Assessing Change in Short Term Therapy for Depression
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      This study will compare mechanisms of action in two forms of brief psychotherapy for major
      depressive disorder in adults. A treatment that targets deficits in motivation in depression
      is expected to show greater improvements in motivation and pursuit of personal goals compared
      to a second treatment that targets irrational thoughts that are typical in depression.
    

Detailed description: 
      Outcome studies have shown that several forms of psychotherapy are effective for depression,
      but questions about how, why, and when these treatments work remain. The proposed study
      answers the call for innovative research designs that allow for more intensive,
      individualized data collection that can address complex questions about the dynamic nature of
      treatment-related change. In this R21 application, we propose a proof-of-concept study using
      an innovative application of experience sampling methodology (ESM) that combines the
      idiographic advantages of single-subject research with the statistical advantages associated
      with larger samples and multilevel analyses. ESM involves sampling aspects of behavior
      occurring in the participant's everyday environment, thereby enhancing ecological validity
      and reducing retrospective bias. Thirtyfour adults with primary major depressive disorder
      will be randomly assigned to 16 weeks of either selfsystem therapy (SST), a new short-term,
      empirically-supported psychotherapy for depression that targets deficits in incentive
      motivation and goal pursuit, or treatment-as-usual (TAU). Participants will complete a
      battery of individual difference and diagnostic measures at pretreatment. One week of
      intensive ESM will be collected at both pre- and post-treatment, during which participants
      will be signaled at random times during each day to answer questions about current
      functioning in several domains (e.g., affect, cognition, and goal pursuit) delivered via a
      phone-based interactive voice response (IVR) system. Throughout the 16 weeks of treatment,
      participants will complete similar IVR assessments on two randomly-selected days per week.
      The proposed study will test three main hypotheses. (1) Patients in SST will show greater
      increases in engagement with promotion goals and activities as well as greater increases in
      goal-related daily experiences of positive affect over the course of treatment compared to
      patients in TAU. (2) Patients in SST will show greater decreases in engagement with
      prevention goals and activities as well as greater decreases in goal- related daily
      experiences of negative affect over the course of treatment compared to patients in TAU. (3)
      Within the SST condition, a history of failure to pursue or achieve promotion goals and
      individual differences in chronic regulatory orientation (i.e., strength of orientation
      toward promotion and prevention goals) will moderate the effects of SST on changes in
      depressive symptoms and on daily experiences of promotion goal engagement. The proposed
      research will have a significant impact on an important public health problem and will expand
      our knowledge of how psychotherapy for depression works. The data to be obtained from this
      study will provide a sound empirical and theoretical framework for largerscale programmatic
      research on the nature of treatment-induced change processes in patients with depression.
    

Intervention name(s): self-system therapy; cognitive therapy
Intervention type(s): Behavioral; Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: self-system therapy; cognitive therapy; depression; psychotherapy; mechanisms of action