Technology dRiven Enhancement to Engage & Connect

Depression in mid- and late-life is characterized with reduced functions of the reward system. The investigators designed a psychotherapy that aims to improve reward functions through engagement in pleasurable activities and in turn reduce depression. Prior work has shown that this therapy is acceptable and reduces depression. This study examines whether a hybrid intervention that combines clinician remotely-delivered psychotherapy, and a novel app named TREE-Connect, reduces late life depression. This TREE-Connect app uses a machine learning algorithm to promote adherence to therapy (completion of therapeutic homework) in late-life depression and increase cost-effectiveness and reach of treatment to older adults. This randomized controlled trials will test whether the hybrid intervention (clinician-delivered psychotherapy + app), compared to a condition that includes solely clinician-delivered therapy is acceptable and reduces late-life depression.

• TREE-Connect (Behavioral): TREE-Connect is a mental health app that aims to increase engagement in rewarding activities
• Clinician-delivered psychotherapy (Behavioral): Clinician-delivered psychotherapy is delivered remotely and aimed to increase engagement in rewarding activities

Primary outcomes

• Acceptability (Client Satisfaction Questionnaire; CSQ) [9 Weeks]: Acceptability will measured using the Client Satisfaction Questionnaire (CSQ) with a benchmar score of >=3 (out of 4; average score); Range: 0 to 4, with higher scores indicating greater acceptability

Sex: All, ages: 50 Years to 80 Years

Inclusion Criteria:

* Adults aged 50-80
* Capacity to provide consent for research assessment and treatment.
* Significant depression, i.e., PHQ-9 ≥ 7 (mild-moderate severity of symptoms)
* Mini Mental Status Exam (MMSE) equal or greater than a score of 23.
* Off antidepressants or on stable dose for 8 weeks and do not intend to change the dose in the next 10 weeks, without individual psychotherapy services during the study period.

Exclusion Criteria:

* Intent or plan to commit suicide in the near future.
* Inability to communicate in English.
* History or presence of psychiatric diagnoses other than major depressive disorder without psychotic features, generalized anxiety disorder, specific phobia, or antisocial or borderline personality disorder.
* Neurological disorders (dementias, amnestic and multidomain Mild Cognitive Impairment, Parkinson's disease, epilepsy, etc.).
* Acute or severe medical illness in the past 3 months (metastatic cancer, multiple sclerosis, decompensated cardiac, liver or kidney failure, major surgery, stroke or myocardial infarction, cardiac, renal, or respiratory failure; severe chronic obstructive pulmonary disease, etc.) that may be the primary cause depressive symptoms, influence brain systems of interest, or impact ability to participate in the study.
* For MRI only: Contraindications to MRI scanning including cardiac pacemaker, heart valve replacement, vascular stent, insulin pump, cochlear implant, any other metallic biomedical implant contraindicating to MRI, and claustrophobia.

• Nili Solomonov, PhD, Principal investigator, Weill Medical College of Cornell University
• Samprit Banerjee, PhD, Principal investigator, Weill Medical College of Cornell University