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DepressionNCT04690946

Comparing Effect and Change Processes in Cognitive Behavioral Therapy and Emotion-Focused Therapy for Depression

A study testing Cognitive Behavioral Therapy and Emotion-Focused Therapy in people with Depression, run by Institutt for Psykologisk Radgivning at 1 site in Norway.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Depression is a common mental illness which is costly for both society and for those affected. There is a need for effective treatments of depression and there is a need to make sure that the treatments that are given are based on scientific findings. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Depression
What is being tested?
Cognitive Behavioral Therapy and Emotion-Focused Therapy
Could I receive a placebo?
No, everyone receives an active treatment
How many people
112 participants
Where
1 siteNorway
Study dates
20 Jan 2021to 30 Jan 2025
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Moderate or major depressive episode as primary diagnosis

Who cannot join

  • Serious mental illness (schizophrenia, severe bipolar disorder, recent or current psychotic episode) or intellectual disability.
  • Severe alcohol or drug abuse, last 12 months.
  • Suicidality last 6 months
  • Severe medical issues
  • If the participant is on antidepressive medication, the dosage must have been stable for more than 4 weeks, and the participant must consent to staying on the same dosage for the duration of the treatment.
  • The participant is currently in another treatment for depression

Trial locations and contacts

1 site in 1 country.

Norway1 site
  • Institutt for Psykologisk rådgivning

    Bergen, Bergen, 5012

Other trials in Norway

About this study

Official title: Randomized Controlled Study Comparing the Therapeutic Effect and Change Processes in Cognitive Behavioral Therapy and Emotion-Focused Therapy for Depression

Depression is a common mental illness which is costly for both society and for those affected. There is a need for effective treatments of depression and there is a need to make sure that the treatments that are given are based on scientific findings. In this study the investigators want to examine and compare two common treatment models for depression - Cognitive Behavioral Therapy and Emotion-Focused Therapy. The investigators want to investigate what characterizes these treatments when they are successful, and seek to better understand what it is like for patients to receive these treatments. Also, the investigators will investigate the experience of patients who abruptly discontinue treatment. To investigate these questions, self-report measures, interviews and analysis of session recordings will be used.

Read the detailed description

Depression is a widespread mental disorder which can result in severe impairment and reduced quality of life for those affected. Cognitive behavioral therapy (CBT) is the approach with strongest empirical support, and is often recommended as treatment for depression, as in the NICE Guidelines for Depression from 2009. However, research indicates that not all patients respond to CBT, indicating a need to expand the range of available evidence-based psychotherapies, and mapping the mechanisms of change in existing treatments.

Emotion focused therapy (EFT) is one promising treatment for depression with empirical support for its efficacy. A previous study found equal outcome in CBT and Process-Experiential treatment/EFT for depression, but more studies are needed to replicate these findings across cultural contexts. The main aim of this study is to investigate whether there are significant differences in the therapeutic effect of EFT compared to that of CBT for patients with moderate and major depressive disorder in a Norwegian outpatient setting.

Although several psychotherapeutic approaches have shown efficacy in the treatment of depression, no psychotherapeutic interventions is beneficial for all patients. There is a need for research that investigates what treatments works for whom, based on patient characteristics and preferences. The present study will investigate whether patient characteristics moderate treatment outcome, both within and between treatment conditions. In addition, qualitative interviews will be conducted to get a deeper understanding of what clients find helpful and challenging within the CBT and EFT condition, and to explore the experience of patients who drop-out of the treatment process.

In order to further develop psychotherapeutic treatments and increase their effectiveness, there is a need to identify processes that are related to good and poor outcome. Process-outcome studies are commonly used for this purpose. The present study will investigate and compare characteristics of psychotherapy processes in both the CBT and EFT conditions and how these are related to outcome.

Study design and Method

The study will be conducted as a randomized controlled trial (RCT) in order to compare the efficacy of EFT to CBT. RCT's are considered the gold standard for efficacy studies. Participants will be recruited from the Norwegian mental health program "Return to work", a publicly funded treatment program where patients with common mental health issues receives outpatient psychotherapeutic treatment to reduce and prevent sick leave.

The present study will address the following research hypothesis and questions:

  1. EFT and CBT will not result in significantly different outcome in the treatment of patients with moderate and major depressive disorder.
  2. Patient characteristics (severity of depression, adverse childhood experiences and clients' initial ability to make sense of their experience) will moderate treatment outcome for both conditions.
  3. Will therapeutic processes (therapeutic alliance, therapist empathy, clients' ability to make sense of their experience and emotional processing) mediate treatment outcome equally for both conditions?
  4. What do patients in both conditions describe as helpful and unhelpful aspects of treatment?
  5. How do patients in both conditions describe their own change or lack or change after treatment?
  6. How do patients that choose to drop out of treatment describe the processes leading to that decision?
Conditions
Depression
Being tested
Cognitive Behavioral Therapy, Emotion-Focused Therapy
Medical subject headings
Depression

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Cognitive Behavioral TherapyBehavioural

    Also called CBT

    14-18 sessions of CBT

  • Emotion-Focused TherapyBehavioural

    Also called EFT

    14-18 sessions of EFT

Study groups in NCT04690946
Study groupRoleWhat they receive
Cognitive Behavioral TherapyActive comparator14-18 sessions of psychotherapy according to principles of Cognitive Behavioral Therapy
Receives: Behavioral: Cognitive Behavioral Therapy
Emotion-Focused TherapyActive comparator14-18 sessions of psychotherapy according to principles of Emotion Focused Therapy
Receives: Behavioral: Emotion-Focused Therapy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Beck Depression Inventory from session to session

    Self-report measure of depressive symptoms, ranging from minimum 0 and maximum 63. Higher scores suggests worse outcome.

    Measured: 1 week before treatment startup, 1 day after each therapy session, within 1 week after treatment, 3 month follow up, 6 month follow up, 12 months follow up

Secondary outcomes (9)
  1. Change in Beck Anxiety Inventory

    Self-report measure of anxiety symptoms, ranging from minimum 0 and maximum 63. Higher scores suggests worse outcome.

    Measured: 1 week before treatment startup, within 1 week after treatment, 3 month follow up, 6 month follow up, 12 months follow up

  2. Change in Repetitive Eating Questionnaire

    Self-report measure of symptoms related to eating disorders, average scores, minimum 0, maximum 6, higher score indicates worse outcome.

    Measured: 1 week before treatment startup, within 1 week after treatment, 3 month follow up, 6 month follow up, 12 months follow up

  3. Change in Inventory of Interpersonal problems

    Self-report measure of interpersonal difficulties, average scores minimum 0, maximum 4. Higher score suggests worse outcome.

    Measured: 1 week before treatment startup, within 1 week after treatment, 3 month follow up, 6 month follow up, 12 months follow up

  4. Change in The Acceptance and Action Questionnaire from session to session

    Self-report measure of psychological flexibility, average scores minimum 1, maximum 7. Higher score suggests worse outcome.

    Measured: 1 week before treatment startup, 1 day after each therapy session, within 1 week after treatment, 3 month follow up, 6 month follow up, 12 months follow up

  5. Change in Emotion Approach Coping Scale

    Self-report measure of emotional processing ability, average scores minimum 1, maximum 4. Higher score suggests better outcome.

    Measured: 1 week before treatment startup, within 1 week after treatment, 3 month follow up, 6 month follow up, 12 months follow up

  6. Change in Penn State Worry Questionaire

    Self-report measure of rumination and cognitive processing, total scores minimum 16, maximum 80. Higher score suggests worse outcome.

    Measured: 1 week before treatment startup, within 1 week after treatment, 3 month follow up, 6 month follow up, 12 months follow up

  7. Change in Self-Compassion Scale

    Self-report measure of self-relating, average scores, minimum 1, maximum 5, higher scores suggests better outcome.

    Measured: 1 week before treatment startup, within 1 week after treatment, 3 month follow up, 6 month follow up, 12 months follow up

  8. Change in Quality of life questionnaire

    Self-report measure of quality of life, average scores, minimum 1, maximum 5, higher scores indicate better outcome.

    Measured: 1 week before treatment startup, within 1 week after treatment, 3 month follow up, 6 month follow up, 12 months follow up

  9. Change in Working Alliance Inventory - short version

    Self report measure on experience of therapeutic alliance, average scores, minimum 1, maximum 7, higher scores suggests better outcome.

    Measured: 1 day after 1st through 14th therapy session.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted31 Dec 2020
  2. Study start20 Jan 2021
  3. Primary completion30 Jul 2024
  4. Study completion30 Jan 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized Clinical Trial
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
112 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04690946
Sponsor's protocol ID
IPR
Status last verified
Mar 2026
First submitted
16 Dec 2020
Last updated
27 Mar 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Dimidjian S, Hollon SD. How would we know if psychotherapy were harmful? Am Psychol. 2010 Jan;65(1):21-33. doi: 10.1037/a0017299.

    PubMed 20063907
  • Blatt SJ, Luyten P. A structural-developmental psychodynamic approach to psychopathology: two polarities of experience across the life span. Dev Psychopathol. 2009 Summer;21(3):793-814. doi: 10.1017/S0954579409000431.

    PubMed 19583884
  • Elliott R. Psychotherapy change process research: realizing the promise. Psychother Res. 2010 Mar;20(2):123-35. doi: 10.1080/10503300903470743.

    PubMed 20099202
  • Goldman, R. N., Greenberg, L. S., & Angus, L. (2006). The effects of adding emotion-focused interventions to the client-centered relationship conditions in the treatment of depression. Psychotherapy Research, 16(5), 537-549.

  • Watson JC, Gordon LB, Stermac L, Kalogerakos F, Steckley P. Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the treatment of depression. J Consult Clin Psychol. 2003 Aug;71(4):773-81. doi: 10.1037/0022-006x.71.4.773.

    PubMed 12924682
  • Greenberg, L & Watson, J. (1998). Experiential Therapy of Depression: Differential Effects of ClientCentered Relationship Conditions and Process Experiential Interventions, Psychotherapy Research, 8:2, 210-224.

  • Kazdin AE. Understanding how and why psychotherapy leads to change. Psychother Res. 2009 Jul;19(4-5):418-28. doi: 10.1080/10503300802448899.

    PubMed 19034715
  • Kazdin AE. Evidence-based treatment research: Advances, limitations, and next steps. Am Psychol. 2011 Nov;66(8):685-698. doi: 10.1037/a0024975.

    PubMed 22082384
  • Kendall JM. Designing a research project: randomised controlled trials and their principles. Emerg Med J. 2003 Mar;20(2):164-8. doi: 10.1136/emj.20.2.164. No abstract available.

    PubMed 12642531
  • Lambert, M. J. (2011). What have we learned about treatment failure in empirically supported treatments? Some suggestions for practice. Cognitive and Behavioral Practice, 18(3), 413-420.

  • What have we learned about treatment failure in empirically supported treatments

  • NICE (2009a). Depression: Treatment and Management of Depression in Adults. Clinical Guideline 90. London: National Institute for Health and Clinical Excellence. Available at www.nice.org.uk

  • Nilsson, T., Svensson, M., Sandell, R. & Clinton, D. (2007). Patients' experiences of change in cognitive-behavioral therapy and psychodynamic therapy: a qualitative comparative study. Psychotherapy Research, 17:5, 553-566.

  • Rice, L. N., & Greenberg, L. S. (Eds.). (1984). Patterns of change: Intensive analysis of psychotherapy process. Guilford Press.

  • Roth, A & Fonagy, P (1996) What works for whom? New York: Guilford Press

Questions about this trial

What is this clinical trial studying?

A study testing Cognitive Behavioral Therapy and Emotion-Focused Therapy in people with Depression, run by Institutt for Psykologisk Radgivning at 1 site in Norway.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 27 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Norway. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Beck Depression Inventory from session to session (time frame: 1 week before treatment startup, 1 day after each therapy session, within 1 week after treatment, 3 month follow up, 6 month follow up, 12 months follow up). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04690946, which also lists 17 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Mar 2026.

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Clinical Trial NCT04690946 | AzTrials