Pilot Randomized Controlled Trial of an Integrative Group Psychotherapy (Terebenin's Method) in Adults With Subclinical and Mild/Moderate Anxiety and Depression

Anxiety and depression are among the most prevalent mental health disorders worldwide, often presenting with overlapping symptoms that amplify the burdens on affected individuals and healthcare systems. According to the World Health Organization (WHO), depression alone affects over 280 million people globally (approximately 3.5% of the population). Anxiety disorders share a similar high prevalence and frequently co-occur with depressive conditions. In response to these challenges, diverse psychotherapy modalities have emerged, including integrative approaches that combine principles from different schools (e.g., psychodrama, Gestalt, family systemic, and body-oriented methods) to enhance treatment effectiveness. Meta-analyses indicate that these integrative strategies can achieve effect sizes (Cohen's d) in the range of 0.60-0.90, making them viable-or in some cases superior-alternatives to single-orientation therapies for mild to moderate depression ].

Within this integrative framework, Terebenin's Method stands out as a structured group intervention designed to address subclinical, mild, or moderate anxiety and depression. Its core elements include psychodrama-inspired enactments (allowing participants to "act out" internal conflicts or emotional challenges in a safe group context), systemic constellation techniques (focusing on relational and family-system dynamics through phenomenological exploration), body-oriented practices (emphasizing awareness of somatic tension and facilitating emotional expression), and a directive therapeutic style (where the therapist actively interprets and guides group processes) . The method posits that enacting and witnessing others' enactments of unconscious or maladaptive patterns facilitates emotional insight and symptom reduction, concurrently reinforcing self-esteem, resilience, and a sense of control.

Besides patient-reported outcomes, growing attention has turned to physiological markers that can provide objective evidence of treatment efficacy. Salivary cortisol (CORT) is widely recognized as an indicator of hypothalamic-pituitary-adrenal (HPA) axis function, known to rise under chronic stress, depressive episodes, and anxiety conditions. Likewise, salivary alpha-amylase (sAA) reflects sympathetic nervous system (SNS) activation and tends to increase during acute stress. Research suggests that effective psychotherapies can lower or normalize these biomarkers, thereby validating clinical improvements captured through self-report and observer-rated scales.

Against this background, the present study is designed as a pilot randomized controlled trial (1:1 allocation) to evaluate the effects of Terebenin's Method in individuals aged 18-60 who exhibit subclinical to moderate anxiety or depressive symptoms. The study will enroll approximately 60 participants (30 per group), enabling the collection of feasibility data and effect size estimates to inform a larger, fully powered RCT. Participants will be randomly assigned to one of two arms: (1) an 8-week course of integrative group therapy using Terebenin's Method (weekly sessions of 2-3 hours, led by 1-2 trained facilitators with a group size of 8-12), or (2) a control condition that may consist of an active psychotherapeutic intervention (e.g., short-term cognitive-behavioral therapy or Gestalt group) conducted on a similar 8-week schedule, or a waitlist if the active control is not feasible.

Inclusion criteria require stable or no psychotropic medication use, absence of severe psychiatric disorders or acute suicidal risk, the ability to attend weekly sessions, compliance with saliva sampling, and written informed consent. Exclusion criteria encompass severe somatic illnesses preventing participation, current psychotherapy likely to confound results, and active substance use disorders unless in stable remission for more than six months.