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

IF 16.8 Q1 PSYCHOLOGY, MULTIDISCIPLINARY Nature reviews psychology Pub Date : 2024-09-16 DOI:10.1038/s44159-024-00355-4
Michelle G. Craske, Barnaby D. Dunn, Alicia E. Meuret, Sakina J. Rizvi, Charles T. Taylor
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Abstract

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.

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治疗抑郁、焦虑和创伤时的积极情绪和奖赏处理
无法体验快乐或对活动不感兴趣(临床上通常称为失乐症)是抑郁症、焦虑症、创伤后应激障碍和其他精神疾病的特征。积极情绪减退和失乐症预示着长期的不良后果,但传统的心理治疗对积极情绪的影响不大。在本综述中,我们将探讨积极情绪减退和失乐症对抑郁症、焦虑症和创伤的影响,并提出证据表明奖赏处理存在潜在缺陷。我们介绍了旨在增加积极情绪的心理治疗方法,包括专门针对奖赏低敏感性的新兴疗法和神经认知训练计划,以及证明其疗效的辅助证据。我们认为,从主要侧重于缓解消极情绪(目前的黄金标准)的治疗模式转向增强奖赏处理和积极情绪的治疗模式,将被证明对提高心理健康患者的治疗反应和整体生活质量具有重要价值。
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