Amplification of Positivity Treatment for Anxiety and Depression: A Randomized Experimental Therapeutics Trial Targeting Social Reward Sensitivity to Enhance Social Connectedness

BackgroundSocial disconnection is common and impairing in anxiety and depressive disorders and does not respond sufficiently to available treatments. The positive valence system supports social bond formation and maintenance yet is often hyporesponsive in those with anxiety or depression. We conducted an experimental therapeutics trial testing the hypothesis that targeting positive valence processes through cognitive and behavioral strategies would enhance responsivity to social rewards, a core mechanism underlying social connectedness.MethodsN=68 adults endorsing clinically elevated anxiety and/or depression with social impairment were randomized 1:1:1 to 5- (n=23) or 10-sessions (n=22) of Amplification of Positivity (AMP) treatment or waitlist (n=23). Pre- to post-treatment change in striatal activity (primary outcome) during social reward anticipation measured using functional magnetic resonance imaging; reactivity to a social affiliation task (secondary); and self-reported social connectedness (exploratory) were examined. Primary analyses compared AMP (doses combined) vs. waitlist. A second aim compared doses.ResultsAMP engaged the hypothesized treatment target – leading to greater striatal activation during anticipation of social rewards versus waitlist (d=1.01 [95% CI 0.42, 1.61]; largest striatal volume). AMP yielded larger improvements on positive affect and approach behavior during the affiliation task (but not other outcomes), and social connectedness. Larger striatal and social connectedness increases were observed for 5- vs. 10-session AMP (d range=0.08-1.03).ConclusionsTeaching people with anxiety or depression strategies to increase positive thoughts, behaviors, and emotions enhances activity in brain regions governing social reward processing and promotes social connectedness. Social reward sensitivity may be a transdiagnostic target for remediating social disconnection.