4 - (SYM 7) Amplifying Positivity to Combat Social Disconnection in Anxiety and Depressive Disorders: A Cognitive Behavioral Experimental Therapeutics Approach

Social disconnection is a pervasive and quality of life lowering feature of anxiety and depressive disorders that often persists following first-line treatments. We hypothesize these suboptimal outcomes occur because current treatments do not sufficiently engage the positive valence system (PVS; e.g., approach motivation, positive affect), which supports social bond formation and maintenance. Amplification of Positivity (AMP) uses cognitive and behavioral strategies to engage the PVS by increasing exposure and responsiveness to positive events, practicing gratitude, and engaging in kind acts towards others. Guided by the NIMH experimental therapeutics framework, two RCTs in adults (age 18-55) endorsing clinically elevated anxiety or depression with social impairment evaluated the effects of AMP on neural, behavioral, and self-report indices of the PVS (the treatment target), alongside changes in social connectedness (the treatment outcome).

Study 1 (N=68; 69% identified as female; 24% identified as Hispanic; 38% identified with a race category other than White) found that AMP 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), as well as larger improvements on approach behavior (d=0.65) and positive affect (d=0.62) during a standardized social affiliation task with an unacquainted partner. A dose-response analysis supported evaluating the briefer (5- vs. 10-session) protocol in future work. Study 2 (N=109; 64% female; 28% Hispanic; 47% non-White) did not replicate neural target engagement compared to a Stress Management Training (SMT) control condition but did replicate AMP-related improvements in approach behavior and positive affect during the social affiliation task. The degree of target engagement on the affiliation task was significantly associated with improvements in social connectedness, including when measured in naturalistic settings using ecological momentary assessment (r range = .23 to .30). Subgroup analyses will explore if treatment effects are comparable across patient characteristics measured at baseline.

Cognitive and behavioral strategies that engage positive valence processes may help reduce social disconnection in people with anxiety or depressive disorders.