The most debilitating symptom of depression can be something that’s actually absent — a void representing the inability to feel positive emotions or experience pleasure.

That symptom — known clinically as anhedonia — affects nearly 90% of people with major depression but is left largely unaddressed by conventional treatment options, researchers say.

Now, a new treatment approach targeting positive emotions has been developed and appears to outperform standard treatments aimed at reducing negative emotions, researchers reported April 24 in JAMA Network Open.

The therapy, called Positive Affect Treatment (PAT), is designed to rebuild depression patients’ capacity for joy, purpose, motivation and reward, researchers said.

“There’s a difference between feeling helpless and feeling hopeless,” lead researcher Alicia Meuret, director of the Anxiety and Depression Research Center at Southern Methodist University in Dallas, said in a news release.

“When you feel helpless, you still have the drive and the will to want to change things. When people feel hopeless, they don’t believe anything will change,” she said. “That’s what anhedonia can look like, and taking away negative emotions doesn’t fix it.”

To test PAT, researchers recruited 98 people with depression. The team randomly assigned half to receive PAT, and the other half to undergo typical depression treatment focusing on negative emotions.

PAT is a 15-session therapy program that directly targets the brain’s reward system, which governs how people experience and learn from positive events.

The treatment involves exercises that engage patients with rewarding activities, redirects their attention toward positive experiences and builds day-to-day practices like gratitude, enjoyment and kindness.

Results showed that patients who got PAT improved on measures of both positive and negative emotions, even though the treatment does not target negativity at all.

Overall, PAT patients experienced greater improvements in depression and anxiety symptoms than those receiving standard treatment at a one-month follow-up, researchers found.

These results indicate that targeting people’s ability to feel positive emotions is key for reducing depression and anxiety, researchers concluded.

“It’s not enough to take away the bad,” Meuret said. “Treatment needs to ask: Is this activity meaningful to you? Will it give you joy or a sense of accomplishment? Does it foster connection?”

However, researchers said future studies with larger groups of people are needed to better understand the potential usefulness of PAT, as well as how it produces better results than standard therapy.