Positive Valence System Enhancement Treatment for Anxiety and Depression: Clinical Efficacy and Neural Changes

Current treatment approaches for anxiety and depression emphasize the reduction of negative
emotions and distress as the central goal of treatment. However, these conditions are also
characterized by low levels of positive emotions, which, although fundamental for life
satisfaction and well-being, have traditionally not been a focus of treatment. The proposed
project aims to test the efficacy of an integrated treatment regimen designed to modulate
functioning of core component processes of the positive emotion system. Specifically, we
will implement positive emotion enhancement procedures, previously tested and validated in
non-clinical samples (Huffman et al., 2011; Lyubomirsky et al., 2005), in a broad community
sample of n=30 individuals seeking treatment for anxiety or depression. Participants will be
randomly assigned to a multi-session positive valence system targeted treatment (n=15) or a
waitlist control group (n=15). Participants will be assessed at baseline and post-treatment
and compared on measures of positive and negative emotions, brain responses to reward and
punishment/loss, subjective well-being, and symptoms. Aim 1 will test the hypothesis that
participants assigned to the positive emotion enhancement intervention will display greater
increases in positive affect and enhanced activity in neural systems that regulate responses
to reward (e.g., nucleus accumbens) relative to participants in the waitlist control group.
Aim 2 will explore whether the effects of the positive emotion system treatment generalize
to parallel measures of the negative emotion system (i.e., negative affect and neural
reactivity to aversive outcomes). We will also explore the effects of the intervention on
subjective well-being and life satisfaction, and will examine the relationship between
changes in subjective emotions and neural indices of positive and negative valence
functioning with changes in well-being and life satisfaction.

Inclusion Criteria:

1. Score on the PHQ-9 is 10 or higher and/or score on the OASIS is 8 or higher.

2. Between the ages of 18-55, inclusive.

3. Have sufficient proficiency in the English language to understand and complete
interviews, questionnaires, and all other study procedures.

Exclusion Criteria:

1. No telephone or easy access to telephone.

2. Any substance use disorder in the past year except subjects with mild alcohol,
nicotine, caffeine, and marijuana use disorders will be permitted in the study.

3. Bipolar I or Psychotic disorders.

4. Moderate to severe traumatic brain injury with evidence of neurological deficits,
neurological disorders, or severe or unstable medical conditions that might be
compromised by participation in the study.

5. Current and regular use (more days than not during the past 30 days) of a medication
that could affect brain functioning, such as anxiolytics, antipsychotics,
antidepressants, mood stabilizers, beta-blockers, sleep medications, opioids/codeine,
migraine medications.

6. MRI contraindications including: cardiac pacemaker, metal fragments in eyes/skin/body
(shrapnel), aortic/aneurysm clips, prosthesis, by-pass surgery/coronary artery clips,
hearing aid, heart valve replacement, shunt (ventricular or spinal), electrodes,
metal plates/pins/screws/wires, or neuro/bio-stimulators (TENS unit), persons who
have ever been a metal worker/welder, history of eye surgery/eyes washed out because
of metal, vision problems uncorrectable with lenses, inability to lie still on one's
back for 60 minutes; prior neurosurgery; tattoos with metal dyes, unwillingness to
remove body piercings, and pregnancy.

7. non-correctable vision or hearing problems, as some tests require intact sensory
functioning.

8. Concurrent psychosocial treatment: Participants completing ongoing psychosocial
treatment will be required to meet a 12-week stability criteria so that symptom
changes as a result of other psychosocial treatments are not confounded with changes
due to the research.

9. Inability to complete the initial assessment battery or treatment sessions.

10. Clinical conditions assessed by the interviewer that necessitate more imminent
clinical care (e.g., active suicidal ideation). These criteria are in place so
participants with these other, more several symptoms can be referred for appropriate
mental health services.