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Investigating patient-specific mechanisms of change in SET vs. EFT for depression: study protocol for a mechanistic
Sigal Zilcha-Mano1, Ben Shahar2, Hadar Fisher3
1The Department of Psychology, University of Haifa, 31905, Haifa, Mount Carmel, Israel. sigalzil@gmail.com.
Background:
Major depressive disorder (MDD) is the leading cause of disability worldwide and one of the most heterogeneous mental health disorders. Although there are effective treatments for MDD, about 50% of patients do not respond to treatment. One of the greatest challenges in improving current treatments is identifying the mechanisms responsible for therapeutic change in MDD. The proposed study aims to identify patient-specific mechanisms of change in two treatments for MDD by investigating whether subpopulations of patients differ in the mechanisms of change that operate when receiving a given treatment. Based on theories of targeting weakness and building on strength, we will examine whether the mechanism of change operating when a treatment is provided depends on whether the treatment targets the patient's strength or weakness.
Method:
To test our hypothesis that two treatments, supportive-expressive treatment (SET) and emotion-focused treatment (EFT), differ in their mechanisms of change and to explore whether focusing on the patient's strength or weakness will result in better treatment outcome, we conduct a mechanistic randomized controlled trial. One hundred and twenty-four individuals diagnosed with MDD are randomized to 16 sessions of either SET or EFT. The two treatments are theorized to differ in their main mechanism of change: SET places emphasis on insight as its main mechanism of change, and EFT places emphasis on emotional processing. Both can serve as strength- or weakness-focused treatments, based on the patient's baseline levels of insight and emotional processing. The primary outcome is the Hamilton Rating Scale for Depression. Additional measures include self-report measures and clinical interviews, hormonal, motion, acoustic, physiological, and neuroimaging assessments, performance on cognitive tasks, and narrative material (collected from the sessions and interviews).
Discussion:
The RCT will expand our understanding of mechanisms of change in psychotherapy, from one-size-fits-all to patient-specific mechanisms of change. By informing therapists about which of the two approaches is most effective with patients based on their baseline characteristics, the RCT will contribute to progress toward personalized treatment.
Trial Registration:
clinicaltrials.gov Identifier: NCT04576182 submitted on October 1st 2020.
Funding:
The Israel Science Foundation. Trial status: Recruitment is ongoing.
Insights
This study investigates patient-specific mechanisms of change in major depressive disorder (MDD) treatments. Findings may personalize psychotherapy by matching treatments to patient strengths or weaknesses for better outcomes.
Area of Science:
- Psychiatry and Psychology
- Clinical Psychology
- Mental Health Research
Background:
- Major Depressive Disorder (MDD) is a leading global cause of disability, characterized by significant heterogeneity.
- Current treatments are effective for only about 50% of patients, highlighting a critical need to understand treatment mechanisms.
- Identifying patient-specific mechanisms of change is crucial for improving therapeutic outcomes in MDD.
Purpose of the Study:
- To identify patient-specific mechanisms of change in two distinct treatments for MDD: Supportive-Expressive Treatment (SET) and Emotion-Focused Treatment (EFT).
- To investigate whether patient subpopulations exhibit different mechanisms of change based on treatment focus (targeting strengths vs. weaknesses).
- To determine if tailoring treatment focus to patient baseline characteristics (insight, emotional processing) enhances therapeutic outcomes.
Main Methods:
- A mechanistic randomized controlled trial (RCT) involving 124 individuals diagnosed with MDD.
- Participants were randomized to 16 sessions of either SET (focus on insight) or EFT (focus on emotional processing).
- Comprehensive assessments included the Hamilton Rating Scale for Depression, self-reports, clinical interviews, physiological measures, neuroimaging, cognitive tasks, and narrative analysis.
Main Results:
- The study is ongoing, with recruitment currently in progress.
- Preliminary data collection is underway, with full results anticipated upon study completion.
- The trial aims to differentiate mechanisms of change between SET and EFT, and their efficacy based on patient profiles.
Conclusions:
- The RCT is expected to advance the understanding of psychotherapy mechanisms beyond a 'one-size-fits-all' approach.
- Findings will contribute to personalized treatment strategies by informing therapists about the most effective approach based on patient baseline characteristics.
- This research aims to improve treatment efficacy for major depressive disorder through personalized therapeutic interventions.
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