Positive affect and reward processing in the treatment of depression, anxiety and trauma

The inability to experience pleasure or interest in activities (commonly referred to in clinical settings as anhedonia) is characteristic of depression, anxiety, post-traumatic stress disorder and other mental health conditions. Diminished positive emotions and anhedonia predict poor long-term outcomes, but conventional psychological treatments have only modest effects upon positive emotions. In this Review, we consider the impact of diminished positive affect and anhedonia on depression, anxiety and trauma and present evidence to suggest underlying deficits in reward processing. We describe psychological treatments that aim to increase positive emotions — including emerging therapies and neurocognitive training programmes that specifically target reward hyposensitivities — and the supporting evidence for their efficacy. We argue that a paradigm shift away from treatments primarily focused on alleviating negative emotions (the current gold standard) towards treatments that augment reward processing and positive emotions will prove valuable to enhance treatment response and overall quality of life of people with mental health conditions. Treatments for depression, anxiety and trauma primarily focus on alleviating negative emotions, but their effectiveness is limited. In this Review, Craske et al. describe evidence suggesting that a shift towards interventions that target positive affect and reward processing could enhance treatment outcomes.