Anhedonia—the reduced capacity to experience interest and pleasure—is a critical, often undertreated feature of depression and anxiety that conventional therapies frequently fail to address. A 2026 randomized clinical trial published in JAMA Network Open found that Positive Affect Treatment (PAT), a psychosocial intervention designed to directly target reward processing, produced greater clinical improvements than a comparison therapy focused on reducing negative affect in adults with severely low positive affect and depression or anxiety.

Study Design and Interventions 

The multisite, assessor-blinded trial enrolled 98 adults across academic outpatient treatment centers in Los Angeles, California, and Dallas, Texas. Participants met criteria for severely low positive affect alongside moderate-to-severe depression or anxiety with clinically significant functional impairment. They were randomized 1:1 to receive 15 weekly individual telehealth sessions of either PAT or Negative Affect Treatment (NAT).

PAT was designed to enhance the three core phases of reward processing: reward anticipation-motivation (planning pleasurable activities, envisioning positive futures), reward consumption (savoring, engagement in enjoyable activities, cultivating positive emotions such as loving-kindness), and reward learning (strengthening associations between positive behaviors and mood). NAT served as a comparison condition, incorporating exposure, cognitive restructuring, and respiratory training while intentionally excluding positive-affect-focused components.

A patient in a CBT session.

Key Findings

PAT produced significantly greater improvement in overall clinical status compared to NAT, with superior outcomes maintained at one-month follow-up. The advantage was driven primarily by larger reductions in depression and anxiety symptoms on the DASS-21 (d = 0.55, P < .001).

Both treatments improved reward anticipation-motivation and response to reward attainment over time, though neither produced gains in reward learning. Of 14 potential mediators examined, six self-reported reward and threat measures significantly mediated clinical outcomes across both treatment groups. Notably, no behavioral or physiological measures emerged as significant mediators.

The authors, including Beck Scholar Alicia E. Meuret, PhD, concluded that “modulation of reward and threat processes was a central mechanism of therapeutic improvement, with a reward-focused intervention producing superior clinical outcomes.”

Commentary and Clinical Takeaways from Dr. Judith Beck

“This research is exciting and very important for our field,” said Dr. Judith Beck, Beck Institute President. “It provides empirical support for directly targeting reward processing in patients who present with anhedonia alongside depression and anxiety.” She also shared that “the PAT approach is consistent with some of the ways I’ve shifted my own clinical practice over the past few years to focus more on helping my clients experience positive emotions both in and out of session.”

This trial demonstrates that reward-focused psychotherapy can produce superior clinical outcomes in adults with depression, anxiety, and severely low positive affect. The findings highlight the importance of directly assessing and targeting anhedonia in clinical practice and support continued development of interventions designed around reward processing mechanisms.

Reference: 

Meuret, A. E., Rosenfield, D., Wang, E., Hough, C. M., Ritz, T., & Craske, M. G. (2026). Positive affect treatment for depression, anxiety, and low positive affect: a randomized clinical trial. JAMA Network Open, 9(4), e267403.

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