Positive Affect Treatment for Depression, Anxiety, and Low Positive Affect: A Randomized Clinical Trial

Area of Science:

• Psychiatry and Behavioral Science
• Clinical Psychology
• Neuroscience

Background:

• Impaired reward processing is a core feature of anhedonia, depression, and anxiety.
• Limited research exists on the mechanisms underlying reward processing interventions for these conditions.
• Targeting reward systems is crucial for reducing suicidality and relapse in depression and anxiety.

Purpose of the Study:

• To compare the efficacy of a novel positive affect treatment (PAT) against a control therapy in engaging reward systems.
• To determine if alterations in reward and threat processing mediate clinical outcomes.
• To assess the superiority of PAT in improving clinical status for individuals with low positive affect, depression, and anxiety.

Main Methods:

• An assessor-blinded, parallel-group, multisite randomized clinical superiority trial.
• 98 treatment-seeking adults with low positive affect and moderate to severe depression/anxiety were randomized to 15 weekly sessions of PAT or negative affect treatment (NAT).
• Clinical status was assessed using self-reported positive affect, interviewer-rated anhedonia, and depression/anxiety scales. Reward and threat processing were measured using self-report, behavioral, and physiological indicators.

Main Results:

• Positive affect treatment (PAT) resulted in significantly greater improvements in clinical status compared to negative affect treatment (NAT).
• Improvements in reward anticipation-motivation and reward attainment were observed but were comparable between PAT and NAT.
• Six of seven self-reported reward and threat measures mediated clinical improvements, while behavioral and physiological measures did not.

Conclusions:

• Positive affect treatment (PAT) demonstrates superior clinical outcomes compared to negative affect treatment (NAT) for individuals with low positive affect, depression, and anxiety.
• Modulation of reward and threat processing mechanisms appears central to therapeutic improvement.
• Findings support the development of reward-focused interventions for conditions characterized by anhedonia and diminished positive affect.