For decades, most depression treatments have focused on reducing distress — easing sadness, anxiety, or fear. But a growing body of research suggests that what many patients are missing is not just relief from pain, but a return to joy.
A new randomised clinical trial offers evidence that targeting positive emotions directly may be more effective.
The study, led by clinical psychologist Alicia Meuret, examined a relatively new approach known as positive affect treatment (PAT). Unlike traditional therapies that aim to reduce negative feelings, PAT is designed to rebuild a person’s capacity to experience pleasure, a function often impaired in depression.
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That impairment, known as anhedonia, is not a minor symptom. As the researchers note, it is “a critical feature of major depressive disorder” and is “associated with chronicity and severity, diminished recovery or remission, and greater functional impairment.” It is also “robust[ly] associated with suicidal behaviors” and can significantly hinder treatment response.
Yet conventional treatments have struggled to address it. The study points out that existing pharmacological and psychological approaches “demonstrate limited efficacy in achieving remission of anhedonia,” leaving many patients without a full recovery.
PAT attempts to fill that gap.
The therapy is grounded in neuroscience. It targets what researchers describe as three core phases of reward processing: anticipating pleasure, experiencing it, and learning from it. These processes are governed by complex brain circuits, and when they malfunction, people may lose the ability to pursue or enjoy rewarding experiences.
“Disruptions in any of the reward phases can substantially impair a person’s ability to pursue, respond to, or learn from rewards,” the study explains, ultimately blunting positive emotions.
To test whether these systems could be retrained, researchers conducted a multisite randomized clinical trial involving 98 adults with “severely low positive affect and moderate to severe depression or anxiety that was functionally impairing.” Participants received either PAT or a more traditional therapy focused on reducing negative emotions, known as negative affect treatment (NAT).
The results were notable.
“PAT produced greater improvements in clinical status than NAT,” the researchers found. Patients receiving the new therapy showed stronger gains not only in positive emotions but also in overall mental health outcomes. These improvements persisted even at follow-up.
The findings also shed light on how the therapy works. “Modulation of reward and threat processes was a central mechanism of therapeutic improvement,” the study concludes, suggesting that restoring the brain’s reward system may be key to recovery.
Interestingly, the strongest indicators of improvement came from patients’ own experiences. “Of 7 reward and threat self-reported target measures, 6 mediated improvements in clinical status,” the researchers noted, while behavioral and physiological measures were less predictive. This highlights the importance of subjective emotional change, how people actually feel in measuring recovery.
The implications are significant. Depression and anxiety have long been treated primarily as disorders of excess negative emotion. But this research suggests they may also be disorders of diminished positive emotion, and that addressing this deficit directly can lead to better outcomes.
The study builds on earlier trials that showed similar results, reinforcing confidence in the approach. Still, the authors caution that more research is needed to confirm the findings across larger and more diverse populations.
Even so, the shift in perspective is striking.
Rather than asking only how to make people feel less bad, therapies like PAT ask a different question: how to help them feel good again.
And for many patients, that may be the difference between coping and truly recovering.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS
