Michael Treanor’s research while affiliated with University of California, Los Angeles and other places

Objective: Positive and negative affect play critical roles in depression and anxiety treatment, but the dynamic processes of how affect changes over treatment in relation to changes in symptoms is unclear. The study goal was to examine relationships among changes in positive and negative affect with changes in depression and anxiety symptoms. Method: This secondary analysis used a combined sample (N = 196) of two trials (Craske et al., 2019, 2023) comparing positive affect treatment (PAT) to negative affect treatment. Longitudinal cross-lag panel models explored whether changes in positive and negative affect (Positive and Negative Affect Schedule; Watson et al., 1988) predicted subsequent changes in depression and anxiety symptoms (Depression Anxiety Stress Scales; Lovibond & Lovibond, 1995), whether symptoms predicted subsequent changes in affect, and whether treatment condition moderated these relationships. Results: Increases in positive affect predicted subsequent decreases in depression and anxiety symptoms, regardless of treatment condition. Symptoms did not reciprocally predict changes in positive affect. For individuals in PAT, decreases in negative affect predicted subsequent decreases in symptoms. Moreover, decreases in symptoms predicted subsequent decreases in negative affect, regardless of treatment condition. Conclusions: Results did not support a reciprocal relationship between positive affect and symptoms of depression and anxiety since positive affect predicted depression and anxiety symptoms but not vice versa. Results supported a reciprocal relationship between negative affect and symptoms of depression and anxiety since negative affect predicted depression and anxiety symptoms in PAT, and depression and anxiety symptoms predicted negative affect in both treatment conditions.

Cognitive behavioral therapy (CBT) focuses on decreasing negative affect rather than increasing positive affect and is ineffective for some individuals. A trial comparing novel Positive Affect Treatment (PAT) to Negative Affect Treatment (NAT; a form of CBT) showed that PAT more effectively increased positive affect and decreased negative affect, depression, and anxiety (Craske et al., 2019). The present exploratory study examined threat sensitivity as a treatment moderator. Threat sensitivity was operationalized as pre-treatment skin conductance response and unconditional stimulus (US) expectancy rating during extinction recall. Participants ( N = 43) then received 15 sessions of PAT or NAT. Growth curve models were tested to explore interactions between extinction recall and treatment condition over time. For skin conductance, weaker extinction recall predicted faster improvement in depression and anxiety in NAT than PAT, whereas stronger extinction recall predicted faster improvement in symptoms in PAT than NAT. Reduced US expectancy ratings predicted a faster decrease in symptoms, regardless of treatment condition. Individuals showing greater threat sensitivity, indexed by weaker extinction recall, may benefit more from a treatment that targets threat sensitivity than a treatment that targets reward sensitivity. Individuals showing the converse may benefit more quickly from a treatment that targets reward sensitivity than threat sensitivity.

Background and objectives: Fear activation and reduction have traditionally been considered important mechanisms of exposure therapy. Evidence to date is mixed and impeded by inadequate methodology. This study examined the extent to which fear activation and reduction within and across exposures predicted treatment outcomes for social anxiety disorder within a paradigm suitable for their measurement. Methods: Sixty-eight adults with social anxiety disorder and fear of public speaking completed seven exposure sessions, each consisting of seven speeches conducted in virtual reality. Exposures were identical in duration, task requirements, and virtual public speaking situation. Fear was measured with skin conductance and subjective distress ratings. At baseline and post-treatment, participants completed a public speaking behavioral approach test with a panel of confederate judges; subjective fear was measured. A standardized questionnaire of anxiety symptoms was administered at baseline, post-treatment, and one-month follow-up. Results: No indices of within- or between-session fear reduction, measured by subjective distress and skin conductance response, predicted treatment outcome. One measure of fear activation was associated with outcomes such that less activation predicted greater symptom reduction; remaining indices did not predict outcomes. Limitations: Data were collected in the context of a randomized controlled trial of scopolamine; drug group was included in analytic models to account for drug influence. VR exposures elicited mild levels of distress that may underestimate levels of distress in clinical settings. Conclusions: Findings failed to support fear activation or reduction within or across exposure sessions as significant predictors of treatment outcome for social anxiety. Treatment implications are discussed.

Positive Affect Treatment for Depression and Anxiety: Therapist Guide contains step-by-step detailed procedures for assessing and treating specific problems and diagnoses. According to the growing consensus, evidence-based practice offers the most responsible course of action for mental health professionals. The guide is intended for clinicians familiar with cognitive–behavioral therapy (CBT) and clinical presentations of depression, anxiety, and anhedonia. Positive Affect Treatment (PAT) was developed to specifically target areas of reward sensitivity that are believed to contribute to anhedonia. The treatment is expected to be an indispensable resource for all practitioners who wish to effectively and efficiently help individuals regain and improve their quality of life.

Positive Affect Treatment for Depression and Anxiety: Therapist Guide contains step-by-step detailed procedures for assessing and treating specific problems and diagnoses. According to the growing consensus, evidence-based practice offers the most responsible course of action for mental health professionals. The guide is intended for clinicians familiar with cognitive–behavioral therapy (CBT) and clinical presentations of depression, anxiety, and anhedonia. Positive Affect Treatment (PAT) was developed to specifically target areas of reward sensitivity that are believed to contribute to anhedonia. The treatment is expected to be an indispensable resource for all practitioners who wish to effectively and efficiently help individuals regain and improve their quality of life.

Positive Affect Treatment for Depression and Anxiety: Therapist Guide contains step-by-step detailed procedures for assessing and treating specific problems and diagnoses. According to the growing consensus, evidence-based practice offers the most responsible course of action for mental health professionals. The guide is intended for clinicians familiar with cognitive–behavioral therapy (CBT) and clinical presentations of depression, anxiety, and anhedonia. Positive Affect Treatment (PAT) was developed to specifically target areas of reward sensitivity that are believed to contribute to anhedonia. The treatment is expected to be an indispensable resource for all practitioners who wish to effectively and efficiently help individuals regain and improve their quality of life.

Positive Affect Treatment for Depression and Anxiety: Therapist Guide contains step-by-step detailed procedures for assessing and treating specific problems and diagnoses. According to the growing consensus, evidence-based practice offers the most responsible course of action for mental health professionals. The guide is intended for clinicians familiar with cognitive–behavioral therapy (CBT) and clinical presentations of depression, anxiety, and anhedonia. Positive Affect Treatment (PAT) was developed to specifically target areas of reward sensitivity that are believed to contribute to anhedonia. The treatment is expected to be an indispensable resource for all practitioners who wish to effectively and efficiently help individuals regain and improve their quality of life.