4 - (SYM 130) Amplifying Positivity to Combat Social Disconnection: A Cognitive and Behavioral Experimental Therapeutics Trial in Anxiety and Depression

Background: Social disconnection is a common and disabling feature of anxiety and depressive disorders that often persists following first-line cognitive and behavioral therapies. One reason for this is current treatments do not sufficiently engage the positive valence system (PVS; e.g., approach motivation, positive affect), which supports social bond formation and maintenance yet is often hyporesponsive in those with anxiety or depression. We developed a cognitive and behavioral intervention designed to engage the PVS by increasing exposure and responsiveness to positive events, practicing gratitude, and engaging in kind acts towards others. We conducted an experimental therapeutics trial testing whether this intervention would enhance responsivity to social rewards and therefore improve social connectedness.

Methods: N=68 adults endorsing clinically elevated anxiety and/or depression with social impairment were randomized 1:1:1 to 5- (n=23) or 10-sessions (n=22) of Amplification of Positivity (AMP) treatment or waitlist (n=23). 69% identified as female; 24% identified as Hispanic; 38% identified with a race category other than White. Pre- to post-treatment change in striatal activity (primary outcome) during social reward anticipation measured using functional magnetic resonance imaging; reactivity to a social affiliation task (secondary); and self-reported social connectedness (exploratory) were examined. Primary analyses compared AMP (doses combined) vs. waitlist. A second aim compared doses.

Results: AMP engaged the hypothesized treatment target – leading to greater striatal activation during anticipation of social rewards versus waitlist (d=1.01 [95% CI 0.42, 1.61]; largest striatal volume). AMP yielded larger improvements on positive affect, t(57)=2.28, p=.026, d=0.62 and approach behavior, t(57)=2.39, p=.020, d=0.65 during the affiliation task, and social connectedness, t(57)=4.11, p< .001, d=1.12. Larger striatal and social connectedness increases were observed for 5- vs. 10-session AMP. An ongoing trial (75% to target completion) is replicating and extending those findings by comparing AMP to Stress Management Training. This trial will also explore if treatment effects are generalizable across demographic subgroups (e.g., race/ethnicity).

Conclusions: Teaching people with anxiety or depression strategies to increase positive thoughts, behaviors, and emotions may reduce social disconnection by engaging biobehavioral processes that regulate responses to social rewards.