Examining the Effectiveness and Feasibility of a Self-Guided Version of Positive Affect Treatment
Anxiety disorders and depression are among the most prevalent mental disorders with close to one third of the population meeting diagnostic criteria at some point during their lifetimes (Kessler et al., 2005; 2012). Cognitive and behavioral therapies (CBT) are considered to be the most efficacious and empirically supported psychosocial interventions for anxiety and depression (Hofmann & Smits, 2008; Norton & Price, 2007; Tolin, 2010). While research indicates CBT to be superior to several other treatments, placebos, and waitlist controls, there is evidence that not every individual benefits from CBT and response rates hover around 50% at post-treatment (Loerinc et al., 2015). There are also several barriers to evidence-based outpatient treatment for anxiety and depression including cost effectiveness, adherence to the CBT model, and clinical attitudes about delivering evidence-based treatments (Addis, 2002; Barlow, 2004; Barlow et al., 1999; Chorpita & Nakamura, 2004). To address the barriers, researchers have begun developing self-guided or internet-based delivery of CBT. Research indicates no differences in effectiveness between self-guided CBT and traditional face-to-face CBT (Cuijpers et al., 2010; Hedman et al., 2012). Additionally, reliance upon the DSM for clinical decision-making does not appropriately align with neuroscience or genetics (Insel et al., 2010) and recent research suggests that anxiety disorders and depression share common higher-order constructs (Brown, 2007). The Research Domain Criteria (RDoC) is an initiative designed to address these limitations (Insel et al., 2010). Thus, using the principals of RDoC, this study sought to examine the effectiveness of a self-guided approach to the treatment of deficits in reward sensitivity using a positive affect protocol. Participants who self-referred for treatment and met criteria for Depression (CSR >4) on the SCID 5 (First et al., 1994) were recruited for the study. Utilizing a multiple baseline experimental design, participants were randomized to a 2, 4, or 6-week baseline prior to treatment administration to test the effects of the positive affect intervention on symptoms of depression and anxiety. The 15-session intervention included pleasant events scheduling, attending to the positive, and cultivating positive emotions. The daily measures largely did not reflect that symptoms remained stable during the baseline phase and reduced during the intervention period. We did find, however, that symptoms of depression and anxiety decreased overall on pre/post measures of depression and anxiety symptoms. Additionally, diagnosis severity of depression decreased for all participants on the SCID 5.