Depression is often described as deep sadness, but for many people the hardest part is something quieter- joy stops making an appearance.
A new randomized clinical trial suggests that a therapy built to restore positive emotions may improve depression and anxiety more than treatment focused mainly on reducing negative emotions.
The symptom is called anhedonia, which means a reduced ability to feel pleasure from things that once mattered, like music, food, hobbies, or time with friends.
It affects nearly 90 percent of people with major depression and is tied to longer illness, harder recovery, and suicide risk, yet many standard treatments barely address it directly.
Why joy can disappear
Anhedonia is not laziness. It is a change in how the brain and mind respond to rewards, meaning the everyday signals that make a person want something, enjoy it, and remember that it was worth doing again.
That system helps explain why a favorite song can lift your mood, or why a small win at school or work can carry you through the day. When it weakens, life can feel flat even when the person knows, logically, that something should feel good.
The study was written by Alicia E. Meuret, David Rosenfield, Emily Wang, Christina M. Hough, Thomas Ritz, and Michelle G. Craske, with teams based at Southern Methodist University and the University of California, Los Angeles.
“It’s not enough to take away the bad,” Meuret said, pointing to the need to rebuild meaning, joy, and connection.
A therapy aimed at reward
The treatment is called Positive Affect Treatment, or PAT. It is a 15-session psychotherapy designed to rebuild joy, purpose, motivation, and sensitivity to reward, not by pretending life is easy, but by training attention and behavior toward experiences that can still matter.
In practical terms, that means patients may work on planning rewarding activities, noticing positive moments, practicing gratitude, savoring good experiences, and strengthening habits such as generosity and loving-kindness. This is not a “just cheer up” message.
It is structured therapy aimed at a specific part of depression that often gets left behind.
PAT differs from many conventional approaches because it focuses exclusively on positive affect. That makes the findings stand out, since patients improved not only in positive measures but also in depression and anxiety symptoms, even though the therapy did not directly target negative emotions.
How the trial worked
The randomized clinical trial included 98 adults with severely low positive affect and moderate to severe depression or anxiety that interfered with daily life. Participants were assigned to either PAT or negative affect treatment, a comparison therapy focused on reducing threat, fear, and negative emotions.
Both groups received 15 weekly one-on-one sessions delivered by telehealth. The comparison therapy used tools from evidence-based treatment, including exposure to feared situations, cognitive strategies, and breathing training, while avoiding pleasant activity scheduling so it stayed focused on threat.
The researchers tracked clinical status through positive affect, interviewer-rated anhedonia, depression, and anxiety. They also examined reward and threat processing, which means how people anticipate good things, respond when they happen, learn from them, and react to possible danger.
What changed in patients
PAT produced greater improvement in overall clinical status than the comparison therapy. That advantage was still present one month after treatment ended, and patients also showed reductions in depression and anxiety symptoms.
The team used nine reward measures and five threat measures to look under the hood of the change. Six of seven self-reported reward and threat measures helped explain the clinical gains, while behavioral and physiological measures did not show the same effect.
That detail matters. It suggests patients’ own reports of motivation, pleasure, and threat may capture important shifts in therapy, but it also shows that the biological picture is not fully settled yet. The brain is not a light switch.
Why this matters
For decades, depression care has often focused on turning down emotional pain. That can be essential, but many patients also want something more basic and more human. They want to feel alive again.
Earlier work had already pointed in this direction. A 2019 clinical trial tested whether treatment aimed at reward sensitivity could help people with depression or anxiety and anhedonia, while a 2023 study found that targeting positive affect led to stronger gains in clinical status and reward sensitivity than targeting negative affect.
The new study adds weight because it tested PAT again and looked more closely at the mechanisms behind the improvement. In everyday language, the question was simple. Can therapy help people not only suffer less, but also want, enjoy, and learn from good experiences again?
A careful next step
The findings do not mean people should stop current depression or anxiety treatment. The trial was relatively small, and the follow-up lasted one month, so larger studies with longer durations will be needed to see how well the benefits hold across different groups and care settings.
Still, the direction is important. A treatment that targets anhedonia directly could help fill a gap for patients who say the sadness may fade, but the color has not come back.
The research was supported by the National Institute of Mental Health, and the study reported that the funder had no role in the design, analysis, or publication decision.
The official study was published in JAMA Network Open.
