A new form of psychotherapy that focuses on rebuilding positive emotions may help people with depression and anxiety who struggle to experience pleasure, according to a randomized clinical trial.
The study tested Positive Affect Treatment (PAT), an approach designed to strengthen the brain systems involved in anticipating and experiencing rewards rather than primarily focusing on reducing negative emotions.
Researchers found that adults with severe anhedonia, depression, and anxiety who received PAT experienced greater overall clinical improvement than those who underwent a traditional therapy centered on reducing negative symptoms. The benefits persisted for one month after treatment, according to the findings.
The results offer a potential new direction for treating anhedonia, a common but often overlooked symptom that can make depression particularly difficult to overcome.
What Is Anhedonia?
Depression is often associated with persistent sadness, but some people experience something different: They simply stop feeling much of anything good.
This loss of interest or ability to experience pleasure is known as anhedonia. It can affect how people respond to enjoyable experiences, anticipate future rewards and find motivation or meaning in activities they once valued.
Anhedonia is common among people with major depression and can also occur in conditions including anxiety disorders, post-traumatic stress disorder, substance use disorders and schizophrenia.
The symptom can be particularly challenging because conventional treatments often emphasize reducing distressing emotions such as sadness, fear and hopelessness. For someone experiencing anhedonia, however, feeling less bad does not necessarily mean feeling good.
A Therapy That Focuses on Feeling Good Again
PAT was developed to directly target the brain's positive or reward system.
The therapy typically involves exercises intended to help people notice and savor positive experiences, reconnect with rewarding activities, cultivate gratitude and kindness, and strengthen motivation and a sense of meaning.
The goal is not simply to make patients happier. Researchers are attempting to retrain processes involved in reward, including the ability to anticipate something positive, experience pleasure after receiving a reward, and learn from rewarding experiences.
Alicia Meuret, director of Southern Methodist University's Center for Anxiety and Depression Research and a researcher involved in the work, has emphasized the distinction between reducing negative emotions and restoring a person's belief that positive experiences are possible.
"There's a difference between feeling powerless and feeling hopeless. Powerlessness still leaves you wanting to change things, while hopelessness erases any belief that change is possible. Just removing negative emotions isn't enough to fix that."
What the Clinical Trial Found
The randomized clinical trial included 98 adults experiencing severe anhedonia alongside depression and anxiety.
Participants who received PAT demonstrated greater overall improvement than those assigned to a more traditional, negativity-focused treatment. The difference remained evident at a one-month follow-up.
Researchers examined several aspects of reward processing, including anticipation and motivation, responses to rewards, and reward-based learning. Changes in these processes appeared to be associated with improvements in both depressive and anxiety symptoms.
The findings suggest that directly strengthening the brain's reward system could improve symptoms beyond anhedonia.
However, the researchers cautioned that the trial was relatively small and represents an early step in evaluating the approach. Larger studies will be needed to determine how effective PAT is across broader populations and whether its benefits persist over longer periods.
Why Targeting the Brain's Reward System Matters
Anhedonia can leave people disconnected from activities, relationships, and experiences that might otherwise help them recover.
When someone no longer expects an activity to be enjoyable, they may stop doing it. That withdrawal can further reduce opportunities for positive experiences, potentially creating a cycle that reinforces depression.
Reward-focused treatments aim to interrupt that cycle by helping patients gradually reconnect with activities that provide pleasure, meaning or a sense of accomplishment.
The approach could also offer a different way of thinking about recovery. Rather than measuring success only by whether sadness or anxiety has decreased, clinicians may increasingly consider whether patients are regaining motivation, enjoyment and connection.
The researchers stressed that PAT is not a replacement for established depression treatments and that more evidence is needed. Still, the findings suggest that treating depression may require more than turning down negative emotions.
