Reward Processes as Risk Factors and Treatment Targets for Depression and Anxiety

Threat and reward sensitivity are fundamental processes that become dysregulated in the context of vulnerability to, or expression of, anxiety and depression. Treatments have traditionally targeted reductions in threat sensitivity with limited effects upon reward mechanisms. Investigation of reward processes is essential for our understanding of anxiety and depression and for targeted treatment approaches. I will present our latest findings regarding neural, behavioral and subjective features of reward responding that correlate with and predict anxiety, depression and anhedonia. These findings led us to develop a treatment that specifically targets reward processes, termed Positive Affect Treatment, which we have shown to be more effective than cognitive behavioral therapy that specifically targets negative affect and threat sensitivity. I will present our replication study in anxious, depressed and extremely low positive affect individuals, where the symptomatic outcomes occur in parallel with changes in target measures of reward anticipation and attainment. I will also present findings from virtual reality technologies for delivering aspects of Positive Affect Treatment. I will conclude with evidence for reward-related mechanisms within the context of exposure therapy for fears and anxiety, and potential methods for targeting such mechanisms.