One summer several years ago, Harry Creffield got a dream job acting in a play in Cornwall, a vacation destination on England’s southern coast. The actor and comedian was given free accommodations and plenty of time outside of rehearsals and performances to explore the picturesque cliffs and beaches.
And yet, he spent most of the summer feeling depressed.
“It felt like I was watching my experiences on television or something,” Creffield said. Even though working in Cornwall was the kind of opportunity he had been dreaming of, he said, “it just didn’t connect with me or make me feel anything at all. And I was constantly in my head thinking, if this isn’t making me happy, maybe I just never can be.”
The feeling Creffield is describing is called “anhedonia” — the inability to experience joy or pleasure. It’s one of the most common and dangerous symptoms of depression — but it’s often not one psychologists treat.
“We do a pretty good job of helping people feel less bad,” said Steven Hollon, a professor of psychology at Vanderbilt University who has studied depression and anxiety for decades. Hollon noted that psychotherapy and medication can be very effective at reducing negative emotions. What has been more elusive is getting people with depression or anxiety to actually feel good.
A study published recently in JAMA targeted anhedonia using a relatively new therapy called positive affect treatment. The researchers wondered what would happen if they tried to make people feel good, rather than just less bad.
According to Hollon, the results were striking. “They’re moving things I haven’t been able to move,” he said.
What is positive affect treatment?
Positive affect treatment, or PAT, is designed to help people find more joy, connection and meaning.
“This is a paradigm shift from how therapies are usually designed,” said Anne Haynos, an assistant professor of clinical psychology at Virginia Commonwealth University.
Haynos said that when a patient seeks out therapy or treatment, the goal of the clinician is usually to solve the problem: to make them feel less depressed or help them overcome a phobia or social anxiety. PAT targets the other end of the emotional spectrum: During 15 weekly therapy sessions, patients are taught a variety of skills that boost mood, such as introducing positive activities into their lives and focusing on the enjoyment of those experiences.
“We know that anhedonia develops when the brain’s reward system becomes less responsive to positive experiences,” said Alicia Meuret, a clinical psychologist and professor of psychology at Southern Methodist University and lead author on the new study. “Positive affect treatment aims to help people rebuild that capacity to experience pleasure and motivation when positive mood is low by directly targeting the brain’s reward system.”
How does it work?
In a series of three randomized clinical trials (the gold standard in scientific research), Meuret and her colleagues have shown evidence that positive affect treatment may be more effective than traditional therapy at helping people retrain their brains to feel more positive emotions — and less negative ones. That second part was a surprise.
“We didn’t expect that,” Meuret said. “We expected that PAT would be better for improving positive affect, anhedonia, and NAT [or negative affect treatment — therapy focused on decreasing symptoms of depression and anxiety like anger or sadness] would be better for decreasing negative affect. But in all cases, PAT was superior. That was a really important finding, and particularly that we were able to replicate that three times.”
Michelle Craske is a distinguished professor in UCLA’s Department of Psychology and another researcher on the series of trials. She and Meuret developed positive affect treatment together and wrote workbooks for clinicians and patients. In her lab and others, there have been promising signs that people who go through PAT actually do change the neural pathways in their brains.
“They’re reacting to things more, they’re activating those regions of the brain that typically are engaged when we’re looking forward to something positive or we’re experiencing something more positively,” Craske said. “There are definite neurobiological pathways that we’re tapping into here with this treatment.”
The study did have some limitations, and its authors noted that more research with larger sample sizes is needed.
“You’d want to see it replicated and other people doing it,” Hollon said. “But these guys are targeting feeling good.”
A little more joy
We all have positive and negative emotions, and both are necessary for our survival. If we didn’t feel fear or pain, we wouldn’t learn to avoid threats. But if we don’t feel enough joy when we have positive experiences, our brain doesn’t reap the rewards or learn to repeat the positive behaviors. Suddenly, going to a friend’s party or going for a jog doesn’t feel worth the effort. It’s easier to stay in bed.
If someone is experiencing clinical depression, it’s always best to seek out professional help. But Craske and Meuret said there are also lessons from positive affect treatment that all of us can use to feel a little happier.
Make plans. Ask a friend to do something fun, and spend time looking forward to whatever will be pleasurable about the activity, no matter how small. One key, the researchers said, is not waiting until you feel motivated. Meuret compared feeling “blah” to the law of inertia — an object at rest stays at rest, and an object in motion stays in motion. If you keep taking positive steps, you’ll eventually gain momentum.
Savor the good moments. Often when people are depressed or unhappy, they are overly focused on the negative. You can retrain your brain by finding the positives in any situation and refocusing on your enjoyment of them.
“We ask patients to go to a social gathering and attend to their positive feelings in that moment,” Meuret said. “What did the food taste like? What did it feel like to talk to this friend that you haven’t seen for a while?”
Find the silver linings. Not all experiences are positive, but with enough time and reflection you may be able to find an upside even when contemplating your worst moments. The goal isn’t to ignore negative emotions but to increase resilience and help your brain be more attuned to reasons to feel hopeful.
Practice generosity and kindness. Not just because it’s nice, but because it also boosts your mood.
Finding joy is a skill that requires practice, Meuret said. “Of course, everyone has days when they feel unmotivated, when they feel that it’s difficult to have positive feelings, when they feel disconnected, when they feel unfulfilled. And so, those PAT skills can really help shift this state by intentionally refocusing one’s attention to the positive aspects of an experience.”
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