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 major depressive disorder (MDD) by strengthening positive affect and modifying dysfunctional beliefs. In an interview with HCPLive, 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

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