3 - (SYM 130) Breaking Bad: Efficacy and Mechanisms of Positive Affect Treatment for Reward Hyposensitivity

Extant psychological and pharmacological treatments are relatively ineffective for low positive affect. Affective neuroscience has elucidated deficits in the appetitive reward system that may underlie anhedonia and should be targeted in therapy.  We determine whether a novel psychosocial treatment improves clinical outcomes and reward sensitivity (anticipation-motivation, response to attainment, and learning) more than cognitive-behavioral therapy that targets negative affect and whether improvements in reward sensitivity correlate with outcomes. Adults with clinically severe and impairing anxiety or depression with anhedonia were randomized to 15-session PAT or NAT (RCT1=96, RCT2=85; 47.3% identified as persons of color). We examined clinical improvements in anhedonia (RCT 1+2) and changes in experiential, behavioral, and physiological target measures of reward anticipation, response to reward attainment, or reward learning (RCT2).  In RCT1 (Craske, Meuret. et al. 2019), at 6-months PAT, compared to NAT, resulted in (1) greater improvements in positive affect and higher positive affect approaching normative levels in the population than NAT, (2) greater improvements in and lower levels of negative affect and symptoms of depression, anxiety, and stress, and (3) lower probability of suicidal ideation (ps < .05). In RCT2 (Craske, Meuret et al., in press), analyses replicate the findings of RCT1 (ps < .05). PAT led to greater changes in selective target measures, including increased heart rate accelerations in response to reward attainment, self-reported reward motivation and consumption, and greater behavioral disengagement of sad faces (ps < .05). PAT addresses an unmet therapeutic need by specifically targeting deficits in reward sensitivity. PAT more effectively improves positive affect, depression and anxiety, and reward sensitivity than NAT. In addition to PAT efficacy, unpublished findings on mediation and moderation will be presented.