Table 1 Overview of Positive Affect Treatment (PAT) for Anorexia Nervosa (AN)
Module 1: Psychoeducation (Session 1) | ||
Activity | Proposed Adaptations for AN | Target |
1. Treatment rationale: learning about treatment content, structure, goals, and background | Sharing AN-specific model; discussing how weight and eating goals will be integrated into primary goal of increasing non-eating-disorder-related positive affect | Education |
2. Introducing positive mood: learning about positive mood, its importance, and its difference from negative mood | Considering which positive emotions are most closely linked to different eating-disorder behaviors | Education |
3. Parts of mood and the mood cycle: learning about the components of mood and how these different parts can cause low positive mood | Discussing the impact of eating-disorder behaviors, starvation, and underweight on positive mood | Education |
Module 2: Pleasant Events Scheduling (Sessions 2–7) | ||
1. Activity planning: identifying events to engage enjoyment, mastery, and/or values | Selecting non-eating-disorder activities that may share a similar function to eating-disorder symptoms; considering how to use exercise as a healthy, rather than disordered, reward (as needed); prioritizing social and long-term rewards; evaluating values | Reward anticipation |
2. Activity engagement: executing planned events; recording event-reward associations | Recording link between positive affect, pleasant events, and eating-disorder symptoms; noticing cognitive barriers to positive affect | Reward experiencing and learning |
3. Activity recounting: learning and practicing techniques to “savor” past pleasant experiences | Sharing pre-recorded exercise to provide a concrete script; option for socially “co-savoring” if struggling with experiential exercise | Reward experiencing |
Module 3: Attending to the Positive (Sessions 8–11) | ||
1. Finding the silver lining: training to shift attention to positive aspects of daily life and positive stimuli | Noticing the silver lining of difficult aspects of recovery | Reward anticipation |
2. Taking ownership: identifying associations between one’s own behavior and rewards | Emphasizing the potential importance of taking ownership to increase a sense of self-control and agency in life; identifying and appreciating one’s own behavior towards recovery | Reward experiencing and learning |
3. Imagining the positive: learning to attend to positive future events | Sharing pre-recorded exercise to provide a concrete script; focusing on goals that will be facilitated through recovery | Reward experiencing and learning |
Module 4: Cultivating the Positive (Sessions 12–15) | ||
1. Loving-kindness and appreciative joy: practicing mental acts of giving | Sharing pre-recorded exercise to provide a concrete script; increasing focus on love, kindness, and appreciation towards oneself to potentially reduce the need for eating-disorder behaviors to boost positive self-referential feelings | Reward experiencing |
2. Generosity practice: practicing physical acts of giving | Noting the importance of balance of generosity towards others and towards oneself; increasing focus on generosity towards oneself to potentially reduce the need for eating-disorder behaviors to boost positive self-referential feelings | Reward experiencing |
2. Gratitude practice: fostering the ability to appreciate the positive aspects of life | Noticing positive aspects of recovery | Reward experiencing |
Module 5: Replacing Positive Aspects of the Eating Disorder (Sessions 16–19) | ||
1. Monitoring and replacing eating-disorder behavior: diverting attention away from eating-disorder behaviors to healthier alternatives that can elicit positive mood | Skill specific to proposed AN adaptation of PAT | Reward learning |
2. Riding the roller coaster: delaying acting on eating-disorder behaviors when positive emotion is low | Skill specific to AN adaptation of PAT | Reward anticipation and learning |
3. Counter-conditioning: incorporating positive experiences into situations associated with negative mood, especially surrounding eating-disorder triggers | Skill specific to proposed AN adaptation of PAT | Reward experiencing and learning |
4. Breaking the links: removing environmental cues that are associated with positive emotions related to the eating disorder | Skill specific to proposed AN adaptation of PAT | Reward anticipation and learning |
Module 6: Relapse Prevention (Session 20) | ||
1. Check-in: assessing mental health and brainstorming ideas about how to increase the experience of positive emotions | Evaluating progress on weight and eating restoration, as well as cognitive eating-disorder thoughts; planning for future eating-disorder lapses and relapses | Reward experiencing and learning |