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

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)

Interventions

BEHAVIORAL

Expectation-Focused Psychotherapeutic Intervention

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).

BEHAVIORAL

Reward Enhancement and Activation Therapy

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).

Sponsors & Collaborators

• German Research Foundation

  collaborator OTHER

• Philipps University Marburg

  lead OTHER

Principal Investigators

• Winfried Rief, Prof. Dr. · Philipps University Marburg

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

80 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-10-13

Primary Completion

2027-12-31

Completion

2028-06-30

Countries

• Germany

Study Locations