<p>Conceptualizing anhedonias and implications for depression treatments</p>

Abstract

Anhedonia has been implicated as a core symptom of depression and schizophrenia, and studying anhedonia has yielded a wide array of important findings aiding the understanding and identification of psychological disorders. However, anhedonia is a complex and multifaceted construct; indeed, the term anhedonia has been defined in psychological and psychiatric research as many different concepts, a number of which are theoretically and methodologically independent of one another. In this review alone, we discuss research that separates social aspects of anhedonia from the physical contexts of anhedonia, with the former emphasizing interpersonal relationships as important to anhedonic symptoms, and the latter emphasizing biological and brain-related impairment as potential causes of chronic anhedonia states. We highlight research that distinguishes between interest in (wanting) or experience of (liking) potential pleasure as definitions of anhedonia and also disambiguate methodologically and theoretically distinct ways of assessing 1) trait-level dispositional tendencies, 2) state-level cross-sectional assessments, and 3) symptom-based recent changes from baseline, all of which have been used to indicate anhedonia. Lastly, we describe cutting-edge translations of basic anhedonia research into treatment and discuss how different conceptualizations of anhedonia, guided by recent theoretical and methodological advances, have begun to usher in a science of anhedonia that is consistent with increasingly personalized assessment and treatment. We conclude with a note for future research, emphasizing that continued application of theoretically based operationalizations of anhedonia and sound design are paramount to continue the recent progress toward meaningful and specific use of the anhedonia construct in clinical research.

Anhedonia in Depressive Disorder: A Narrative Review

“…Assessment of anhedonia as such could then lead to a better understanding of the depressed patient and (in the end) better outcome. This better understanding in general could be as (or even more) important than the different phases of the pleasure cycle as specific targets for biological or psychotherapeutic interventions [70].…”

Negative affect interference and fear of happiness are independently associated with depressive symptoms

“…Lastly, Dunn and colleagues' (2019) new Augmented Depression Therapy (ADepT) that addresses why depressed individuals are hesitant to approach positivity has recently shown to be an efficacious treatment for patients who did not initially respond traditional CBT, with stronger changes in dampening appraisals about prospective positivity for individuals who completed ADepT versus CBT (for a review of other novel depression treatments, see Winer et al, 2019). Taken together, recent clinical research has emphasized a need for focusing on the upregulation of positive affect in both anxiety and depression, and new treatments are highlighting ways to increase those outcomes.…”

“…For example, hallmark treatments for depression have often focused on reducing negative affect and/or assuming the depressed patient suffers from an inability to experience positive affect (Beck & Bredemeier, 2016). Further, current nosology also simply emphasizes a “markedly diminished interest” in activities (American Psychiatric Association, 2013), possibly conflating distinct experiences that can result in this loss of interest (Winer et al, 2019).…”

Increases in depressive anhedonia predict psychopathology symptoms in adolescents

“…Negative schizotypy was speci cally associated with increases in trait social and state anhedonia whereas disorganized schizotypy and affective symptoms were uniquely associated with increases in depressive anhedonia. This nding is supported by research showing that anhedonia is heterogeneous across psychiatric disorders, depending on which parts of the pleasure networks are most affected [14,36]. Indeed, more trait-like expression of social anhedonia and physical-related hedonic de cits emerge more robustly in relation to schizophrenia-spectrum symptoms whereas recent increases in anhedonia are predictive of symptoms that are more indicative of depression and suicidal ideation [9,10,13,21].…”

“…Previous studies have suggested that recent changes in anhedonia were an important predictor of negative symptoms, depression and suicidal ideation [7][8][9][10][11][12][13]. It suggested recent changes in anhedonia may be uniquely predictive of key elements of psychopathology [14,15]. These nding have suggested that the distinction between trait, state and recent changes in anhedonia is of crucial importance when studying anhedonia, and recent changes in anhedonia, may be a stronger predictor of psychological disorders than trait and state anhedonia.…”