What the SMU and UCLA Researchers Actually Did

I want to walk through this carefully because the design matters. The study, published in JAMA Network Open in 2026, was a randomized clinical trial with 98 adults (Meuret et al., 2026). All participants had severely low positive affect along with moderate to severe depression or anxiety. They were randomly assigned to one of two treatments, each delivered as 15 weekly individual therapy sessions over telehealth.

One arm received Positive Affect Treatment, or PAT. The other received Negative Affect Treatment, or NAT — a comparison condition built from established components of conventional therapy for anxiety and depression.

What PAT actually looks like

PAT was developed over more than a decade by Craske, Meuret, and colleagues to directly target the brain's reward system (Craske et al., 2019; Craske et al., 2023). Where most therapies focus on reducing what hurts, PAT focuses on rebuilding what feels good. The therapy is organized around three components of reward processing.

First, reward anticipation and motivation. Patients plan pleasurable activities and practice envisioning positive future experiences. The goal is to re-engage the part of the mind that looks forward to things.

Second, reward consumption. Patients are guided through active engagement in enjoyable activities, then trained in vivid present-focused mental rehearsal — the technical term is savoring. Cognitive strategies redirect attention toward positive aspects of experience. Structured practices cultivate positive emotions, including loving-kindness and generosity.

Third, reward learning. The therapy strengthens the association between positive behaviors and improved mood, and encourages self-attribution for positive outcomes. Patients are taught to recognize that they themselves caused something good.

I notice that none of these techniques would feel out of place in a journaling practice. Savoring, gratitude, attention redirection toward positive experience, self-attribution — these are reflective practices, not pharmacological interventions. That is part of why this study interests me.

What NAT looked like

The comparison treatment, NAT, used established evidence-based components for anxiety and depression: exposure to feared situations, cognitive restructuring of distorted appraisals, respiratory training to reduce physiological arousal. It deliberately excluded any positive-affect components to maintain its mechanistic distinction. This is the kind of therapy most people receive when they walk into a clinic with depression or anxiety today.

What they found

PAT produced greater improvements in overall clinical status than NAT (Meuret et al., 2026). The advantage held at one-month follow-up. Patients in the PAT arm showed significant reductions in depression and anxiety symptoms — even though the treatment never explicitly targeted negative affect at all.

That last detail is what stopped me. A therapy that focused exclusively on rebuilding the capacity for joy produced larger reductions in depression and anxiety than a therapy that focused exclusively on reducing them. The work of cultivating positive emotion appeared to do something the work of reducing negative emotion did not.

The researchers also identified, through extensive mediation analyses, that modulation of reward and threat processes was the central mechanism driving these gains. Of seven self-reported reward and threat measures, six mediated clinical outcomes.

The next chapter is about a single sentence from one of the researchers that has stayed with me.

References

Craske, M. G., Meuret, A. E., Ritz, T., Treanor, M., Dour, H., & Rosenfield, D. (2019). Journal of Consulting and Clinical Psychology, 87(5), 457-471.

Craske, M. G., Meuret, A. E., Echiverri-Cohen, A., Rosenfield, D., & Ritz, T. (2023). Journal of Consulting and Clinical Psychology, 91(6), 350-366.

Meuret, A. E., Ritz, T., Craske, M. G., et al. (2026). JAMA Network Open.