Anhedonia reduces the ability to feel joy and affects nearly 90% of people with major depression. Most conventional therapies do little to treat it.
Most people think of depression as a disorder defined by sadness. For millions of patients, however, one of the most disabling symptoms is different: a reduced ability, or complete inability, to feel positive emotions.
Anhedonia affects nearly 90% of people with major depression. It is linked to longer and more severe illness, makes recovery harder, and is a major predictor of suicidal behavior. It also occurs in anxiety disorders, PTSD, substance use disorders, and schizophrenia, yet most standard therapies do not directly treat it.
For decades, depression treatment has focused mainly on reducing negative emotions, leaving the loss of positive emotion largely overlooked. Many patients, however, say their main goal is to regain positive feelings, even more than reducing negative symptoms.
A new study in JAMA Network Open by SMU psychologists Alicia E. Meuret and Thomas Ritz, along with Michelle G. Craske at UCLA, suggests that directly targeting positive emotions may be a more effective treatment strategy. The work brings together more than a decade of clinical trials on Positive Affect Treatment, or PAT, a 15 session psychotherapy designed to help restore joy, purpose, motivation, and sensitivity to reward.
“There’s a difference between feeling helpless and feeling hopeless,” said Meuret, who leads the Anxiety and Depression Research Center at SMU. “When you feel helpless, you still have the drive and the will to want to change things. When people feel hopeless, they don’t believe anything will change. That’s what anhedonia can look like, and taking away negative emotions doesn’t fix it.”
Targeting the brain’s reward system
PAT was created to act directly on the brain’s reward system, which helps people look forward to positive experiences, feel pleasure from them, and learn from rewarding events. The therapy aims to retrain what the researchers describe as the brain’s “positive system” through exercises that reconnect patients with rewarding activities, shift attention toward positive experiences, and strengthen habits such as gratitude, savoring, and loving kindness.
Unlike many conventional treatments, which focus directly on negative emotions, PAT works entirely through positive affect. That makes the findings especially notable: patients improved on both positive and negative measures, even though the therapy did not directly target negativity.
In a randomized controlled trial involving 98 adults with severe anhedonia, depression, and anxiety, PAT led to greater improvements in overall clinical status than a conventional therapy focused on negative affect. That advantage remained at the one-month follow-up. Patients also had significant reductions in symptoms of depression and anxiety. The researchers found that changes in reward and threat processing were central to those improvements.
Reducing key risk factors in depression and anxiety
The researchers concluded that improving impaired reward processing is important for reducing major risk factors in depression and anxiety, including suicidality and relapse.
“It’s not enough to take away the bad,” Meuret said. “Treatment needs to ask: Is this activity meaningful to you? Will it give you joy or a sense of accomplishment? Does it foster connection?”
The study used 9 measures to track changes in reward sensitivity across three areas: anticipation and motivation for reward, response after receiving a reward, and reward learning. It also included 5 measures of threat processing, based on self-report, behavioral tasks, and physiological assessments. Six of the seven self-reported reward and threat measures helped explain clinical outcomes. Behavioral and physiological measures did not show the same effect.
Reference: “Positive Affect Treatment for Depression, Anxiety, and Low Positive Affect: A Randomized Clinical Trial” by Alicia E. Meuret, David Rosenfield, Emily Wang, Christina M. Hough, Thomas Ritz and Michelle G. Craske, 24 April 2026, JAMA Network Open.
DOI: 10.1001/jamanetworkopen.2026.7403
The research was supported by the National Institute of Mental Health under Award R61MH115138 (PIs Craske, Meuret, Ritz).
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