Positive Affect Treatment For Depression And Anxiety: Therapist Guide

The Positive Affect Treatment For Depression And Anxiety therapist guide provides step-by-step instructions and evidence-based strategies for supporting individuals with depression and anxiety. A client workbook is downloadable separately.

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Chapter 1: Introductory Information for Therapists

Chapter 2: Behavioral Science and Neuroscience Identify Targets For Treatment of Anhedonia

Chapter 3: General Treatment Format and Guiding Therapy Principles

Chapter 4: Psychoeducation

Chapter 5: Actions Toward Feeling Better

Chapter 6: Attending to the Positive

Chapter 6: Audio – Imagining the Positive

Chapter 7: Building Positivity

Chapter 7: Audio – Loving-Kindness

Chapter 7: Audio – Appreciative Joy

Chapter 8: Continuing the Journey After Treatment

Appendix

References

Front Matter

Overview

Positive Affect Treatment (PAT) is an evidence-based intervention targeting anhedonia – a reduced ability to experience pleasure – commonly seen in depression and anxiety. Unlike traditional approaches that focus on reducing negative emotions, PAT addresses deficits in the brain’s reward system, such as reduced anticipation of rewards, diminished enjoyment, and difficulty learning from positive experiences. Drawing from behavioral science and affective neuroscience, PAT combines behavioral activation, cognitive strategies, and experiential practices. Clients are guided to engage in meaningful activities, savor positive memories, identify silver linings, imagine positive futures, and cultivate gratitude and loving-kindness. These techniques aim to enhance responsiveness to rewarding experiences. Clinical trials show PAT improves positive affect, depression, anxiety, and well-being by building the ability to anticipate, enjoy, and learn from rewards. By directly targeting anhedonia, PAT offers a promising, comprehensive approach to restoring emotional vitality.

Why Use This Resource?

This program provides a step-by-step, structured approach for depression and anxiety. It includes:

  • Detailed explanations of cognitive-behavioral principles tailored to depression and anxiety.
  • Evidence-based interventions for overcoming mood problems.
  • Practical guidance for structuring sessions and implementing client exercises.
  • Strategies for overcoming common obstacles during treatment.

Key Benefits

Structured

Offers a clear, session-by-session outline for delivering effective therapy.

Educational

elps clients understand the nature of their difficulties.

Effective

Supports therapists in implementing effective interventions for addressing depression and anxiety.

Trusted

Part of the Treatments That Work™ series, developed by leading experts.

Who is this for?

Depression

Characterized by persistent low mood and loss of interest.

Generalized Anxiety Disorder

Chronic worry or excessive nervousness.

Integrating it into your practice

01

Assessment

Explore how clients experience depression or anxiety.

02

Psychoeducation

Teach clients about mood problems and what maintains them.

03

Skills

Implement effective cognitive-behavioral interventions to address key symptoms.

04

Monitoring

Use structured worksheets to track progress and refine interventions.

05

Relapse Prevention

Equip clients with long-term strategies for maintaining their progress.

Theoretical Background & Therapist Guidance

Anhedonia, a core feature of many mental health conditions, involves a diminished ability to experience pleasure or interest in life’s usual activities. It is prevalent across various disorders, including depression, anxiety, psychosis, and substance use, serving as a significant predictor of poor psychosocial functioning, treatment resistance, and suicidality (Ducasse et al., 2018; Winer et al., 2014). Despite its profound impact, traditional psychological and pharmacological treatments have largely emphasized reducing negative affect, often neglecting the deficits in the reward system that underlie anhedonia (Craske et al., 2016).

To address these limitations, positive affect treatment (PAT) was developed as an evidence-based intervention specifically targeting the reward system disruptions that characterize anhedonia. PAT’s theoretical framework is rooted in the dual-systems model of emotion regulation, which emphasizes the interplay between the approach system (linked to positive affect) and the avoidance system (linked to negative affect) in shaping behavior and emotional responses (Lang & Bradley, 2013). By enhancing the reward system’s functionality, PAT aims to restore balance and improve overall emotional well-being.

PAT employs a multi-faceted approach to systematically build “wanting,” “liking,” and “learning” capacities related to reward responsiveness. The treatment integrates strategies across three domains:

  • Action towards feeling better: This foundational intervention encourages clients to plan and engage in positive activities that provide pleasure, accomplishment, or align with personal values. Activities are designed to enhance the anticipation (“wanting”) and enjoyment (“liking”) of rewards. Memory specificity training, or “Savoring the Moment,” deepens the hedonic impact of these experiences by guiding clients to visualize and recount positive events vividly, focusing on sensations, thoughts, and emotions (Barry et al., 2019; Yang et al., 2018).
  • Attending to the positive: PAT introduces a distinct cognitive approach aimed at redirecting attention to positive experiences, fostering appreciation for past achievements, and imagining future rewards. Techniques such as “Finding the Silver Linings” help clients identify positive elements in everyday situations, while “Taking Ownership” and “Imagining the Positive” strengthen self-efficacy and anticipation of joy (Holmes et al., 2006; Pictet et al., 2011). These strategies enhance both “liking” and “learning” by reinforcing positive emotional associations.
  • Building positivity: PAT includes experiential exercises such as loving-kindness meditation, gratitude practices, and acts of generosity to cultivate and sustain positive emotions (Fredrickson et al., 2008). These activities are designed to improve interpersonal connections, self-compassion, and mood while reinforcing the brain’s reward pathways (Hofmann et al., 2015; Snippe et al., 2018).

A randomized controlled trial comparing PAT with negative affect treatment (NAT), a cognitive-behavioral therapy intervention, demonstrated PAT’s superior efficacy in fostering positive affect and reducing symptoms of anxiety, depression, stress, and suicidality. Participants in the PAT group showed significant improvements in positive affect, with scores on the Positive and Negative Affect Schedule (PANAS) reaching population norms by the end of treatment and maintained at a six-month follow-up. Notably, PAT also significantly reduced negative affect compared to NAT, highlighting its dual effectiveness in addressing emotional dysregulation.

The program includes two books:

  • Positive Affect Treatment For Depression And Anxiety: Therapist Guide
  • Positive Affect Treatment For Depression And Anxiety: Workbook

Authored by leading psychologists including David Barlow, Michelle Craske and Edna Foa, Treatments That Work™ is a series of manuals and workbooks based on the principles of cognitive behavioral therapy (CBT). Each pair of books (Therapist/Clinician Guide and Workbook) – contains step-by-step procedures for delivering evidence-based psychological interventions and will help you to provide the best possible care for your clients.

At Psychology Tools, we are proud to make many of the Treatments That Work™ titles available to our members. Each book is available to download chapter-by-chapter, and Psychology Tools members with a currently active subscription to our ‘Complete’ plan are licensed to share copies with their clients.

What's inside

  • A structured, session-by-session treatment manual.
  • Therapist checklists and progress monitoring tools.
  • Detailed guidance for implementing cognitive-behavioral interventions for eating disorders.
  • Case examples and troubleshooting tips for common challenges.
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FAQs

No, this resource is designed for therapists. Clients may benefit from the companion Client Workbook, which provides exercises for independent practice.
The full program is designed to be completed over multiple sessions, but can be tailored to individual client needs.
The guide includes structured assessments and self-monitoring tools to evaluate symptom changes over time.
Encourage gradual implementation and support clients in identifying and addressing the barriers they encounter.

How This Resource Improves Clinical Outcomes

By integrating this resource into therapy, therapists are able to:

  • Deliver a structured, comprehensive treatment specifically developed for depression and anxiety.
  • Implement effective, evidence-based interventions.
  • Help clients maintain long-term gains through relapse prevention strategies.
  • Tailor treatment to meet diverse client needs.

References And Further Reading

  • Craske, M. G., Treanor, M., Dour, H. J., & Meuret, A. E. (2022). Positive affect treatment for depression and anxiety: Therapist guide. Oxford University Press.
  • Barlow, D. H. (2004). Psychological treatments. American Psychologist, 59, 869–878.
  • McHugh, R. K., & Barlow, D. H. (2010). Dissemination and implementation of evidence-based psychological interventions: A review of current efforts. American Psychologist, 65(2), 73–84.
  • Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070.