This study is not without limitations. First, it is possible thatparticipants in the control condition, who were not allowedaccess to CBT sessions at the beginning but only after thewaiting period, may have suffered “disappointment effect”through the intervention period. We tried to mitigate thislimitation that may be common to many waiting list-controlledtrials by not making our control condition a simple waiting listcontrol in which the participants are not allowed to change theirtreatment [54], but an active medication change, which is oneof the recommended treatment options forantidepressant-refractory patients. Nonetheless, the possibilityof some contribution of disappointment effect among the controlgroup cannot be negated. Secondly, it was impossible to mask