Positive Affect Treatment (PAT) Shows Promise For Treating Depression

When you think of conditions like depression, you might think of periods of intense sadness.

That can certainly be a part of it. But depression can manifest in other ways, too, including anhedonia, where you feel numb and devoid of many feelings at all.

Anhedonia “has been recognised as a critical feature of major depressive disorder,” affecting as many as 90% of those with depression, recent research published in JAMA Network Open found.

Treatment for depression has typically focused on reducing negative emotions, but hasn’t really addressed anhedonia.

Some people with mental illnesses like depression have said they were more interested in feeling positive emotions than they were in stopping the negative ones completely.

So, to help test that theory, researchers looked into positive affect treatment (also known as PAT).

PAT is designed to activate the brain’s reward system. It can involve activities which train the mind to focus on gratitude, joy, connection, and “loving kindness”, and encourage rewarding activities.

“Reward learning is promoted by strengthening the association between positive behaviours and enhanced mood and by encouraging self-attribution for positive outcomes,” the paper reads.

It’s not so much about discussing negative emotions directly, also known as “negative affect”.

This randomised controlled trial included 98 people with severe anhedonia, depression and anxiety. PAT lasted 15 sessions.

Compared to the same amount of more traditional “negative affect” treatments (NAT), participants who’d had PAT saw a greater reduction in anxiety and depression symptoms.

They also appeared to experience more positive emotions and fewer negative ones, which study co-author and psychologist Dr Alicia E. Meuret told The Washington Post surprised her.

“We expected that PAT would be better for improving positive affect, anhedonia, and NAT would be better for decreasing negative affect. But in all cases, PAT was superior. That was a really important finding,” she said – and it’s something she and her team have been able to replicate thrice.

Benefits seemed to last, too. “Clinical status improved more rapidly with PAT than NAT, with superior outcomes [one month later],” the paper said.

We can’t say for sure, and it’s important to note that many research-backed approaches use elements of NAT.

Additionally, both NAT and PAT gave participants benefits in this study.

But study co-author and psychologist Dr Meuret said: “There’s a difference between feeling helpless and feeling hopeless.

“When you feel helpless, you still have the drive and the will to want to change things. When people feel hopeless, they don’t believe anything will change. That’s what anhedonia can look like, and taking away negative emotions doesn’t fix it.”

She added that “it’s not enough to take away the bad” and ended: “Treatment needs to ask: Is this activity meaningful to you? Will it give you joy or a sense of accomplishment? Does it foster connection?”

• Mind, open Monday to Friday, 9am-6pm on 0300 123 3393.
• Samaritans offers a listening service which is open 24 hours a day, on 116 123 (UK and ROI – this number is FREE to call and will not appear on your phone bill).
• CALM (the Campaign Against Living Miserably) offer a helpline open 5pm-midnight, 365 days a year, on 0800 58 58 58, and a webchat service.
• The Mix is a free support service for people under 25. Call 0808 808 4994 or email help@themix.org.uk
• Rethink Mental Illness offers practical help through its advice line which can be reached on 0808 801 0525 (Monday to Friday 10am-4pm). More info can be found on rethink.org.