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

New findings suggest preventive cognitive therapy (PCT) may lower relapse risk in remitted recurrent major depressive disorder (MDD) by improving pleasure and modifying dysfunctional attitudes.

In an interview with HCPLive, 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; P =.003] and dysfunctional attitudes (OR, 0.93; 95% CI, 0.86–0.99; P =.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.

van Tol has no reported disclosures.

References

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. J Affect Disord. 2026;406:121705. doi:10.1016/j.jad.2026.121705