Most of the ones I’ve played have been “X, but with drama!” rather than “Drama! In setting X!” 
Running a PbtA game versus a more traditional game?
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I suppose it’s a fine line!
But in either case, it all relies on the drama to make for a fun game.
At least, I haven’t played any PbtA games that don’t work that way (I’m sure they can exist, in theory, but I haven’t played any myself).
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This is very much like I feel about any game that has a philosophy like pbta (blades, heart/spire, etc), and games that are not like pbta (osr, “traditional games”, etc). The only times I’ve felt “punishment” or “necessary risk” in pbta are when the gm doesn’t fully get moves and tries to do their own thing instead of sticking with their moves and how the game is meant to be played. In comparison, most of the time when playing more “traditional” games, most rolls seems like necessary risks, and punishments when trying to do something cool.
I don’t know, but maybe this is really one of the clearly distinctions between osr and pbta.
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