Treatment for Anhedonia: A Neuroscience Driven Approach

Abstract

Anhedonia, or loss of interest or pleasure in usual activities, is characteristic of depression, some types of anxiety, as well as substance abuse and schizophrenia. Anhedonia is a predictor of poor long-term outcomes, including suicide, and poor treatment response. Because extant psychological and pharmacological treatments are relatively ineffective for anhedonia, there is an unmet therapeutic need for this high-risk symptom. Current psychological and drug treatments for anxiety and depression focus largely on reducing excesses in negative affect rather than improving deficits in positive affect. Recent advances in affective neuroscience posit that anhedonia is associated with deficits in the appetitive reward system, specifically the anticipation, consumption, and learning of reward. In this paper, we review the evidence for positive affect as a symptom cluster, and its neural underpinnings, and introduce a novel psychological treatment for anxiety and depression that targets appetitive responding. First, we review anhedonia in relation to positive and negative valence systems and current treatment approaches. Second, we discuss the evidence linking anhedonia to biological, experiential, and behavioral deficits in the reward subsystems. Third, we describe the therapeutic approach for Positive Affect Treatment (PAT), an intervention designed to specifically target deficits in reward sensitivity.

Rostral Anterior Cingulate Cortex Morphology Predicts Treatment Response to Internet-Based Cognitive Behavioral Therapy for Depression

“…Continuous analyses of HRSD scores yielded a similar pattern of findings. Importantly, these findings were significant after controlling for a number of clinical and demographic variables previously linked with depressive symptom improvement, specifically age (6), gender (7, 10), and race (11), and pre-treatment severity of depressive symptoms (10), anxiety (16), and anhedonia (19) (as well as when statistically adjusting for total intracranial volume in all models). Thus, in contrast to most prior studies that include no or few such control variables, our findings indicate that right rACC volume provides predictive information above and beyond previously established clinical and demographic predictors.…”

“…To our knowledge, no study has examined neurobiological predictors of treatment response to iCBT for depression. In order to be clinically useful, neural variables must demonstrate incremental predictive validity above and beyond much more inexpensive and easily administered clinical and demographic measures previously found to predict treatment response, including age (6), gender (7–10), and race (11), as well as pre-treatment severity of depressive symptoms (10, 12–15), anxiety (16–18), and anhedonia (19–21). …”

Anhedonia as a clinical correlate of suicidal thoughts in clinical ketamine trials

“…These techniques could help to both conceptualize the symptom of anhedonia as well as serve as potential predictors or clinical correlates of suicide risk. Perhaps more importantly, the results underscore the possibility that therapies already available for anhedonia—such as CBT and BAT (Craske et al, 2016)—may be used to treat patients with suicidal ideation by decreasing anhedonia symptoms and improving neural responses in the reward system (Treadway and Zald, 2011). Additional analyses using rapid-acting interventions, such as ketamine, can help further our understanding of the neurobiology of both suicidal thoughts and anhedonia, leading to innovative treatments.…”

Neural reactivity to reward and internalizing symptom dimensions

“…Several IPs are characterized by deficits in reward and effort valuation, reward outcome, and decision-making processes (e.g., Craske et al, 2016). As a result, RDoC identified a number of reward-related biologically based constructs within the Positive Valence System, including initial responsiveness to reward attainment.…”