Depression is often reduced to deep sadness when, for many, the major blockage is the inability to feel pleasure, called anhedonia. This symptom remains little targeted by traditional treatments, mainly focused on reducing negative emotions. Psychologists from Southern Methodist University and the University of California Los Angeles have however tested, in the journal JAMA Network Open, an approach which firstly aims at the return of positive emotions.
This new therapy, Positive Affect Treatment (PAT), targets the brain’s reward system during fifteen structured sessions. The idea is to retrain three key stages: motivation before a pleasant activity, the pleasure felt during it, then the learning that makes you want to repeat it. Treating anhedonia then becomes less a fight against sadness than active work to restore meaning, curiosity and joy to everyday life.
How Positive Affect Treatment works for depressed patients
In PAT, each session is based on concrete tasks: planning pleasant activities, keeping a gratitude journal, consciously enjoying a coffee or a walk. The goal is that these moments no longer go unnoticed and little by little reactivate the brain’s “positive system”.
The trial, conducted on 98 adults with anhedonia, depression and often anxiety, compared PAT to NAT, a therapy that primarily targets negative affect. After fifteen weekly sessions, PAT gave a greater overall clinical improvement, still visible one month later. Symptoms of depression and anxiety also decreased more in this group.
Why strengthening positive emotions also changes negative emotions
For a long time, depression therapies mainly aimed to reduce distress and anxiety. However, many patients say they above all want to rediscover the taste of going out, of seeing loved ones, of projecting themselves. The authors observe that this work focused on positive affects also reduces, in return, negative emotions.
Analyzes published in JAMA Network Open suggest that this improvement mainly involves better sensitivity to reward assessed by questionnaires, while behavioral or physiological tests remain less telling. A previous trial carried out in 2019 on 96 patients already showed benefits of PAT maintained for up to six months, with much less suicidal ideation than with NAT, 1.7% of patients compared to 12.0%.
For whom Positive Affect Treatment could become an option
These results remain from modest-sized trials, and the authors insist on the need for replications before widespread dissemination of PAT. For a person suffering from depression marked by anhedonia, however, they open up a concrete avenue to discuss with a psychiatrist or psychologist, in the same way as cognitive-behavioral therapies or medications. The challenge is not only to suffer a little less, but to relearn to feel that life can still bring something.