Reward-related predictors of symptom change in behavioral activation therapy for anhedonic adolescents: a multimodal approach

Abstract

Anhedonia is a cardinal characteristic of depression which predicts worse treatment outcome and is among the most common residual symptoms following treatment. Behavioral Activation (BA) has been shown to be an effective treatment for depressed adults, and more recently, depressed adolescents. Given its emphasis on systematically and gradually increasing exposure to and engagement with rewarding activities and experiences, BA may be a particularly effective intervention for adolescents experiencing anhedonia and associated reward system dysfunction.In the present study, anhedonic adolescents (AA; n = 39) received 12 weekly sessions of BA and completed a multimodal (i.e., neural, behavioral, and self-report [ecological momentary assessment]) assessment of reward function at pre-treatment and post-treatment (as well as weekly self-report assessments of anhedonia). Typically developing adolescents (TDA; n = 41) completed the same measures at corresponding timepoints. Multilevel models tested pretreatment reward-related predictors of anhedonia improvement, as well as change in reward measures over the course of BA. Analyses revealed significant reductions in anhedonia following BA treatment. Enhanced pre-treatment neural (striatal) reward responsiveness predicted greater anhedonia improvement. In contrast, baseline self-report and behavioral reward measures did not predict treatment outcome. A group x time interaction revealed greater increases in both reward-and loss-related neural responsiveness among AA relative to TDA adolescents. Consistent with a capitalization (rather than compensatory) model, pre-treatment neural -but not self-report or behavioral -measures of relatively enhanced reward responsiveness predicted better BA outcome. In addition to alleviating anhedonia, successful BA may also increase neural sensitivity to affectively salient (e.g., reward-and loss-related) stimuli among anhedonic youth.

Aesthetic chills cause an emotional drift in valence and arousal

“…Following the embodied model of emotions ( Pezzulo, 2013 ), we hypothesize that such manipulation of interoceptive signals should influence further the emotional drift in valence and arousal reported by participants in this study, in line with the recent framework outlined in Schoeller et al (2022a) . Such controlled manipulations could be useful for mood disorders such as depression, specifically to address anhedonia symptoms and reward sensitivity ( Webb et al, 2022 ).…”

Dynamic processes in behavioral activation therapy for anhedonic adolescents: Modeling common and patient-specific relations.

“…Adolescents ages 13–18 were recruited from the greater Boston area for a BA treatment trial for adolescent anhedonia. For sample size determination and additional clinical trial information (see Webb et al, 2023), and for clinical trial preregistration see https://clinicaltrials.gov (NCT02498925). Eligible youth had elevated anhedonia (item score >1) on the anhedonia symptom of the depression module of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS; Kaufman et al, 2013) for the Diagnostic and Statistical Manual of Mental Disorders , fifth edition and the Snaith-Hamilton Pleasure Scale (SHAPS; Snaith et al, 1995; total score ≥3 based on binary scoring).…”

“…During the initial eligibility session (baseline assessment 1), adolescents completed a diagnostic interview and self-report measures assessing anhedonia and depression symptoms. Within 2 weeks of the initial session, eligible participants completed an MRI scan (see Webb et al, 2023), a computer task, and self-report questionnaires (baseline assessment 2). Following the MRI scan visit, participants were enrolled in the BA treatment, which included 12 weekly 60-min individual therapy sessions based on an established treatment manual (McCauley, Schloredt, et al, 2016).…”

“…1 Given that it is a brief, relatively simple, and activity-focused intervention, BA may be well-suited to many adolescents (McCauley, Schloredt, et al, 2016). In addition, given its emphasis on increasing reward-related activities, BA may be particularly beneficial for adolescents with prominent anhedonia (i.e., blunted pleasure and interest; Murray et al, 2022; Webb et al, 2023), a core depressive symptom experienced by at least 50% of depressed teens (Goodyer et al, 2017; Orchard et al, 2017) which predicts worse treatment outcome (Bringmann et al, 2015; McMakin et al, 2012), increases suicide risk (Auerbach et al, 2015), and is among the most common residual symptom following psychotherapy or antidepressant treatment (Craske et al, 2019; Dunn et al, 2020; Nierenberg, 2015). More specifically, by teaching depressed adolescents strategies to counteract maladaptive avoidance patterns and to gradually and systematically re-engage with intrinsically rewarding and positively reinforcing activities, BA may be a relatively effective and efficient means to boost reward function (e.g., as reflected by enhanced positive affect [PA]; Webb et al, 2023), which may have a downstream positive impact on other depressive symptoms.…”

“…Thus, those with dynamic processes where PA relates to many other variables may have even greater improvements following BA therapy. Despite a growing body of research supporting the efficacy of BA for depressed adolescents (McCauley, Gudmundsen, et al, 2016; Ritschel et al, 2016; Tindall et al, 2017; Webb et al, 2019, 2023), the processes of change that account for its beneficial effects are unknown. In particular, to what extent do the underlying processes of change of BA support a reward-related account of its mechanisms?…”