Process-based Therapy for Difficult-to-treat Anxiety Disorders and Depression

This study is testing a newer psychological approach called Process-Based Therapy (PBT) for people in Germany who have depression or anxiety disorders that have not improved despite trying at least two standard treatments. PBT is a flexible therapy that focuses on the mental processes underlying distress rather than applying a fixed protocol. **You may be eligible if...** - You are 18–65 years old - You have a primary DSM-5 diagnosis of a depressive disorder or anxiety disorder - You have already tried and not responded to at least two different treatments (medication or psychological therapy) following German clinical guidelines - You have a sufficient understanding of the German language - You are willing to keep your current medications stable during the treatment period (you do not need to stop them) **You may NOT be eligible if...** - You have high or active suicidal thoughts - You are currently using substances or alcohol in a way that would interfere with treatment - You have a severe personality disorder or psychotic illness that would require different primary treatment Talk to your doctor to see if this trial is right for you.