Psychiatry

Positive Affect Treatment modestly outperforms Negative Affect Treatment for low-positive-affect depression and anxiety

Adults with severely low positive affect and functionally impairing depression or anxiety were randomized to 15 weekly sessions of Positive Affect Treatment (PAT) or Negative Affect Treatment (NAT). PAT produced greater improvement in a composite of positive affect, interviewer-rated anhedonia, and self-reported depression and anxiety than NAT over treatment. PAT also maintained a small advantage at one-month follow-up on the same clinical composite. Improvement in reward anticipation–motivation and reward attainment statistically mediated the superior clinical gains with PAT. Findings support targeting reward processes and positive affect as a mechanistically distinct psychotherapy pathway for anhedonia, depression, and anxiety. 1

Sham-controlled meta-analysis confirms robust antidepressant efficacy of prefrontal rTMS without clear linear dose–response

This sham-controlled meta-analysis pooled 30 randomized comparisons (N = 1850) of prefrontal rTMS or theta burst for major depression and treatment-resistant depression. Active stimulation significantly reduced depressive symptoms versus sham (Hedges' g ≈ -1.06) with high between-study heterogeneity. Response (OR ≈ 4.8; NNT ≈ 2.9) and remission (OR ≈ 3.6; NNT ≈ 4.4) probabilities were both substantially higher with active treatment and high-certainty by GRADE. Meta-regressions found no significant linear relationships between efficacy and stimulation frequency, intensity, total pulses, number of sessions, or treatment duration. Effect sizes were larger in single-blind than double-blind trials, highlighting ongoing concerns about blinding and expectancy effects in rTMS studies. 2

Emotion-regulation deficits are large, transdiagnostic, with disorder-specific strategy profiles

This systematic review and multilevel meta-analysis synthesized 619 studies, comparing emotion regulation (ER) in 41,590 adults with mental disorders versus 36,787 controls. Across disorders, clinical groups showed large overall ER difficulties (SMD = 1.70) versus controls. Patients used helpful strategies less (acceptance, problem-solving, reappraisal) and maladaptive strategies more (avoidance, rumination, suppression), with moderate-to-large differences. Difficulties in ER, reduced reappraisal, and increased rumination and suppression appeared in nearly all disorders, confirming their transdiagnostic relevance. Personality and depressive disorders showed particularly pronounced and distinct ER profiles, suggesting value for both transdiagnostic and disorder-tailored ER interventions. 3

Functional connectivity neurofeedback selectively reduces brooding by normalizing executive–default mode coupling

This real-time fMRI functional connectivity neurofeedback (FCNef) study expanded prior work to a final sample of 68 adults with depressive symptoms. Training targeted connectivity between dorsolateral prefrontal cortex and posterior cingulate/precuneus, aiming to normalize Executive Control–Default Mode network coupling. The protocol replicated earlier findings: normalization of this connectivity was associated with reductions in brooding rumination but not anxiety symptoms. Analyses showed that Executive Control–Default Mode connectivity decreased significantly with FCNef, highlighting network-specific modulation. Varying parameters suggested that consecutive training days with greater external rewards produced the most favorable symptom and connectivity changes. 4