A New Intervention to Reduce Anhedonia in Schizophrenia

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Meta-analyses of cognitive behavioral therapy for positive symptoms of schizophrenia have demonstrated its effectiveness in reducing hallucinations or delusions. In schizophrenia “negative symptoms’ refer to a reduction of normal functioning, and it encompasses apathy, anhedonia, flat effect, avolition, social withdrawal, and, sometimes, psychomotor retardation.

The purpose of this study is the idea that Anhedonia is a challenging symptom of schizophrenia and remains largely recalcitrant to current pharmacological treatments. The goal of this exploratory pilot study was to assess if a cognitive-sensory intervention could improve anticipatory pleasure. Results show that the patients improved on the anticipatory scale of the Temporal Experience of Pleasure Scale. Daily activities of the patients were also increased. In nursing research, it has been shown that the sense of mastery is negatively correlated with negative symptoms or even with the fact of being left alone.

Two research questions were addressed in a sample of five participants. Does cognitive-sensory training in anticipatory pleasure in persons with schizophrenia? Does cognitive-sensory training in anticipatory pleasure lead to an increase in the number and complexity of daily activities performed by persons with schizophrenia? They did not expect that anticipatory pleasure cognitive skills training would directly improve consummatory pleasure. If persons with schizophrenia show a deficit in their ability to anticipate pleasure rather than consummatory pleasure, then it becomes possible to consider cognitive training might help these individuals anticipate pleasure from foreseeable, future activities.

I feel the author did a good job using literature to support their predictions and I was convinced by their argument. The author used well supporting concepts to prove their points as they discussed theories about Anticipatory Pleasure Skills Training: A New Intervention to Reduce Anhedonia in Schizophrenia. I particularly liked the idea that they did a two year comprehensive program including assertive community treatment, social skills training, and multifamily therapy groups that led to significantly less positive and negative symptoms, less comorbid substance abuse, and significantly greater satisfaction with treatment. The author thought a more specific and symptom-centered approach because they felt it might lead to specific improvement in a shorter period of time. This symptom-specific strategy has been used in other studies for positive symptoms, allowing the development of successful specific therapeutic techniques.

The case studies presented in this article highlight the use of this specific symptom approach for Anhedonia. Anhedonia has been defined as a reduction in the ability to experience pleasure. It has been regarded as a core clinical feature of schizophrenia. Research has produced a paradoxical set of findings, raising questions about its nature. Individuals with schizophrenia typically report experiencing lower levels of pleasure in their daily lives than non-patients on self-report measures of trait social and physical Anhedonia. Anticipatory pleasure is linked to motivational processes that promote goal-directed behaviors; consummatory pleasure is associated with satiety. The Temporal Experience of Pleasure Scale is a trait measure of pleasure that distinguishes between “momentary pleasure” and “anticipation of future pleasure activities.”

The illumination of a new way of conceptualizing Anhedonia in schizophrenia permits redefinition and calibration of the symptom complex as a target for treatment. If persons with schizophrenia show a deficit in their ability to anticipate pleasure rather than consummatory pleasure, then it becomes possible to consider that cognitive training might help these individuals anticipate pleasure from foreseeable, future activities. Greater ability to anticipate pleasure would lead to...
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