What the study found
A reward-focused psychotherapy called positive affect treatment (PAT) led to better clinical improvement than a comparison therapy called negative affect treatment (NAT) in adults with severely low positive affect, depression, and anxiety. The study also found that changes in reward and threat processing were linked to clinical improvement.
Why the authors say this matters
The authors say that targeting impaired reward processing, which underlies anhedonia (reduced ability to feel pleasure) and low positive affect, is important for reducing key risk factors in depression and anxiety, including suicidality and relapse. The study suggests that reward- and threat-related processes may be central to therapeutic improvement.
What the researchers tested
This was an assessor-blinded, parallel-group, multisite randomized clinical superiority trial at outpatient centers in Los Angeles and Dallas. Ninety-eight treatment-seeking adults received 15 weekly individual sessions of either PAT or NAT, and the team measured positive affect, anhedonia, depression, anxiety, and 14 reward- and threat-related targets using self-report, behavioral, and physiological measures.
What worked and what didn't
Clinical status improved more with PAT than NAT overall, and PAT also had better clinical status at 1-month follow-up. Improvement in reward anticipation-motivation and reward attainment targets was comparable for PAT and NAT, while 6 of 7 self-reported reward and threat measures mediated clinical improvement; none of the behavioral or physiological measures did.
What to keep in mind
The study included 98 adults from two U.S. outpatient treatment centers, so the findings apply to that sample and setting. The abstract notes limited evidence for moderated mediation, and it does not describe additional limitations beyond the available summary.
Key points
- Positive affect treatment (PAT) produced better clinical improvement than negative affect treatment (NAT).
- PAT also had better clinical status at 1-month follow-up.
- Changes in reward and threat processing were linked to clinical improvement.
- Reward anticipation-motivation and reward attainment improved similarly in PAT and NAT.
- Six of seven self-reported reward and threat measures mediated improvement, but behavioral and physiological measures did not.
Disclosure
- Research title:
- Positive affect treatment improved clinical status more than comparison therapy
- Authors:
- Alicia E. Meuret, David Rosenfield, Emily Wang, Christina M. Hough, Thomas Ritz, Michelle G. Craske
- Institutions:
- Southern Methodist University, University of California, Los Angeles, Neurobehavioral Systems
- Publication date:
- 2026-04-24
- OpenAlex record:
- View
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