Anhedonia In Schizophrenia: How It Manifests

Anhedonia can be defined as a diminished capacity to experience pleasure or positive emotions. Anhedonia is often considered a prominent symptom in multiple mental health disorders, including major depressive disorder and schizophrenia. Anhedonia, along with other symptoms of schizophrenia, can usually be treated with a combination of doctor-prescribed medication and regular therapy sessions with a licensed mental health professional.

Anhedonia as a feature of schizophrenia

Anhedonia can be a common symptom of schizophrenia. This symptom is related to a reduced ability to experience pleasure and is typically viewed as one of the negative symptoms associated with the condition. Researchers generally view anhedonia as a "transdiagnostic symptom that is associated with deficits in neural reward and aversion functions." This can be linked with neurocognitive deficits in evaluating the value of rewards, such as perceiving the future benefit of engaging in an activity now. 

Research on anhedonia in schizophrenics

Anhedonia has been described as the loss of interest in experiencing pleasure or the lack of ability to experience pleasure. This ability may be related to reward processing, decision-making, anticipatory pleasure, and motivation.

Research suggests that many people with schizophrenia can experience pleasure. When using self-reported measures of trait or physical anhedonia, many individuals with schizophrenia report experiencing less pleasure in their daily lives. However, some laboratory studies with real-life stimuli suggest an equal or greater ability to experience pleasure when compared to those without schizophrenia.

Anhedonia in this context may be more closely associated with the "inappropriate valuation of rewards." Someone with schizophrenia may be more likely to underestimate the value of future rewards, for example. This may result in them having less motivation to engage in goal-oriented activities, thus impacting their decision-making process. 

Anticipatory and consummatory pleasure 

Reward processes that go beyond the ability to experience pleasure can include anticipation, motivation, and reinforcement. Evidence suggests that anticipatory pleasure and consummatory pleasure may work separately. Anticipatory pleasure generally refers to the ability to experience pleasure from predicting a positive outcome or reward. Meanwhile, consummatory pleasure can refer to one's ability to feel pleasure while having an experience. For example, a person might experience anticipatory pleasure as they look forward to taking a fun trip with friends, and they might experience consummatory pleasure while enjoying the trip itself.

Patients with schizophrenia can experience pleasure

Some research indicates that people with schizophrenia may experience consummatory pleasure but have a harder time with anticipatory pleasure. Other findings suggest an "intact capacity to experience pleasure during reward anticipation in schizophrenia." This may mean that individuals with schizophrenia tend to have varying experiences with pleasure and anhedonia.

Negative symptoms of schizophrenia

Negative and positive symptoms can be seen as central features of schizophrenia. Positive features typically refer to symptoms that distort reality, such as hallucinations and delusions, as well as disorganized thinking and speech.

Effects of negative symptoms

Negative symptoms usually affect one's ability to function. They can include impaired speech (alogia), loss of motivation (avolition), and the loss of or reduced ability to experience pleasure (anhedonia). Negative symptoms are usually classified as either primary or secondary. Primary features may relate to characteristic features of schizophrenia itself, whereas secondary features are often considered temporary and contingent, such as depression or social isolation.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) characterizes negative symptoms as “restricted emotional expression and avolition.” Avolition is defined as “a decrease in motivated self-initiated purposeful activities.” Other clinical symptoms of schizophrenia may include anhedonia and asociality.

Social anhedonia in patients with schizophrenia

In general, scientists consider humans to be highly sociable as a species. Those with social anhedonia, however, tend to derive less pleasure from social engagement, which may lead to withdrawal and a reduced ability to engage with others. Extreme social isolation is often linked with feelings of loneliness. 

While social anhedonia can be strongly linked with schizophrenia and related conditions, its nature and expression may vary. Some researchers note that while concepts like pleasure, reward, anhedonia, and social anhedonia can be distinct, they may also be interrelated. Studies that look at social anhedonia in people without a diagnosed mental health disorder indicate that "the capacity to attend to, and ultimately learn from, important aspects of one’s environment may be a key issue in social anhedonia." Factors like working memory and anticipatory pleasure in social engagement may play a role in this capacity. 

High levels of social anhedonia tend to be linked with more severe schizophrenia symptoms and lower self-esteem, subjective recovery, and quality of life. Researchers also note that social anhedonia, rather than the presence of positive symptoms, may "be responsible for decreased social engagement across the psychosis continuum."

Physical schizophrenic anhedonia

According to the United Brain Association, some scientists believe that anhedonia can be divided into physical and social anhedonia. Physical anhedonia generally relates to a lack of or reduced interest in activities involving physical sensations, such as exercise, sex, and eating. Symptoms of anhedonia may include:

• Loss or lack of interest in activities that were previously enjoyed
• Loss or lack of interest in social activities
• Reduced interest in food
• Loss or lack of interest in having personal relationships

A potential intervention for anhedonia in schizophrenia

In one study, a “positive emotions program for schizophrenia” (PEPS) aimed to reduce "the syndrome of a diminished capacity to experience." The program used principles of positive psychology and was tested in many groups of schizophrenia patients. Intended to be a short-term, group-based intervention to improve pleasure and motivation, PEPS employed a recovery-oriented approach to schizophrenia. Studies that have examined its efficacy suggest that it may clinically improve participants' anticipatory and consummatory pleasure as measured by the Temporal Experience of Pleasure Scale (TEPS). 

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Therapy for addressing anhedonia or depressive disorder

Speaking to a therapist can be helpful when you're struggling to find joy and pleasure in daily life. A therapist can introduce helpful ways to manage stress and help you find ways to live in the moment, such as by practicing mindfulness. Online therapy through platforms like BetterHelp can be convenient (and affordable) for many people who would rather speak to a therapist by phone, video, or online chat. 

Effectiveness of online therapy for mental health

Studies suggest that online therapy can be effective in relieving the symptoms of many mental health conditions, although individuals with schizophrenia experiencing acute psychotic symptoms may need to seek in-person care. One review and synthesis consisting of sixty-one studies looking at online interventions for individuals with psychotic disorders noted that "web-based interventions have been associated with symptom reduction" and that "increased engagement is associated with improved outcomes."