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Psychotherapy for Anxiety Disorders: Decreases Negative Mood But Fails to Increase Positive Mood (2024 Study)

Anxiety-related disorders, characterized by heightened negative affect (NA) and sometimes diminished positive affect (PA), pose significant challenges for mental health treatment.

Despite the prevalence of these disorders, the efficacy of psychotherapies in improving PA versus NA remains underexplored.


  • Psychotherapeutic interventions demonstrate a significantly larger effect on reducing negative affect (NA) than on enhancing positive affect (PA) in individuals with anxiety-related disorders.
  • Cognitive Behavioral Therapy (CBT) and exposure therapy, while effective at reducing NA, show modest improvements in PA.
  • Interventions incorporating mindfulness and social functioning components may offer more substantial improvements in PA.
  • Enhancing PA, in addition to reducing NA, could potentially improve overall treatment outcomes, including quality of life and social functioning.

Source: Journal of Affective Disorders (2024)

Positive vs. Negative Affect: What do these terms mean?

Positive and negative affect represent two broad and independent dimensions of human emotions, central to the study of affective science and psychology.

They encompass the range of feelings and moods that individuals experience, differing not only in their valence (positive or negative) but also in their role in psychological functioning and behavior.

Positive Affect

Positive affect refers to the extent to which an individual experiences pleasurable engagement with the environment.

This includes a wide spectrum of feelings, from contentment and satisfaction to more intense emotions such as joy, enthusiasm, excitement, and euphoria.

Positive affect is associated with a sense of well-being, happiness, and vitality.

It reflects the degree to which a person feels enthusiastic, active, and alert.

High levels of positive affect are characterized by energy, full concentration, and pleasurable engagement, whereas low levels of positive affect are marked by sadness and lethargy.

Positive affect is crucial for several adaptive psychological functions, including fostering resilience, enhancing creativity, promoting problem-solving abilities, and building social connections.

Negative Affect

Negative affect, on the other hand, encompasses a range of aversive mood states, including emotions such as anger, guilt, fear, sadness, and disgust.

It is indicative of a person’s level of distress and dissatisfaction with their environment.

Negative affect is associated with a subjective experience of distress and unpleasurable engagement, where high levels of negative affect are characterized by a variety of aversive mood states, and low levels suggest a state of calmness and serenity.

It plays a critical role in signaling potential threats in the environment, preparing individuals for fight or flight responses, and motivating behavior change in the face of adverse situations.

Independence of Positive & Negative Affect

The conceptualization of positive and negative affect as independent dimensions is based on the observation that individuals can experience both positive and negative emotions simultaneously, to varying degrees.

This means a person can feel stressed or sad while also experiencing moments of joy or satisfaction in different aspects of their life.

The independence of these affective dimensions highlights the complexity of human emotions and challenges the simplistic notion of a single happiness-sadness continuum.

Instead, it suggests that well-being and distress are part of a dynamic emotional landscape, where both positive and negative affects play essential roles in psychological health and behavior.

Major Findings: Mood Change After Psychotherapy for Anxiety Disorders (2024)

A systematic review and meta-analysis conducted by Hoffman et al. unearthed several critical insights into the effects of psychotherapeutic interventions on mood change in individuals with anxiety-related disorders.

These findings contribute significantly to our understanding of the differential impacts on positive affect (PA) and negative affect (NA), offering implications for the development and refinement of treatment approaches.

1. Disproportionate Improvement in Negative Affect Over Positive Affect

The analysis revealed a significantly larger effect size for the reduction of NA (g = −0.90) compared to the improvement in PA (g = 0.27).

This pronounced difference underscores the effectiveness of psychotherapeutic interventions in mitigating the symptoms of anxiety through the reduction of negative emotions such as fear, worry, and sadness.

However, it also highlights a critical gap in these treatments’ ability to concurrently enhance positive emotional states such as happiness, satisfaction, and well-being.

2. Variability in Treatment Efficacy

The included studies evaluated a range of psychotherapeutic approaches, including cognitive behavioral therapy (CBT), exposure therapy, and interventions that incorporate mindfulness and social functioning elements.

Across these diverse treatment modalities, the consistent trend was a more substantial reduction in NA.

However, interventions that included components focusing on mindfulness and enhancing social functioning showed somewhat more promise in improving PA.

This suggests that incorporating strategies specifically designed to increase positive experiences and foster social connectivity may offer additional benefits in treating anxiety-related disorders.

3. Efficacy by Type of Therapy

Cognitive Behavioral Therapy (CBT) & Exposure Therapy

These traditional approaches demonstrated considerable efficacy in reducing NA, aligning with their theoretical underpinnings and clinical focus on addressing negative thought patterns and behaviors.

The effect sizes for NA reduction were generally large, indicating their strength in alleviating the negative affective components of anxiety disorders.

Mindfulness & Social Functioning Interventions

Treatments incorporating mindfulness practices and elements aimed at improving social functioning indicated a potential for greater improvement in PA.

Although the effect sizes for PA enhancement were generally small, they were notably higher than those observed in more traditional therapeutic approaches.

This finding suggests the value of integrating such components into treatment protocols to address the positive affective domain more effectively.

Positive vs. Negative Affect Change in Psychotherapy for Anxiety (2024 Review)

This study aimed to clarify whether current psychotherapies are more effective at improving negative affect compared to positive affect (mood) in patients with anxiety disorders.


  • The methodology involved a comprehensive search of several databases, including the Cochrane Central Register of Controlled Trials, PubMed, PsychInfo, and Web of Science, to identify relevant studies.
  • Eligible studies had to involve adults with a principal or co-principal diagnosis of an anxiety-related disorder and include pre- and post-treatment scores or a change index for both PA and NA.
  • The search and selection process adhered to PRISMA guidelines.
  • Effect sizes were calculated for included studies, facilitating a meta-analysis to compare the extent of change in PA and NA resulting from psychotherapeutic interventions.


  • The review included 14 studies, encompassing a total of 1001 adults with anxiety-related disorders.
  • These studies examined the effects of various psychotherapeutic approaches, including cognitive behavioral therapy (CBT), exposure therapy, and interventions incorporating mindfulness and social functioning elements.
  • The meta-analysis revealed a significant large effect size for the reduction of NA (g = −0.90) and a small effect size for the improvement in PA (g = 0.27).
  • This indicates that while psychotherapies are effective at reducing negative emotional states associated with anxiety disorders, their impact on enhancing positive emotional states is comparatively modest.


  • The small number and heterogeneity of included studies limit the generalizability of the findings.
  • The majority of studies relied on self-reported measures of PA and NA, which may introduce bias.
  • There was considerable variability in the types of psychotherapeutic interventions and anxiety-related disorders studied, complicating direct comparisons between treatment efficacies.
  • The studies predominantly focused on short-term outcomes, leaving the long-term effects of psychotherapeutic interventions on PA and NA largely unexplored.

Psychotherapy Treatments for Anxiety Disorders (Overview)

Psychotherapy for anxiety disorders encompasses a broad range of approaches, each underpinned by distinct theoretical frameworks yet aimed at mitigating the symptoms and underlying causes of anxiety.

1. Cognitive Behavioral Therapy (CBT)

CBT stands as one of the most extensively studied and efficacious treatments for anxiety disorders.

It operates on the premise that maladaptive thought patterns and beliefs significantly contribute to the maintenance of anxiety.

CBT interventions focus on identifying, challenging, and altering these negative thought patterns, thereby reducing maladaptive behaviors and emotional distress.

Skills taught include problem-solving, cognitive restructuring, and exposure techniques, which allow individuals to face and gradually desensitize to their fears.

2. Exposure Therapy

A subset of CBT, exposure therapy is specifically designed to address the avoidance behaviors that characterize many anxiety disorders.

By systematically and repeatedly exposing individuals to feared objects, activities, or situations in a controlled and safe manner, it aims to reduce the fear response.

This method is based on the principles of habituation and extinction, where the repeated confrontation with the anxiety-provoking stimulus without the expected negative outcome leads to a decrease in anxiety.

3. Mindfulness-Based Therapies

Mindfulness-based therapies, including Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), encourage individuals to adopt a non-judgmental, present-focused awareness of their thoughts, emotions, and bodily sensations.

By promoting acceptance and mindfulness, these therapies aim to disrupt the automatic negative thought patterns associated with anxiety, fostering a more balanced and less reactive emotional state.

3. Acceptance & Commitment Therapy (ACT)

ACT emphasizes psychological flexibility—the ability to contact the present moment fully and change or persist in behavior that aligns with one’s values.

Through processes such as cognitive defusion (learning to observe thoughts without being ensnared by them) and committed action (taking action guided by one’s values), ACT helps reduce the struggle with unwanted thoughts and feelings, effectively reducing the impact of anxiety.

Why Psychotherapy May Have Bigger Impact on Negative Moods

Psychotherapy’s differential impact on negative and positive affect in individuals with anxiety-related disorders can be attributed to several factors.

1. Theoretical & Clinical Focus

Many psychotherapeutic approaches, especially those like Cognitive Behavioral Therapy (CBT), are fundamentally designed to identify, challenge, and modify negative thought patterns and maladaptive behaviors.

This focus naturally lends itself to the reduction of negative affect, as these therapies directly target the cognitive and behavioral underpinnings of distress and anxiety.

Conversely, these traditional modalities may not explicitly include strategies or exercises aimed at cultivating positive emotions or enhancing well-being, leading to less pronounced improvements in positive affect.

2. Measurement & Assessment Bias

The tools and methods used to assess changes in therapy often emphasize symptom reduction over improvements in well-being or happiness.

This bias towards measuring decreases in negative symptoms rather than increases in positive outcomes can skew perceptions of therapy’s effectiveness, underrepresenting its impact on positive affect.

Additionally, it’s often easier to quantify the reduction of symptoms (e.g., fewer panic attacks) than to measure enhancements in positive states, which can be more subjective and varied.

3. Patient Expectations & Goals

Individuals seeking therapy for anxiety disorders are often primarily motivated by a desire to alleviate their distress and symptoms of anxiety.

As a result, therapeutic goals and interventions may be more aligned with reducing negative affect rather than building positive affect.

This focus on symptom relief over the development of positive emotional experiences could limit the opportunities within therapy to cultivate positive affect explicitly.

4. Complexity of Positive Affect

Enhancing positive affect involves more than just reducing negative emotions; it requires building resilience, fostering engagement, nurturing relationships, and developing a sense of purpose and meaning.

These aspects of positive psychology are complex and multifaceted, requiring targeted interventions that may not be fully integrated into traditional psychotherapeutic approaches focused on anxiety disorders.

Building positive affect may require more time and a broader range of interventions than those typically employed in anxiety-focused therapies.

5. Natural Tendency Towards Negativity Bias

Humans have a natural tendency toward a negativity bias, where negative experiences or emotions are given greater weight than positive ones.

This bias can make it inherently more challenging to shift and increase positive affect, as negative emotions are more easily activated and can be more resistant to change.

Therapeutic interventions may need to work harder to overcome this bias and foster positive emotional experiences.

6. Environmental & Contextual Factors

Finally, the ability of psychotherapy to increase positive affect may be influenced by external environmental and contextual factors beyond the therapy room.

Factors such as social support, life stressors, and individual circumstances play a significant role in an individual’s overall mood and well-being.

While psychotherapy can provide tools and strategies for managing anxiety and fostering positive emotions, its impact may be moderated by these external factors, which can limit the observable improvements in positive affect.

Benefits of Psychotherapy in Anxiety Beyond Mood

While the primary aim of psychotherapy in treating anxiety disorders often involves modifying affect (mood), its benefits extend far beyond mere mood regulation.

Even in cases where a direct change in positive or negative affect is minimal, psychotherapy offers substantial advantages.

Reduction of Anxiety Symptoms

Psychotherapy, particularly CBT, has been proven to significantly reduce the symptoms of anxiety, such as persistent worry, physical tension, and panic attacks.

These improvements may occur even without marked changes in overall mood, as individuals learn to manage and reduce their anxiety symptoms effectively.

Development of Coping Skills

A key benefit of psychotherapy is the acquisition of coping skills that empower individuals to handle stressors and anxiety-provoking situations more effectively.

Techniques such as relaxation training, mindfulness, and cognitive restructuring equip patients with practical tools to manage their anxiety in real-time, fostering resilience and a sense of control over their emotional responses.

Improved Functional Outcomes

By addressing the underlying cognitive and behavioral patterns contributing to anxiety, psychotherapy can lead to improved functional outcomes, including enhanced social and occupational functioning.

Even if mood per se is not dramatically altered, the ability to engage more fully in life activities and maintain meaningful relationships can significantly improve quality of life.

Long-Term Benefits

Psychotherapy offers long-term benefits by targeting the root causes of anxiety rather than merely alleviating symptoms.

Through the internalization of new cognitive strategies and coping mechanisms, individuals can achieve lasting changes that protect against future anxiety episodes, contributing to sustained improvements in mental health and well-being.

Takeaway: Psychotherapy for Anxiety Disorders & Mood Changes

The systematic review and meta-analysis presented here underscores the significant impact of psychotherapeutic interventions on reducing negative affect in individuals with anxiety-related disorders, while also highlighting a notable gap in the enhancement of positive affect.

This finding emphasizes the need for psychotherapy approaches to not only focus on mitigating negative emotions but also to actively foster positive emotional experiences.

The variability in the efficacy of different therapeutic methods, particularly those incorporating mindfulness and social functioning components, suggests a promising direction for developing more holistic treatments.

These treatments could potentially improve both negative and positive affect, thereby offering a more comprehensive approach to anxiety disorder management.

Furthermore, the broader benefits of psychotherapy, such as the development of coping skills and improved functional outcomes, affirm its value beyond affect change alone.

This analysis calls for an expansion of psychotherapeutic strategies to more effectively address the full spectrum of emotional experiences in anxiety disorders, ultimately enhancing overall well-being and life satisfaction for individuals affected by these conditions.


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