WISE-Therapy (What's Important: schedule and Engage) and bouldering psychotherapy for depression: a randomized clinical trial

BACKGROUND: Group therapies address the growing treatment demand‐supply gap for depression. This study evaluated whether the novel WISE‐Therapy (WISE‐T; What's Important: Schedule and Engage) and Bouldering Psychotherapy (BPT) are more effective in reducing depressive symptoms in an outpatient group therapy setting than treatment as usual (TAU). METHODS: This randomized, controlled, assessor‐blinded, longitudinal, clinical trial was conducted in a naturalistic monocentric setting in Erlangen (Germany) between April 2022 and March 2023, with follow‐up until July 2024. 128 adults were randomly assigned to WISE‐T (44), BPT (40), or TAU (44). In 10 weekly 2‐hour group sessions, WISE‐T focused on identifying what is important, scheduling meaningful activities, and engaging in them for long‐term mental health, and BPT combined psychotherapy with bouldering, while the control group received TAU. Depression severity was measured with the Montgomery‐Asberg Depression Rating Scale at baseline, post‐intervention, and one‐year follow‐up, and analyzed with a hybrid marginal model. RESULTS: Both intervention groups showed significantly greater reduction in depressive symptoms than controls at post‐intervention (WISE‐T: ‐5.5 points, 95%‐CI [‐9.5 to ‐1.5], P = .007, d = 0.62; BPT: ‐4.2 points, 95%‐CI [‐8.2 to ‐0.3], P = .037, d = 0.48). Response rates were 35.3% for WISE‐T, 29.7% for BPT, and 21.1% for controls. Remission rates were significantly higher in WISE‐T (17.6%) than in controls (2.6%, P = .047). Treatment adherence was good with minimal adverse events reported. The secondary outcomes showed significant results for anxiety, sense of coherence, self‐efficacy, and mindfulness during physical activity. CONCLUSIONS: Both interventions demonstrated efficacy in reducing depressive symptoms compared with controls in this single‐center setting. The study supports the integration of both therapies into outpatient care settings. TRIAL REGISTRATION: Study procedures received approval from the Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Ethics Committee (Ref. 21‐332‐B) on December 13, 2021. The Trial was preregistered in March 2022 via ISRCTN12347878 .