Using Affective Differences to Predict Response to Behavioral Treatment for Major Depressive Disorder

Major depressive disorder is a serious form of depression that may be treated with
psychotherapy. However, up to 40% of adults with depression do not show reduced symptoms when
treated with cognitive therapy or behavioral activation (BA), two common forms of
psychotherapy. Certain indicators are generally linked with a successful outcome of
psychotherapy—demographic and clinical characteristics, comorbidity, and treatment
adherence—but no factors reliably predict outcomes of psychotherapy in individuals. This
study will test whether two characteristics related to the way people process emotions,
affective asymmetry and affective reactivity, can predict whether people with depression will
improve with BA therapy.

Both depressed and healthy participants will be recruited for this study. Participation in
this study will last 31 weeks. All participants will complete baseline assessments at Weeks 1
and 2. Depressed participants will then begin receiving 16 weekly sessions of BA therapy. All
participants will be assessed again after 8, 16, 17, and 28 weeks. Assessments will include
the following: a urine toxicology screening; interviews on mental and physical health, family
and childhood experiences, and current mood and functioning; computer tasks; recordings of
electroencephalography (EEG) activity; recordings of reaction to a startle probe; recordings
of electromyography (EMG) activity; recordings of electrodermal activity (EDA); and
measurement of blood pressure.

Inclusion Criteria:

- Healthy participants should have no lifetime history of psychiatric disorder

- Depressed participants should have a current diagnosis of major depressive disorder,
as defined by the DSM-IV

Exclusion Criteria:

- History of bipolar affective disorder

- History of psychosis

- Current non-psychotic Axis I disorder, if it constitutes the predominant aspect of the
clinical presentation and immediately requires treatment other than that offered in
the study

- History of substance dependence within the past 6 months

- Antisocial, borderline, schizotypal, or schizoid personality disorders

- Evidence of any medical disorder or condition that could cause depression or preclude
the use of study treatments

- Current treatment with catecholaminergic antihypertensive medication, such as
reserpine, beta-blockers, clonidine, and alphamethyldopa

- Current use of antidepressant medication

- Clear indication of secondary gain

- Current suicide risk sufficient to preclude treatment on an outpatient basis

- Severe, unstable concurrent psychiatric conditions likely to require hospitalization
within 6 months of study entry

- Already receiving a targeted psychotherapy aimed at depression