Supportive-Expressive and Emotion-Focused Treatment for Depression
Supportive-Expressive and Emotion-Focused Treatment for Depression
This study will explore the mechanisms of change that are activated when individuals receive
 a treatment that targets their weakness and the mechanisms activated when the treatment
 capitalize on their strength. Patients will be assigned to one of two types of
 psychotherapies in treating people with a major depression disorder, expressive-supportive
 vs. emotion-focused treatment. Their ability to benefit from treatment based on their
 pre-treatment levels of insight and emotional processing will be examined. This is a
 four-month protocol, with a 2 year follow up period.
One hundred and twenty-four patients suffering from major depressive disorder will be
 randomized to participate in 16 sessions of either supportive-expressive therapy or
 emotion-focused therapy. The two treatments are theorized to differ in their main mechanism
 of change: supportive-expressive therapy places emphasis on insight as its main mechanism of
 change, and emotion-focused therapy places emphasis on emotional processing as its main
 mechanism of change. Both can serve as strength- or weakness-focused treatments, based on the
 patient's baseline levels of insight and emotional processing. Importantly, this study will
 employ multiple complementary methods, which will include session-by-session self-report
 questionnaires from both patient and therapist, as well as interdisciplinary measures based
 on hormonal and acoustic measures, cognitive tasks, clinician interviews, and behavioral
 coding systems to complement the self-report measures. In addition, prior the beginning of
 treatment patients will complete diaries via mobile survey application. The findings will
 contribute to the research on personalized mechanisms of change and can help clinicians focus
 on more efficient treatment delivery, adapted to given subpopulations of patients, according
 to their strengths and weaknesses. If a mechanism most likely to stimulate change for a
 subpopulation is identified, a corresponding treatment can be chosen that is most likely to
 activate that particular mechanism and by that improve the rate of patients' respondent to
 treatment.
Inclusion Criteria:

 -  Meeting major depressive disorder diagnostic criteria using the structured clinical
 interviews for Diagnostic and Statistical Manual of Mental Disorders-5 and scoring
 more than 14 on the 17-item Hamilton rating scale for depression at two evaluations
 (one week apart) (Hamilton, 1967).

 -  If on medication, patients' dosage must be stable for at least three months prior to
 entering the study, and they must be willing to maintain stable dosage for the
 duration of treatment

 -  Age between 18 and 65

 -  Hebrew language fluency

 -  Provision of written informed consent.

 Exclusion Criteria:

 -  Current risk of suicide or self-harm

 -  current substance abuse disorders

 -  current or past schizophrenia or psychosis, bipolar disorder, or severe eating
 disorder requiring medical monitoring

 -  history of organic mental disease

 -  currently in psychotherapy