Marie-José van Tol, PhD, from the University of Groningen.

Marie-José van Tol, PhD

Targeting Positive Affect May Prevent Depression Relapse, With Marie-José van Tol, PhD

New data suggest preventive cognitive therapy (PCT) may reduce relapse risk in recurrent 

by strengthening positive affect and modifying dysfunctional beliefs. In an interview with 

Marie-José van Tol, PhD, from the University of Groningen, described practical techniques clinicians can incorporate to enhance resilience during remission and potentially lower recurrence risk.

One strategy emphasized in PCT is “positive fantasizing,” a structured exercise designed to challenge rigid negative self-beliefs. Patients first identify a maladaptive belief, such as “I must do everything right to be worthwhile,” and then deliberately invert it.

“When you…think ‘I have to do everything right in order to be worthwhile,’ so making a mistake makes me [a] worthless person, we invited them to think…even if I do everything wrong, people will still find me fantastic,” van Tol said. “They were invited to think of their dream world, where they would live according to this fantasy belief, and that makes them experience that if they would think differently about themselves, they would feel different. They would have a different posture, they would say different things, they [might] make different jokes. So, it is [both] a positive effect enhancer, but it also invites people to understand the link between what they think and how they feel and experience that maybe there is some room, and their rigid negative belief might be shifted a bit towards a more helpful content.”

Van Tol suggested clinicians encourage patients to track events that went well, note moments of enjoyment, and “savor” small pleasurable experiences. Maintaining a positivity diary may help individuals recovering from depression re-engage with reward processing and rebuild comfort with positive emotions, which can diminish during depressive episodes. These practices aim to strengthen consummatory pleasure and support adaptive cognitive reappraisal

Although the findings are based on a relatively small and selective sample, van Tol noted that stability analyses, including bootstrapping approaches, supported the robustness of the observed associations. She emphasized that larger studies are needed to confirm generalizability and clarify causal relationships, particularly through more frequent longitudinal sampling of beliefs and affective states. Future research will also examine whether specific interventions, such as positive fantasizing, translate into sustained reductions in relapse risk.

“It's very important to realize that there is we focus often on the negative, effective domain in depression, but…there is [another] important domain,” she said. “I think that's good news, and I think it's very important to realize that even after a depression, we can help people build up resilience through offering certain therapy.”

Watch part 1 of the interview with van Tol here: 

Preventive Therapy Targeting Positive Affect May Reduce MDD Relapse, With Marie-José van Tol, PhD

Angeles-Valdez D, van Kleef R, van Valen E, Garza-Villarreal EA, Bockting C, van Tol MJ. The role of cognitive and affective changes in preventing depressive relapse: A network analysis approach to understanding the mechanisms of preventive cognitive therapy. 

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Preventive cognitive therapy may reduce relapse in recurrent depression by strengthening positive affect and addressing anhedonia, van Tol explained.


New findings suggest preventive cognitive therapy (PCT) may lower relapse risk in remitted recurrent 

by improving pleasure and modifying dysfunctional attitudes.

, Marie-José van Tol, PhD, from the University of Groningen, discussed new data examining the cognitive and affective mechanisms underlying preventive cognitive therapy (PCT), highlighting the role of positive affect and anhedonia in reducing relapse risk.

“In order to change dysfunctional attitudes that are very quite rigid and related to depressive relapse, we need to also focus on increasing the ability to experience pleasure and to up regulate positive emotions,” van Tol said.

The study included 69 unmedicated individuals with remitted MDD at high risk for recurrence from the NEWPRIDE randomized controlled trial. The findings showed a 3-month PCT intervention directly improved consummatory pleasure, the inverse of anhedonia, and increased use of cognitive reappraisal, which together contributed to reductions in dysfunctional attitudes associated with relapse vulnerability. Change in anhedonia (odds ratio [OR], 0.79; 95% CI, 0.68–0.92; 

 =.003] and dysfunctional attitudes (OR, 0.93; 95% CI, 0.86–0.99; 

 =.041) predicted relapse status at 18-month follow-up in PCT-recipients.

The analysis demonstrated that improvements in pleasure mediated the relationship between PCT and reductions in maladaptive beliefs (P =.003). Van Tol described this as a “cross-valence” mechanism, in which strengthening positive affective experiences may buffer against the impact of negative life events.

“It seems that if we focus on improving the ability to have positive feelings, this might lower the impact that negative events have on us, and thereby also lower the impact it has on an individual, and thereby de-learning, in a sense, these negative beliefs about yourself,” she said.

The study focused on unmedicated individuals, but van Tol noted prior evidence suggests PCT may also provide benefit when combined with maintenance antidepressant therapy. She added that the observed mechanisms involving positive affect require further validation in broader populations.

From a practical standpoint, van Tol suggested clinicians consider incorporating strategies that actively promote positive emotional experiences alongside traditional cognitive techniques. These approaches may include encouraging engagement in rewarding activities, fostering savoring of positive experiences, and strengthening emotion regulation skills through reinterpretation of situations. She said these interventions may improve resilience and reduce vulnerability to recurrence.

Although cognitive reappraisal improved following PCT, it did not independently predict relapse in this study. Van Tol indicated that reappraisal likely contributes as part of a broader set of skills rather than as a standalone therapeutic target.

“Focusing on improving a reappraisal probably will not be enough,” van Tol said.

Research suggests preventive cognitive therapy reduced relapse risk in recurrent depression by improving positive affect and anhedonia, van Tol explained in an interview.

Marie-José van Tol, PhD

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