Treating Anhedonia in Depression

Treatment-resistance in depression is a major problem. In the world of depression care, first-line antidepressant and psychotherapy treatments frequently fail to achieve adequate treatment response. 

 

One of the strongest risk factors for treatment-resistance in depression is the presence of anhedonia, a core feature of depression that refers to a loss of pleasure in activities and/or a lack of reactivity to usually pleasurable stimuli due to reduced positive affect. Critically, while anhedonia is highly prevalent in patients with depressive disorders and is associated with worse short- and long-term outcomes, anhedonia remains a relatively unexplored treatment target to date.

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To address the gap in treatments targeting anhedonia, our team has designed an enhanced form of cognitive-behavioral therapy (CBT), called Reward and Stress Focused CBT (RS-CBT). This therapy is informed by cutting edge decision-making and stress science. The intervention specifically targets two critical mechanisms underlying anhedonia:

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1. dysregulated reward processing and sensitivity

2. dysregulated stressor processing and sensitivity

 

The intervention seeks to improve upon standard CBT for depression by concurrently targeting both positive and negative affect. More specifically, this intervention seeks to improve how life stressors and rewards are processed and responded to by combining established, evidence-based practices (e.g., problem appraisal, solving, mindfulness-based stress reduction) with a novel intervention feature that promotes actively open-minded thinking (AOT).

 

AOT describes a style of thinking that actively addresses inherent human decision-making biases and weighs new evidence against favored beliefs, specifically focusing on rewarding beliefs and experiences rather than targeting cognitive distortions, as is common in conventional CBT.

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Progress to date & next steps. The novel AOT intervention has been developed and piloted among a small group of patients to date. Data collection is ongoing. Based on qualitative and quantitative feedback (e.g., user interviews, changes in validated depression and functioning scales), the intervention prototype will be refined before testing more rigorously on a larger scale.

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