Changes in positive and negative affect during pharmacological treatment and cognitive therapy for major depressive disorder: A secondary analysis of two randomized controlled trials

Dunn, Barnaby D.; German, Ramaris E.; Khazanov, Gabi; Xu, Colin; Hollon, Steven D.; DeRubeis, Robert J.

doi:10.1177/2167702619863427

Cited by 92Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Changes in positive and negative affect during pharmacological treatment and cognitive therapy for major depressive disorder: A secondary analysis of two randomized controlled trials

Dunn, Barnaby D., German, Ramaris E., Khazanov, Gabi, Xu, Colin, Hollon, Steven D., DeRubeis, Robert J.·2020·Clinical Psychological Science

DOI 10.1177/2167702619863427

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Abstract

The cardinal symptoms of major depressive disorder (MDD) are heightened depressed mood (negative affectivity, or NA) and diminished interest or pleasure (positive affectivity, or PA). It is unknown how well treatments for MDD repair either symptom. Two secondary analyses of randomized controlled trials were therefore conducted. In Study 1, 180 adult outpatients with MDD received 16 weeks of antidepressant medication (ADM; n = 120) or cognitive therapy (CT; n = 60). In Study 2, adult outpatients with MDD were treated until remission with ADM ( n = 225) or ADM and CT ( n = 227). Across trials and treatments, intake disturbances were more marked in PA than NA, there was smaller repair of PA than NA during treatment, and disturbances remained more pronounced for PA than NA after treatment. Greater change in PA and NA were independently associated with depression symptom change. These findings suggest that depression treatments more effectively repair NA than PA and that outcomes may be improved with more effective targeting of the latter.

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First-line treatments do not sufficiently repair positive valence deficits in individuals with anxiety or depression.
“First-line treatments do not sufficiently repair positive valence deficits in individuals with anxiety or depression,(34–36) which may explain in part why social impairments persist following established treatments.(4, 5)”
From Amplification of Positivity Treatment for Anxiety and Depression: A Randomized Experimental Therapeutics Trial Targeting Social Reward Sensitivity to Enhance Social Connectedness (2024) · cites this paper as [34]
Improvements in positive affect and well-being tend to be smaller and lag behind reductions in clinical symptoms following established treatments.
“improvements in positive affect and well-being tend to be smaller and lag behind reductions in clinical symptoms following established treatments.(4, 5, 34)”
From Amplification of Positivity Treatment for Anxiety and Depression: A Randomized Experimental Therapeutics Trial Targeting Social Reward Sensitivity to Enhance Social Connectedness (2024) · cites this paper as [34]
In existing treatments for anxiety and depression, improvement in positive affect tends to be modest and does not always match changes in negative affect or symptoms, nor return to normative levels, on average.
“improvement in positive affect tends to be modest and does not always match changes in negative affect or symptoms, nor return to normative levels, on average (Dunn et al., 2020; Kring et al., 2007; Sewart et al., 2019; Strege et al., 2018).”
From Enhancing social connectedness in anxiety and depression through amplification of positivity: Preliminary treatment outcomes and process of change (2020) · cites this paper as Dunn et al., 2020

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Opportunities and Challenges for the Emerging Field of Positive Emotion Regulation: A Commentary on the Special Edition on Positive Emotions and Cognitions in Clinical Psychology
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Positive affect and reward processing in the treatment of depression, anxiety and trauma
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Psychological Treatments for Anhedonia
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Amplification of Positivity Treatment for Anxiety and Depression: A Randomized Experimental Therapeutics Trial Targeting Social Reward Sensitivity to Enhance Social Connectedness
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Preliminary clinical and cost effectiveness of augmented depression therapy versus cognitive behavioural therapy for the treatment of anhedonic depression (ADepT): a single-centre, open-label, parallel-group, pilot, randomised, controlled trial
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Parent Emotion Socialization and Positive Emotions in Child and Adolescent Clinical Samples: A Systematic Review and Call to Action
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Anhedonia in Posttraumatic Stress Disorder: Prevalence, Phenotypes, and Neural Circuitry
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Effectiveness of a Transdiagnostic guided internet-delivered protocol for emotional disorders versus treatment as usual in specialized care: randomized controlled trial
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Changes in neural reward processing following Amplification of Positivity treatment for depression and anxiety: Preliminary findings from a randomized waitlist controlled trial
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Reward-Related Neural Predictors and Mechanisms of Symptom Change in Cognitive Behavioral Therapy for Depressed Adolescent Girls
Webb, C. A., Auerbach, R. P., Bondy, E., Stanton, C. H., Appleman, L., & Pizzagalli, D. A. (2020) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2020.07.010 · Cited by 31 · see citing works
Dynamics of daily positive and negative affect and relations to anxiety and depression symptoms in a transdiagnostic clinical sample
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Positive and negative affect change following psychotherapeutic treatment for anxiety-related disorders: A systematic review and meta-analysis
Hoffman, S. N., Rassaby, M. M., Stein, M. B., & Taylor, C. T. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.01.086 · Cited by 22 · see citing works
Behavioral Activation and Brain Network Changes in Depression
Jung, M., & Han, K. (2024) · Journal of Clinical Neurology · doi:10.3988/jcn.2024.0148 · Cited by 23 · see citing works
A qualitative study exploring adolescents’ experience of brief behavioural activation for depression and its impact on the symptom of anhedonia
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Demonstration of a ‘leapfrog’ randomized controlled trial as a method to accelerate the development and optimization of psychological interventions
Blackwell, S. E., Schönbrodt, F. D., Woud, M. L., Wannemüller, A., Bektas, B., Rodrigues, M. B., Hirdes, J., Stumpp, M. T., & Margraf, J. (2022) · Psychological Medicine · doi:10.1017/s0033291722003294 · Cited by 20 · see citing works
Daily Affective Dynamics in Major Depressive Disorder: The Role of Daily Stressors and Positive Events
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Feasibility of computerised positive mental imagery training as a treatment adjunct in in-patient mental health settings: randomised controlled trial
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New Perspectives on Treatment of Depression in Coronary Heart Disease
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Targeting positive valence systems function in children of mothers with depressive symptoms: A pilot randomized trial of an RDoC-Informed preventive intervention
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EEG microstate as a biomarker of personalized transcranial magnetic stimulation treatment on anhedonia in depression.
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Neural changes in reward processing following approach-avoidance training for depression
Bomyea, J. A., Choi, S., Sweet, A. M., Stein, M. B., Paulus, M. P., & Taylor, C. T. (2021) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsab107 · Cited by 14 · see citing works
The potential of Future Event Specificity Training (FEST) to decrease anhedonia and dampening of positive emotions: A randomised controlled trial
Bogaert, L., Hallford, D. J., Loyen, E., D’Argembeau, A., & Raes, F. (2024) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12524 · Cited by 11 · see citing works
Assessing well-being in clinical research and treatment
Goodman, F. R. (2025) · Nature Mental Health · doi:10.1038/s44220-024-00381-4 · Cited by 11 · see citing works
‘It just doesn't feel right’ and other reasons why some people fear and avoid positive emotions
Bogaert, L., Dunn, B. D., Walentynowicz, M., & Raes, F. (2023) · Acta Psychologica · doi:10.1016/j.actpsy.2023.103901 · Cited by 10 · see citing works
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Experiential processing increases positive affect and decreases dampening appraisals during autobiographical memory recall in an anhedonic sample
Sandman, C. F., & Craske, M. G. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104606 · Cited by 11 · see citing works
A parallel-arm, randomized trial of Behavioral Activation Therapy for anhedonia versus mindfulness-based cognitive therapy for adults with anhedonia
Cernasov, P., Walsh, E. C., Nagy, G. A., Kinard, J. L., Kelley, L., Phillips, R., Pisoni, A., Diehl, J. M., Haworth, K., West, J. S., et al. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104620 · Cited by 11 · see citing works
Increases in positive emotions as precursors to therapeutic change
McNeil, G. D., & Repetti, R. L. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2698 · Cited by 10 · see citing works
Savoring the moment: A link between affectivity and depression
Kahrilas, I. J., Smith, J. L., Silton, R. L., & Bryant, F. B. (2020) · International Journal of Wellbeing · doi:10.5502/ijw.v10i2.779 · Cited by 11 · see citing works
A randomized controlled trial of brief behavioral activation plus savoring for positive affect dysregulation in university students
Kumar, D., Corner, S. E., Kim, R., & Meuret, A. E. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104525 · Cited by 11 · see citing works
Positive Affect Treatment for Depression, Anxiety, and Low Positive Affect
Meuret, A. E., Rosenfield, D., Wang, E., Hough, C. M., Ritz, T., & Craske, M. G. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.7403 · Cited by 9 · see citing works
Examining the relationship between anhedonia symptoms and trait positive appraisal style in adolescents: A longitudinal survey study
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Analysis on Influences of College Students’ Psychological Capital in Entrepreneurial Learning Engagement
Zhang, B., Xu, Q., Han, S. I., & Jiao, L. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.02029 · Cited by 8 · see citing works
Investigating low intensity focused ultrasound pulsation in anhedonic depression—A randomized controlled trial
Rotstein, N. M., Cohen, Z. D., Welborn, A., Zbozinek, T. D., Akre, S., Jones, K. G., Null, K. E., Pontanares, J., Sanchez, K. L., Flanagan, D. C., et al. (2025) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2025.1478534 · Cited by 7 · see citing works
The association between positive affect and depressive symptoms in individuals with diagnosed or probable major depressive disorder: A systematic review and meta-analysis
Schürmann‐Vengels, J., Kneuer, A., Cavus, Ö., & Flückiger, C. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104789 · Cited by 8 · see citing works
Cognitive behavioral therapies are evidence-based – based on what? A systematic review and meta-analysis of recent randomized controlled trials of cognitive behavioral therapies for depression
O’Toole, M. S., Ramsdal, N. B., Nørskov, C. S., Roepstorff, I. G., Buskbjerg, C. R., Mads, B., Christiansen, & Elkjær, E. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119791 · Cited by 7 · see citing works
Anhedonia in Major Depressive Disorder: Prevalence and Treatment Expectations and Satisfaction with Treatment Goals Among Patients and Physicians in Asia-Pacific
Herr, K. J., Berk, M., Huang, W.-L., Kato, T., Lee, J. G., Ng, C. G., Wang, Z., Webb, T., Kasahara‐Kiritani, M., & Vandervoort, L. (2024) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s487747 · Cited by 6 · see citing works
The Leuven Exeter Dampening Scale (LEDS) to measure dampening appraisals towards positive affect: Psychometric evaluation and initial validation in a Dutch and English community sample.
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Predictive models for social functioning in healthy young adults: A machine learning study integrating neuroanatomical, cognitive, and behavioral data
Miley, K. M., Michalowski, M., Yu, F., Leng, E., McMorris, B. J., & Vinogradov, S. (2022) · Social Neuroscience · doi:10.1080/17470919.2022.2132285 · Cited by 6 · see citing works
Levels of depressed mood and low interest for two years after response to cognitive therapy for recurrent depression
Vittengl, J. R., Clark, L. A., Thase, M. E., & Jarrett, R. B. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103996 · Cited by 6 · see citing works
Changes in positive and negative affect following prolonged exposure for PTSD comorbid with alcohol use disorder: Secondary analysis of a randomized clinical trial
Hoffman, S. N., Lyons, R. C., Stein, M. B., Taylor, C. T., & Norman, S. B. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104097 · Cited by 6 · see citing works
Targeting Positive Affect as a Way to Improve Social Anhedonia in Schizophrenia
Catalano, L. T., Patel, P. K., Weittenhiller, L. P., & Green, M. F. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf117 · Cited by 5 · see citing works
Non-invasive neuromodulation treatment for depression in adolescents: A systematic review and meta-analysis
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Aerobic Exercise Training and Depressive Symptoms in People With Multiple Sclerosis: Brief Report on Default-Mode Network Resting-State Functional Connectivity
Iosipchuk, O., Wylie, G. R., Motl, R. W., & Sandroff, B. M. (2025) · International Journal of MS Care · doi:10.7224/1537-2073.2024-003 · Cited by 4 · see citing works
Improving Positive Life Event Predictions through Cognitive Behavioral Therapy
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Evaluating a Comprehensive Model of Euthymia
Vittengl, J. R., Jarrett, R. B., Ro, E., & Clark, L. A. (2023) · Psychotherapy and Psychosomatics · doi:10.1159/000529784 · Cited by 5 · see citing works
Counteract anhedonia! Introducing an online-training to enhance reward experiencing – A pilot study
Limpächer, C., Kindt, T., & Hoyer, J. (2024) · Clinical Psychology in Europe · doi:10.32872/cpe.13751 · Cited by 3 · see citing works
The power of positivity: Exploring affective and social processes of change throughout a positive valence treatment for anxiety or depression
Rassaby, M. M., Adams, S. N., Stein, M. B., & Taylor, C. T. (2025) · Journal of Mood and Anxiety Disorders · doi:10.1016/j.xjmad.2025.100146 · Cited by 3 · see citing works
Reward Sensitivity and Noise Contribute to Negative Affective Bias: A Learning Signal Detection Theory Approach in Decision-Making
Lütkenherm, I. K., Locke, S. M., & Robinson, O. J. (2024) · Computational Psychiatry · doi:10.5334/cpsy.102 · Cited by 3 · see citing works
A qualitative study exploring depressed participants’ experiences of receiving Augmented Depression Therapy (ADepT)
Demetriou, K., Widnall, E., Warbrick, L. A., Reed, N., Marchant, K., Geschwind, N., Watson, R., Magner-Parsons, I., Barter, R., Wright, K. A., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-088726 · Cited by 3 · see citing works
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The integrated constructionist approach to emotions: A theoretical model for explaining alterations to positive emotional experiences in the aftermath of trauma
Bishop, L. S., & Reed, K. M. P. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.104008 · Cited by 5 · see citing works
The effect of positive mental imagery versus positive verbal thoughts on anhedonia
Blackwell, S. E., Rölver, A., Margraf, J., & Woud, M. L. (2024) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12626 · Cited by 5 · see citing works
TRAC: A randomised clinical trial testing the acceptability and preliminary efficacy of an exergame-augmented dynamic imagery add-on to Behavioural Activation for depression
Tiba, A., Drugas, M. I., Sîrbu, I., Trip, S., Bora, C. H., & Voss, L. (2026) · Behaviour Research and Therapy · doi:10.1016/j.brat.2026.105025 · Cited by 2 · see citing works
Examining specific and non-specific symptoms of the best-fitting posttraumatic stress disorder model in conflict-exposed adolescents
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A pilot evaluation of a training and supervision pathway for Augmented Depression Therapy (ADepT) in a Devon NHS Talking Therapies Service
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Physical activity as a tool for preventing and treating depression: Lessons learned from the COVID‐19 pandemic
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What do clients think about amplifying positivity? Client change perspectives following a cognitive and behavioural positive activity intervention for anxiety and depression
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Augmented Depression Therapy for young adults: A mixed methods randomised multiple baseline case series evaluation
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A task-invariant prior explains trial-by-trial active avoidance behaviour across gain and loss tasks
Granwald, T., Dayan, P., Lengyel, M., & Guitart‐Masip, M. (2025) · Communications Psychology · doi:10.1038/s44271-025-00254-1 · Cited by 4 · see citing works
Effects of mindfulness and movement on affect and vitality
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Associations Between Parenting Behavior and Positive and Negative Affect in Elementary Age Children
Visalli, K. M., Pössel, P., Blackburn, A. D., & Adelson, J. L. (2022) · Journal of Child and Family Studies · doi:10.1007/s10826-022-02469-w · Cited by 1 · see citing works
Mindfulness Based Anhedonia Reduction (MBAR) Therapy in reducing Major Depression in University Students.
Abouzaid, A. M. G., & Abdelhamid, H. G. (2024) · Sohag University International Journal of Educational Research (SUIJER) /Sohag University International Journal of Educational Research (SUIJER) · doi:10.21608/suijer.2024.339398 · Cited by 1 · see citing works
Amplification of positivity for depression and anxiety: Neural prediction of treatment response
Kryza‐Lacombe, M., Spaulding, I. G., Ku, C. K., Pearson, N., Stein, M. B., & Taylor, C. T. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104545 · Cited by 1 · see citing works
An Exploratory Randomized Controlled Trial Comparing Positive Imagery Shifts and Cognitive Restructuring in Enhancing Behaviour Activation for Depression
Chen, C., Liu, M., Huang, Y., Qian, L., Zhou, Z., & Wei, L. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70138 · Cited by 1 · see citing works
Regulating Affect Through Prohedonic Goals in Major Depressive Disorder: An Experience Sampling Study
Pacheco-Romero, A. M., Zetsche, U., Neumann, P., Sánchez-López, Á., Vázquez, C., Koster, E. H. W., & Hoorelbeke, K. (2026) · Behavior Therapy · doi:10.1016/j.beth.2026.03.004 · Cited by 1 · see citing works
The Application of Exposure Principles to the Treatment of Depression
Hayes, A. M., Yasinski, C. W., & Alpert, E. (2022) · Springer eBooks · doi:10.1007/978-3-031-04927-9_17 · Cited by 1 · see citing works
The mediating role of anxiety between negative feelings and depression among students with congenital physical disabilities
Uwimbabazi, M. P., MUZIKI, J. D., Muhayisa, A., Uwera, T., & Mutabaruka, J. (2023) · PLoS ONE · doi:10.1371/journal.pone.0281430 · Cited by 1 · see citing works
Improving the Hope and Happiness of Patients With an Ostomy
Farmitani, Z., Farokhzadian, J., Forouzi, M. A., Ramezani, T., & Zarandi, B. E. (2023) · Journal of Wound Ostomy and Continence Nursing · doi:10.1097/won.0000000000000948 · Cited by 1 · see citing works
The Impact of Mental Imagery Instructions on Patients' and Therapists' Positive Affect and Strength‐Based Behaviours Within Psychotherapy Sessions: A Randomized Controlled Process Study
Schürmann‐Vengels, J., Flückiger, C., Reyer, E., Odyniec, P., & Willutzki, U. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.3036 · Cited by 1 · see citing works
The Effect of Electroconvulsive Therapy on Positive Affect and Hedonism in Patients With Depression
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The relationship between positive affect and negative affect during treatment for major depressive disorder
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Does cognitive behavioral therapy for depression target positive affect? Examining affect and cognitive change session-to-session.
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Changes in Positive and Negative Affect during Acute Psychiatric Treatment in People with Social Anxiety Disorder
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Authors: Dunn, B. D., German, R. E., Khazanov, G., Xu, C., Hollon, S. D., & DeRubeis, R. J.
Affiliations: University of Exeter (GB)
National Institutes of Health (US)
University of Pennsylvania (US)
Vanderbilt University (US)
Corresponding author: Dunn, Barnaby D.
ORCID: Dunn, Barnaby D.
German, Ramaris E.
Xu, Colin
Hollon, Steven D.
DeRubeis, Robert J.
Venue: Clinical Psychological Science
Publisher: SAGE Publications
Published: 2019-11-07
Volume: 8
Issue: 1
Pages: 36-51
ISSN: 2167-7026 (ISSN-L)
2167-7034
DOI: 10.1177/2167702619863427
OpenAlex: W2969658555
Cited by: 92
References: 92
Citations by year: 2026: 12 · 2025: 14 · 2024: 21 · 2023: 12 · 2022: 11 · 2021: 13 · 2020: 8 · 2019: 1
FWCI: 5.14
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Clinical Psychological Science (publishedVersion)
Open Research Exeter (University of Exeter) (acceptedVersion)
Figshare (submittedVersion)
Funders: National Institute of Mental Health (MH55877)
national institutes of health (MM555875)
Topics: Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords: major depressive disorder, positive affect, negative affect, antidepressants, cognitive therapy, treatment response, anhedonia, remission, outpatients

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Changes in positive and negative affect during pharmacological treatment and cognitive therapy for major depressive disorder: A secondary analysis of two randomized controlled trials

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