investigator: Winfried Rief, Prof. Dr. — Philipps University Marburg
- Study coordinator: Masia Fernanda Hoffmann, M.Sc.
- Email: fernanda.hoffmann@uni-marburg.de
- Phone: +4917656538480
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How to take part
- Review the eligibility criteria above with your treating physician.
- Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
- Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.