Treatment for Affect Dimensions
Condition: Depression; Anxiety
MeSH terms: Depression
Study type: Interventional

Summary: 
      The purpose of this study is to evaluate the efficacy and targets of Positive Affect
      Treatment, a psychotherapy specifically aimed at enhancing reward sensitivity in individuals
      with low positive affect (a core feature of anhedonia) in the context of depression or
      anxiety.

      Target enrollment is 68 male and female participants with low positive affect and depression
      or anxiety and impaired functioning, between the ages of 18 and 65 years, who will be
      randomized to either Positive Affect Treatment or Negative Affect Treatment (designed to
      reduce threat sensitivity). Participants will complete laboratory tests, psychiatric
      assessments, and self-report questionnaires as part of the study.

      The total length of participation is around 4 months.
    

Detailed description: 
      Low positive affect in the context of depression or anxiety has been relatively resistant to
      pharmacological and psychological treatments. Newer treatments that focus upon positivity or
      reward sensitivity have shown promising results.

      As an NIMH funded R61 phase trial, the purpose of the current randomized controlled trial is
      to evaluate the efficacy and targets of Positive Affect Treatment (designed to augment reward
      sensitivity) for individuals with low positive affect in the context of depression or anxiety
      symptoms. Targets include behavioral, cognitive, physiological and experiential measures of
      three reward processes: reward anticipation, response to reward attainment, and reward
      learning. Specificity of target engagement is assessed by comparison with Negative Affect
      Treatment, designed to reduce threat sensitivity.

      Clinical outcomes are assessed at baseline and either weekly or at Week 5, Week 10, and Week
      15 (post). Targets are assessed at baseline, Week 5, Week 10, and Week 15. Statistical models
      evaluate whether change in outcomes and change in target measures are greater as a result of
      Positive Affect Treatment compared to Negative Affect Treatment and whether changes in target
      measures correlate with changes in outcome measures.

      Target enrollment is 68 male and female participants with low positive affect and depression
      or anxiety and impaired functioning between the ages of 18 and 65 who will be randomized to
      Positive Affect Treatment or Negative Affect Treatment, each comprising 15 individual
      psychotherapy sessions.

      Participants will complete laboratory tests and psychiatric assessments and self-report
      questionnaires as part of the study. Total length of participation is around 4 months.
    

Intervention name(s): Positive Affect Treatment; Negative Affect Treatment
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Sessions 1-7: Pleasurable activities + imaginal recounting and reinforcement of positive mood effects (continued for sessions 8-15) Sessions 8-10: Cognitive exercises focusing on identifying positive aspects of experience, taking responsibility for positive outcomes, and imagining future positive events Sessions 11-14: Exercises to cultivate and savor positive experiences Session 15: Relapse prevention.; Sessions 1-7: Exposure therapy to feared or avoided situations, sensations, or memories (continued for sessions 8-15) Sessions 8-10: Cognitive restructuring of probability, cost, and attributional biases Sessions 11-14: Capnometry-assisted respiratory training Session 15: Relapse prevention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment