Treatment for Anhedonia: A Neuroscience Driven Approach: 2015 ADAA Scientific Research Symposium: Treatment for Anhedonia
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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.
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Early CBT approaches for anxiety disorders aimed almost entirely at lowering negative affect and related impairment.
“In alignment with this defensive system, ‘first’ and ‘second-wave’ cognitive behavioral approaches for anxiety disorders almost exclusively focused on achieving reductions in negative affect – including fear and anxiety – and associated functional impairment (Barlow, Ellard, Sauer-Zavala, Bullis, & Carl, 2014; Carl, Soskin, Kerns, & Barlow, 2013; Craske, Meuret, Ritz, Treanor, & Dour, 2016).”
From Examining Positive and Negative Affect as Outcomes and Moderators of Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy for Social Anxiety Disorder. (2019) · cites this paper as Craske, Meuret, Ritz, Treanor, & Dour, 2016
Low levels of positive affect can be targeted directly through newer psychological interventions designed specifically to improve reward sensitivity, with initial results showing effectiveness in both anxious and depressed patients, albeit in need of replication.
“Low levels of positive affect can be targeted directly through newer psychological interventions designed specifically to improve reward sensitivity 236,237 , with initial results showing effectiveness in both anxious and depressed patients, albeit in need of replication.”
From The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management (2021) · cites this paper as [236]
Depression often involves low levels of positive affect.
“It is well known that depression often involves low levels of positive affect [22, 93] that increase the severity of the problem [94].”
Current psychological treatments for depression focus largely on reducing excesses in negative affect rather than on specifically improving deficits in positive affect and well-being.
“Furthermore, current psychological treatments for depression focus largely on reducing excesses in negative affect rather than on specifically improving deficits in positive affect and well-being [36, 93].”
Treatment research is moving toward neuroscience-based interventions for endophenotypes that cross diagnoses.
“Further, the field is shifting toward neuroscience-driven treatments for transdiagnostic endophenotypes (Craske et al., 2016).”
From The role of inflammation in core features of depression: Insights from paradigms using exogenously-induced inflammation. (2018) · cites this paper as Craske et al., 2016
Through its treatment components, Positive Affect Treatment likely both induces and augments positive affect, involving both bottom-up and top-down processes (i.e., emotional reactivity and regulation).
“Through its treatment components, PAT likely both induces and augments positive affect, involving both bottom-up and top-down processes (i.e., emotional reactivity and regulation).”
From Positive and Negative Emotion Regulation in Adolescence: Links to Anxiety and Depression (2019) · cites this paper as [111]
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- Authors
- Craske, M. G., Meuret, A. E., Ritz, T., Treanor, M., & Dour, H. J.
- Affiliations
- University of California, Los Angeles (US)
- Southern Methodist University (US)
- Corresponding author
- Craske, Michelle G.
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2016-10
- Volume
- 33
- Issue
- 10
- Pages
- 927-938
- ISSN
- 1091-4269 (ISSN-L)
- OpenAlex
- W2528414896
- Cited by
- 387
- References
- 149
- Citations by year
- 2026: 43 · 2025: 48 · 2024: 59 · 2023: 54 · 2022: 59 · 2021: 33 · 2020: 31 · 2019: 35 · 2018: 16 · 2017: 8 · 2012: 1
- FWCI
- 27.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- anhedonia, positive affect, reward sensitivity, depression, anxiety, schizophrenia, substance abuse, negative valence, positive valence, reward learning, treatment-resistant depression
- MeSH terms
- Affect, Anxiety Disorders, Appetitive Behavior, Brain, Depressive Disorder, Humans, Motivation, Psychotherapy, Reward, Anticipation, Psychological, Anhedonia
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