Systematic Review of Positive Affect Therapy on a Variety of Neurotic Disorders

Abstract

Context: Positive affect therapy reduces sensitivity to negative stimuli in neurotic disorders by activating dopaminergic pathways and strengthening the brain's reward system. This mechanism alleviates symptoms of neurotic disorders by restructuring cognitive appraisals and disrupting the cycle of rumination. Accordingly, this study aimed to examine evidence for the effectiveness of positive affect psychotherapy across various neurotic disorders. Evidence Acquisition: This systematic review followed the PRISMA guidelines and searched PubMed, Web of Science, Google Scholar, SID, Magiran, and IranMedex for English- and Persian-language articles published from 2012 to 2024. The inclusion criteria were clinical trials involving neurotic disorders according to DSM-5, with positive affect therapy as the primary intervention. Studies without a control group, involving participants aged < 18 years, or not published in English or Persian were excluded. Study quality was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. In total, 215 articles were identified; after applying the eligibility criteria, 15 articles were included in the final analysis. Results: Of the 15 trials analyzed, 11 focused on depression, all showing significant score reductions ranging from 18% to 45%. Seven studies assessed anxiety reduction, with five showing statistically significant results (7% to 38% reduction). Five studies evaluated stress reduction, with three reporting statistically significant findings. Other outcomes (suicidality, sleep disturbance, eating disorders, obsession, PTSD) were each evaluated in only one study. According to the RoB 2 assessment, 7 studies were of high quality, 5 were of moderate quality, and 3 were of low quality. Discussion: Preliminary findings suggest that positive affect-based therapy may reduce symptoms of neurotic disorders; however, the evidence is limited by small sample sizes and a lack of long-term follow-up. Therapists may consider this approach as a complementary intervention, but it should be applied cautiously and not regarded as a standalone cure.